Initial Experience of Endoscopic Phonosurgery With a Prototype of the Therapeutic Rhinolarynx Electronic Endoscope

We performed endoscopic phonosurgery in a patient with a laryngeal lesion using a prototype of the therapeutic rhino-larynx electronic endoscope connected to a video processor (Asahi Optical Co., Ltd.). This therapeutic electronic endoscope differs from the fiberoptic endoscope, because it contains an instrument channel and a miniature television camera attached to the tip of the endoscope, consisting of a small light-sensitive CCD chip. The dynamic image provided by this system is superior in resolution to that obtained by conventional flexible laryngofiberscopes. Using this therapeutic electronic endoscope and flexible forceps, we succeeded in removing a vocal fold polyp. This endoscope can be passed through the nasal passage into the laryngeal cavity. The therapeutic electronic endoscope is introduced and a clinical case is presented

Lymphoepithelial Cyst of the Hypopharynx

A rare case of lymphoepithelial cyst formed in the piriform sinus of the hypopharynx is reported. Histopathological examination revealed a lymphoepithelial cyst. It was removed by laryngomicrosurgical technique using a side-opened direct laryngoscope. Because this cyst was wide-based on the antero-medial region in the right piriform sinus of the hypopharynx, the mucous membrane around the cyst was incised electrosurgically and then detached to facilitate removal. In this paper, we describe our surgical procedure for removing the cyst in this case and discuss the possible causes of the disease

Transoral Videolaryngoscopic Surgery (TOVS)

Transoral videolaryngoscopic surgery (TOVS) for laryngopharyngeal cancer developed by Shiotani et al., uses the laparoscopic surgical system and distending laryngoscope. This method enables precise procedures and en bloc resection under a good view with videoendoscope in the structurally complex laryngopharynx. The major indications are Tis-2, and selected T3 lesions of hypopharyngeal, oropharyngeal, and supraglottic laryngeal cancer. TOVS is also considered for resectable rT1 and rT2 radiation failure cases and selected T3–4 advanced cases following neoadjuvant chemotherapy. Patients with resectable lymph node metastases are treated by neck dissection. Major contraindications are cricoarytenoid joint fixation, circumferential invasion of more than half, bilateral arytenoid invasion, and invasion to the thyroid cartilage, cricoid cartilage, hyoid bone, deep pharyngeal constrictor muscle. Oncological outcomes are good in long-term survival and larynx preservation rates with sparing radiation in half of the patients. However, advanced T stage and N3 cases showed a worse prognosis. Regarding functional outcome, swallowing function can maintain in most patients. Postoperative voice impairment can occur after wound healing. TOVS has some advantages particularly for hypopharyngeal cancer, in maneuver with smaller diameter instruments and tactile sense, and in less invasiveness without a tracheostomy, compared to other transoral surgeries

Conservative Therapy for Nonspecific Granuloma of the Larynx Using a Beclomethasone Dipropionate Inhaler

Nonspecific granuloma of the larynx is a benign tumor that usually occurs on the posterior glottis. Conventional treatment for this laryngeal lesion has consisted of surgical resection. However, this lesion has a strong tendency to recur postoperatively and may require multiple repeated operative procedures. Conservative treatment, consisting mainly of beclomethasone dipropionate inhalation therapy, was instituted in 20 cases with good results. We discussed the effect of beclomethasone dipropionate on this lesion as well as the etiology of this disease

Newly Designed Specula for Laryngomicroscopy

We produced specula for laryngomicroscopy to observe blind spots in the operating field. Use of these specula has facilitated detailed observation of the lower surface of the false vocal folds, laryngeal ventricle, and subglottis, which were previously in blind spots. The specula are useful in the following ways: 1) clarifying blind spots for improved diagnosis and providing more accurate surgical margins; 2) observing the lower lips of the vocal folds in phonosurgery; and 3) Vaporizing with laser reflection. The specula are cheap and easy to use and are well worth considering for application to laryngomicroscopy

The prognostic impact of sarcopenia on elderly patients undergoing pulmonary resection for non-small cell lung cancer

Purpose The number of elderly patients who undergo surgery is increasing, even though they are at a high risk due to a decreased physical strength. Furthermore, sarcopenia is generally associated with a poor prognosis in patients with non-small cell lung cancer (NSCLC). Methods This study included NSCLC patients  ≥ 65 years old who underwent pulmonary resection in our hospital between 2012 and 2015. Sarcopenia was assessed using the psoas muscle mass index based on computed tomography at the level of the third lumbar vertebra. We elucidated the impact of sarcopenia on short- and long-term outcomes after surgery. Results We enrolled 259 patients, including 179 with sarcopenia. Patients with sarcopenia before surgery tended to have postoperative complications (p = 0.0521), although they did not show a poor prognosis. In patients with sarcopenia, a multivariate analysis revealed that postoperative complications and the progression of sarcopenia 1 year after surgery were significant risk factors for a poor prognosis (p = 0.0169 and 0.00370, respectively). Conclusions The progression of sarcopenia after surgery is associated with a poor prognosis in elderly NSCLC patients with sarcopenia. A strategy to prevent postoperative progressive sarcopenia may be necessary for improving the clinical outcome of this population

Attempting to define sentinel node micrometastasis in oral squamous cell carcinoma

OBJECTIVE:The aim of this supplemental study of a sentinel node (SN) biopsy (SNB) trial for oral squamous cell carcinoma (OSCC) was to assess the effectiveness in identifying micrometastasis and determining whether elective neck dissection (END) is necessary. MATERIALS AND METHODS:Twenty-three patients with pathologically positive SNs were included. The sizes of the metastatic lesions in positive SNs (SMSNs) were classified and the rates of occult metastasis of non-SNs were compared. RESULTS:The patients were divided according to the SMSN:<0.2 mm (group A, n=3);0.2 mm to <2.0 mm (group B, n=7);and ≥2.0 mm (group C, n=13). The rates of occult metastasis in groups A, B, and C were 0% (0/3), 14% (1/7) and 23% (3/13), respectively. CONCLUSION:Rare cancer cell distribution to nodes other than SNs was observed in the patients with SN metastatic lesions of at least smaller than 0.2 mm in size, suggesting the possibility of defining SN micrometastasis in N0 OSCC

Primary tumor-secreted lymphangiogenic factors induce pre-metastatic lymphvascular niche formation at sentinel lymph nodes in oral squamous cell carcinoma

Objectives: The objectives of this study were to evaluate the formation of lymphvascular niches in lymph nodes of patients with oral squamous cell carcinoma (OSCC), and investigate the roles of lymphangiogenic and angiogenic factors, such as vascular endothelial growth factor (VEGF)-A, VEGF-C, and VEGF-D, expressed in the primary tumors. Materials and Methods: Forty-four patients with previously untreated clinically late T2 or T3 OSCC of cN0 were evaluated for primary tumors and 166 sentinel lymph nodes (SLNs). Primary tumors were immunohistochemically analyzed for expressions of VEGFs. Densities of lymphatic vessels (LVDpodoplanin) and high endothelial venules (HEVD) in the SLNs were also calculated using antibodies for each marker, podoplanin and MECA-79, respectively. Results: In 25 patients, all lymph nodes were metastasis-negative, whereas, in 19 patients, metastasis was positive for at least one lymph node (either at SLN, non-SLN, or nodal recurrence). From the analyses of 140 SLNs without metastasis, LVDpodoplanin in 50 SLNs of metastasis-positive cases was significantly higher than that in 90 SLNs of metastasis-negative cases (p = 0.0025). HEVD was not associated with lymph node metastasis. The patients with VEGF-A-High or VEGF-D-High tumors had significantly higher LVDpodoplanin than patients with their Low counterparts (p = 0.0233 and p = 0.0209, respectively). In cases with lymph node metastasis, the VEGF-D-expression score was significantly higher than in those without lymph node metastasis (p = 0.0006). Conclusions: These results suggest that lymph node lymphangiogenesis occurs before metastasis in OSCC. VEGF-A and VEGF-D play critical roles in this process. VEGF-D is a potential predictive marker of positive lymph node metastasis in cN0 patients. © 2015 Wakisaka et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Transoral surgery for superficial head and neck cancer: National Multi‐Center Survey in Japan

Head and neck cancers, especially in hypopharynx and oropharynx, are often detected at advanced stage with poor prognosis. Narrow band imaging enables detection of superficial cancers and transoral surgery is performed with curative intent. However, pathological evaluation and real-world safety and clinical outcomes have not been clearly understood. The aim of this nationwide multicenter study was to investigate the safety and efficacy of transoral surgery for superficial head and neck cancer. We collected the patients with superficial head and neck squamous cell carcinoma who were treated by transoral surgery from 27 hospitals in Japan. Central pathology review was undertaken on all of the resected specimens. The primary objective was effectiveness of transoral surgery, and the secondary objective was safety including incidence and severity of adverse events. Among the 568 patients, a total of 662 lesions were primarily treated by 575 sessions of transoral surgery. The median tumor diameter was 12 mm (range 1–75) endoscopically. Among the lesions, 57.4% were diagnosed as squamous cell carcinoma in situ. The median procedure time was 48 minutes (range 2–357). Adverse events occurred in 12.7%. Life-threatening complications occurred in 0.5%, but there were no treatment-related deaths. During a median follow-up period of 46.1 months (range 1–113), the 3-year overall survival rate, relapse-free survival rate, cause-specific survival rate, and larynx-preservation survival rate were 88.1%, 84.4%, 99.6%, and 87.5%, respectively. Transoral surgery for superficial head and neck cancer offers effective minimally invasive treatment