下咽頭癌に対する喉頭温存・下咽頭喉頭部分切除術

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  • 松浦 一登
    宮城県立がんセンター頭頸部外科 東北大学大学院医学系研究科連携講座頭頸部腫瘍学分野

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タイトル別名
  • Laryngeal Preservation Surgery for Hypopharyngeal Cancer
  • カイントウ ガン ニ タイスル コウトウ オンゾン ・ シタ イントウ コウトウ ブブン セツジョジュツ

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<p>Patients with hypopharyngeal cancer are well known to often have multiple primary cancers, including, in particular, esophageal cancer. Radiotherapy is not suitable for the treatment of hypopharyngeal cancer if the patient has already received irradiation for esophageal cancer. Therefore, we regard partial pharyngectomy as a very important strategy for the purpose of laryngeal preservation in patients with hypopharyngeal cancer.</p><p>We use one of two techniques for laryngo–pharyngeal surgery.</p><p>The first is endoscopic laryngo-pharyngeal surgery (ELPS), conducted in cooperation with a gastrointestinal endoscopist as a minimally invasive surgery. We have shown that it is a useful technique for patients with superficial pharyngeal cancer. Pharyngeal expansion using the curved laryngoscope is very useful for improved observation, and the extent of spread of the lesion is determined by gastrointestinal endoscopy. We have performed over 100 cases of ELPS since 2007, and the 5-year cause-specific survival rate is approximately 98%.</p><p>The second technique is laryngeal preservation surgery, for cases with invasive hypopharyngeal cancer. We have performed laryngeal preservation surgery in 46 patients since 2004. Recently, for more precise resection, we determined the extent of resection by endoscopy and performed a mucosal incision. Then, we removed the tumor via a cervical approach. Using this method, we achieved complete resection in all cases, as confirmed by postoperative histopathological examination. The 5-year cause-specific survival rate is approximately 90%.</p>

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