Abstract Objective This study aimed to evaluate the benefits of recipient site of closed incision negative pressure therapy (ciNPT) on postoperative complications in head and neck reconstruction. Study Design A single‐center retrospective observational study was conducted on patients who underwent head and neck reconstruction for both benign and malignant disease using pedicled or free tissue transfers between November 2023 and September 2024. Setting A tertiary care institution. Methods Patients were divided into ciNPT and non‐ciNPT groups. 30‐day postoperative complication rates, including skin necrosis, surgical site infection (SSI), hematoma, lymphorrhea, anastomotic leakage, and flap vascular compromise, were compared between groups. Results 44 patients (median age: 68.0, female: 38.6%) were included in the analyses (21 ciNPT, 23 non‐ciNPT). The ciNPT group had a higher median intraoperative blood loss (510 vs 175 mL; P = .004) and higher rates of intra/postoperative blood transfusion (5 vs 0; P = .019). A total of 39 patients underwent free tissue transfer, comprising 17 in the ciNPT group (81.0%) and 22 in the non‐ciNPT group (95.7%). Clavien‐Dindo grade IIIa complications occurred in 19.0% of ciNPT and 21.7% of non‐ciNPT cases (P = 1.000), while grade IIIb complications occurred in 19.0% and 13.0%, respectively (P = .693). Overall, no significant differences were found between groups across complication categories. Although overall complication rates were comparable between the 2 groups, this study emphasizes practical techniques for the clinical application of ciNPT in complex reconstruction cases. Larger, prospective, multi‐center studies are warranted to validate its benefits and optimize clinical use. Level of Evidence Ⅲ.

Background/Objectives: Parathyroid hormone (PTH), which rises compensatory with vitamin D insufficiency and has been shown to down-regulate vitamin D receptor expression, represents a biologically plausible effect modifier. We investigated whether pretreatment serum PTH modifies the effect of postoperative vitamin D supplementation on relapse-free survival, and whether adding tumor p53 status further refines subgroup identification in an exploratory analysis. Methods: This post hoc analysis utilized data from the AMATERASU trial (UMIN000001977), a single-center, randomized, double-blind, placebo-controlled trial evaluating vitamin D3 (2000 IU/day) versus placebo in patients with curatively resected stage I-III digestive tract cancers (maximum follow-up, 7.5 years). Patients were dichotomized at the cohort median PTH (41 pg/mL). The primary outcome was relapse-free survival (RFS), analyzed using multivariable Cox proportional hazards models. Results: Of 417 randomized patients, 410 had baseline PTH data. In the lower PTH subgroup (≤41 pg/mL), vitamin D significantly improved RFS compared with placebo (fully adjusted hazard ratio [HR], 0.45; 95% confidence interval [CI], 0.24-0.81; p = 0.008). Conversely, no benefit was observed in the higher PTH subgroup (>41 pg/mL; fully adjusted HR, 1.25; 95% CI, 0.64-2.44; p for interaction = 0.016). Exploratory stratification of 365 patients with p53 data showed that the supplementation benefit appeared greatest in patients with both low PTH (≤41 pg/mL) and p53-positive tumors (fully adjusted HR, 0.38; 95% CI, 0.18-0.78; p = 0.009). Conclusions: Pretreatment serum PTH is a candidate effect modifier of postoperative vitamin D supplementation in digestive tract cancers.

OBJECTIVES:This study aimed to compare oncologic and surgical outcomes between conventional and endoscope-assisted total maxillectomy for primary maxillary sinus squamous cell carcinoma, a technically demanding procedure, particularly with respect to posterior and medial margin control. MATERIALS AND METHODS:This retrospective cohort study was conducted at two tertiary referral centers between February 2018 and September 2024. Twenty-four patients with primary maxillary sinus squamous cell carcinoma who underwent total maxillectomy with curative intent were included. Twelve patients underwent conventional open surgery, and twelve underwent endoscope-assisted total maxillectomy. Surgical margin status, recurrence patterns, postoperative pterygoid plate length, and survival outcomes were compared between groups. Recurrence-free survival (RFS) and overall survival (OS) were estimated using the Kaplan-Meier method. RESULTS:All patients underwent curative-intent resection. Positive surgical margins were observed in two patients (16.7%) in the conventional group and in none in the endoscope-assisted group. The endoscope-assisted group was significantly associated with improved early recurrence control compared with the conventional group (2-year RFS, 100% vs 50% [95% CI, 0.21-0.74]; log-rank p = 0.02). Firth-corrected Cox regression analysis confirmed this association (HR 0.17, 95% CI 0.018-0.788, p = 0.022). OS data are presented descriptively due to the limited number of events (2-year OS, 100% vs 91.7% [95% CI, 53.9-98.8]). The postoperative residual length of the pterygoid plate was significantly shorter in the endoscope-assisted group, supporting the technical feasibility and precision of posterior resection. CONCLUSION:Endoscope-assisted total maxillectomy was associated with improved early recurrence control within the observation period and more precise posterior resection compared with the conventional approach. Although limited by its retrospective design and small sample size, this study provides proof-of-concept evidence supporting the feasibility and oncologic safety of endoscope-assisted total maxillectomy and warrants further validation through multi-institutional studies.

OBJECTIVE:Closed incision negative pressure therapy (ciNPT) has been associated with a reduced risk of surgical wound complications, but its effectiveness in head and neck reconstruction has not been fully studied. This study aimed to evaluate the association between ciNPT use and the incidence and severity of complications at flap harvest sites that were primarily closed. METHODS:A retrospective analysis was conducted on 85 patients who underwent head and neck reconstruction at a single institution between 2021 and 2024. Patients were divided into ciNPT (n = 46) and non-ciNPT (n = 39) groups. Rates of postoperative complications, including wound dehiscence, skin necrosis, surgical site infections (SSIs), hematomas, and seromas, occurring within 30 days were assessed. Multivariate logistic regression was used to identify risk factors and adjust for confounding variables. RESULTS:Of 85 patients, 13 (15.3%) experienced complications, with significantly lower rates in the ciNPT group (4.3%) compared to the non-ciNPT group (28.2%). Non-ciNPT use was associated with a higher relative risk of complications compared with ciNPT use (adjusted OR: 7.942; 95% CI: 1.602-39.365; p = 0.011). In the ciNPT group, complications were limited to minor seromas (Clavien-Dindo grade I). In contrast, the non-ciNPT group had more severe complications, including wound dehiscence, skin necrosis, SSIs, seromas, and hematomas. CONCLUSION:ciNPT was associated with lower incidence of complications at flap harvest sites in head and neck reconstruction. These findings highlight the potential benefits of ciNPT in improving postoperative wound outcomes. Further studies, including randomized controlled trials, are needed to confirm these results and refine ciNPT application. LEVEL OF EVIDENCE: 3: TRIAL REGISTRATION:umin.ac.jp/ctr Identifier: UMIN000056066.

IntroductionCarcinoma of the external auditory canal (EAC) is rare, and squamous cell carcinoma (SCC) is the most common histological type. There are few reports on the treatment outcomes for a large number of cases at a single institution, and a standard treatment has not been established.MethodsTreatment details and prognoses were retrospectively examined for patients who underwent primary treatment for SCC of the EAC at The Jikei University between April 2015 and May 2023.ResultsTwenty-seven patients with SCC of the EAC were included (median age of 64 years). Analysis using the revised Pittsburgh classification revealed that there were 3 cases of T1, 4 cases of T2, 9 cases of T3, and 11 cases of T4. Among the patients, 13 were treated surgically, 1 underwent partial resection of the EAC, 11 underwent lateral temporal bone resection, and 1 underwent subtotal temporal bone resection. The remaining 14 patients received nonsurgical treatment: 1 with radiotherapy, 3 with concurrent chemoradiotherapy, and 10 with induction chemotherapy (ICT). The overall survival (OS) and disease-free survival (DFS) rates at 3 years were 72.8% and 50.5%, respectively. When the surgical and non-surgical groups were compared, the 3-year OS and DFS rates were 92.3% and 68.3% for those who underwent surgery and 47.6% and 35.7% for those not treated with surgery, respectively, suggesting a better prognoses for patients who underwent surgical treatments (p = 0.045, 0.052). In the non-surgical group, the 3-year OS and DFS rates were 90.0% and 50.0% for those who received ICT and 0% and 0% for those who did not receive ICT, respectively, indicating better prognoses for patients treated with ICT (p = 0.0075, 0.0012).ConclusionAt our institution, the 3-year OS and DFS rates of patients with SCC of the EAC were favourable for those who underwent surgery and received ICT. These findings suggest that treatment outcomes can be improved by using ICT in nonsurgical treatments for patients with SCC of the EAC.

This study presents a practical non-robotic surgical technique for the treatment of lateral wall oropharyngeal squamous cell carcinoma, utilizing only standard head and neck surgical instruments. By integrating tumor pull-through resection, primary closure, and submandibular gland mobilization, this method circumvents the need for free flap reconstruction while maintaining postoperative functionality. Clinical outcomes indicate favorable survival rates and quality of life, supporting its viability as a cost-effective alternative in resource-constrained settings.

Background: Regarding drain removal timing in head and neck reconstruction, each institution applies its criteria, and a clear consensus has not been established. This pre-post study aims to identify risk factors for surgical site infection (SSI) after reconstructive surgical procedure for head and neck cancer, specifically examining the influence of drain removal timing. Patients and Methods: A cohort of 220 patients undergoing reconstructive surgical procedure was analyzed. Patients had closed suction drains removed on post-operative day (POD) 2 or POD3. The primary endpoint was SSI incidence within 30 days after operation. Secondary endpoints included the incidence of hematoma and lymphorrhea within 30 days after operation and drain tip culture results. Statistical analyses were performed using Fisher exact test and logistic regression models. Results: SSIs occurred in 14.5% of patients, with no significant difference between the POD2 (14.6%) and POD3 (14.5%) groups. No substantial differences were found for hematoma and lymphorrhea. The positive rate of drain tip cultures was significantly greater in the POD3 group (38.2%) compared with the POD2 group (18.0%). Multi-variable analysis showed no correlation between SSI and POD3 drain removal (odds ratio [OR], 0.728; p = 0.471). However, significant SSI risk factors included oral cavity lesions (OR, 3.510; p = 0.003) and ampicillin prophylaxis (OR, 5.266; p < 0.001). Conclusions: Oral cavity lesions and ampicillin prophylaxis were substantial SSI risk factors in reconstructive surgical procedure for head and neck cancer. However, drain removal timing did not significantly affect SSI incidence or other complications. Considering benefits such as shorter hospital stays and less chance of retrograde bacterial invasion, removing drains on POD2 is preferable compared with removal on POD3. Further research is needed to refine prophylactic protocols and enhance patient outcomes.

Midface reconstruction should address both functional and cosmetic aspects. The vascularized fibular osteomyocutaneous flap (VFOF) is a promising first choice because of its numerous advantages in this type of reconstruction.This study aimed to investigate the causes of VFOF failure during midface reconstruction. We retrospectively reviewed patients who underwent midface defect reconstruction using VFOF from August 2011 to May 2022 at a single center. The primary outcome variable was VFOF loss within 30 days, and secondary outcomes included late complications related to VFOF occurring at least 6 months postoperatively.A total of 62 patients underwent VFOF reconstruction for midface defects. The VFOF technique was primarily used in 56 (90.3%) patients for initial reconstruction. according to the Brown and Shaw classification, most reconstructions were performed for Class III (77.4%) and Class b (83.6%) defects. Skin paddles of the VFOF were used in 51 (82.3%) patients, and a double flap technique utilizing the fibular was employed in 24 (38.7%) patients. VFOF failure occurred in 10 (16.1%) patients. Prognostic factors associated with VFOF failure included sex (p = 0.01) and maxillary Brown and Shaw classification (horizontal; p = 0.01). Long-term follow-up of 47 patients revealed late complications in 11 (23.4%) patients, and diabetes mellitus was identified as a significant risk factor (p < 0.01).The VFOF is suitable for midface defect reconstruction; however, proper placement of the fibular bone, avoiding pedicle vessel kinking, ensuring tension-free vascular anastomosis during surgery, considering the use of an additional flap in addition to the fibula flap for large defects, and diligent postoperative nasal care are essential.

This study presents a pioneering report on an endoscopic assisted total maxillectomy that allows for en bloc resection without a facial skin incision. Laryngoscope, 135:124-129, 2025.

ObjectiveWide defects resulting from subtotal or total glossectomy are commonly reconstructed using a bulk flap to maintain oral and speech functions. The flap, including muscle tissue, diminishes with time. This study aimed to compare the surgical outcomes of deep inferior epigastric artery perforator and rectus abdominis musculocutaneous free flap reconstructions after glossectomy with laryngeal preservation.MethodsMedical records of 13 and 26 patients who underwent deep inferior epigastric artery perforator and rectus abdominis musculocutaneous free flap reconstructions, respectively, from 2014 to 2022 at our institution were reviewed. Patients who underwent middle pharynx resection except for the base of the tongue, mandibular bone resection, and sensory reinnervation were excluded.ResultsThe rectus abdominis musculocutaneous groups showed a higher number of lymph node dissection and shorter operative time than the deep inferior epigastric artery perforator groups. No significant differences in postoperative complications or functional oral intake scale scores at 6 months were observed. Volumetric changes on computed tomography images at 6 and 12 months were significantly lower in the deep inferior epigastric artery perforator group. Cancer recurrence was significantly associated with reduced oral function.ConclusionsOral function in patients with cancer is influenced by various other factors. However, the deep inferior epigastric artery perforator flap may be suitable for tongue reconstruction because of the minimal postoperative changes in flap volume, easy adjustment of flap thickness, elevation of multiple flaps, and minimal complications at the donor site.

To evaluate the effect of vitamin D3 supplementation on cancer mortality in the general population and on prognosis in cancer patients, a systematic review and meta-analysis of randomised, placebo-controlled trials (RCTs) and individual patient data (IPD) was conducted. Overall, 14 RCTs with a total of 104,727 participants (2015 cancer deaths) were identified and 7 RCTs, including 90 % of all study participants (n = 94,068), could be included in the IPD meta-analyses. The main meta-analysis of the 14 RCTs yielded a statistically non-significant reduction in cancer mortality by 6 % (risk ratio (RR) [95%-confidence interval (95%CI)]: 0.94 [0.86-1.02]). Subgroup analyses revealed a 12 % lower cancer mortality in the vitamin D3 group compared with the placebo group in 10 trials with a daily dosing regimen (RR [95%CI]: 0.88 [0.78-0.98]), whereas no mortality reduction was seen in 4 trials using a bolus regimen (RR [95%CI]: 1.07 [0.91-1.24]; p-value for interaction: 0.042). The IPD meta-analysis (RR [95%CI]: 0.93 [0.84; 1.02]) confirmed the finding of all trials. The IPD were used to test effect modification by age, sex, body mass index, ethnicity, baseline serum 25-hydroxyvitamin D concentration, adherence and cancer-related factors but no statistically significant findings were obtained in meta-analyses of all trials. When restricted to trials with daily dosing in a post-hoc analysis, adults aged ≥ 70 years (RR [95%CI]: 0.83 [0.77; 0.98]) and subjects with vitamin D3 therapy initiation before cancer diagnosis (RR [95%CI]: 0.87 [0.69; 0.99]) appeared to benefit most from daily vitamin D3 supplementation. Measurements of baseline 25-hydroxyvitamin D levels and inclusion of other than non-Hispanic White adults were too sparse in the trials to draw conclusions. Results for all-cause and cancer-specific survival of participants with cancer were comparable to those obtained in the general population for cancer mortality. In conclusion, vitamin D3 did not reduce cancer mortality in the main meta-analysis of all RCTs because the observed risk reduction by 6 % was not statistically significant. However, a subgroup analysis revealed that vitamin D3 administered daily, in contrast to bolus supplementation, reduced cancer mortality by 12 %.

下咽頭がんは本邦の頭頸部がんの中でも2番目に多いがん種であり，予後は不良である。頭頸部癌の予後に対しての炎症や栄養のパラメータについての研究が多くなされているが，その結果の臨床応用についての一致した見解は得られていない。本研究は，これらのパラメータの当院下咽頭がん集団における再現性と有用性を評価した。2015年から2020年までに当院で根治治療を施行した下咽頭がん83例について診療録から後方視的に調査を行った。5年全生存率は59.3％（95％信頼区間 46.8〜69.8％）であり，炎症や栄養のパラメータの予後予測因子としての再現性が確認できた。その中でもGeriatric nutritional risk indexやGlasgow prognostic scoreはカットオフ値が予め定義されているため，臨床応用の際に施設間格差の均一化という点で汎用性の高いパラメータであると考えられた。

Although elevated serum levels of soluble CD40 ligand (sCD40L) were reported in patients with cancer, the importance of high sCD40L levels in clinical oncology remains unknown. We conducted a post hoc analysis of the AMATERASU randomized clinical trial of vitamin D3 supplementation (2000 IU/day) in patients with digestive tract cancer to assess its significance. Serum sCD40L levels were measured by ELISA in 294 residual samples, and were divided into tertiles. In patients with colorectal cancer (CRC), 5-year relapse-free survival (RFS) rates in the middle and highest tertiles were 61.6% and 61.2%, respectively, which was significantly lower than 83.8% in the lowest tertile. A Cox proportional hazard analysis showed that the lowest tertile had a significantly lower risk of relapse or death than the highest tertile even with multivariate adjustment (hazard ratio (HR), 0.30; 95% confidence interval (CI), 0.11–0.80; p = 0.016). In the subgroup of CRC patients with the highest tertile of sCD40L, the 5-year RFS rate in the vitamin D group was 77.9%, which was significantly higher than 33.2% in the placebo group (HR, 0.30; 95% CI, 0.11–0.81; p = 0.018 [Pinteraction = 0.04]). In conclusion, elevated sCD40L might be a biomarker of poor prognosis in patients with CRC, but vitamin D supplementation might improve RFS in patients with high sCD40L.

近年では,従来行われている鼻中隔矯正術に加え,鼻柱切開を行わない前弯矯正術や鼻柱切開による鼻中隔外鼻形成術も行われるようになった。しかし厚生労働省により定められている鼻中隔手術の診療報酬には,前弯矯正や上弯矯正,外鼻矯正などの概念はない。また外鼻形成術の診療報酬には,鼻中隔矯正という概念は含まれていない。現在の診療報酬は,鼻中隔手術の進歩からくる労力を反映していない可能性がある。そのため今回我々は,鼻中隔手術についての現状分析を行うことを目的として,全国の主要施設に対しアンケート調査を施行した。

Background:Extranodal NK/T-cell lymphoma, nasal type (ENKL), is an aggressive tumour with poor prognosis. Its early diagnosis may improve the prognosis of patients; however, it is often overlooked in many cases and misdiagnosed as an inflammatory sinus disease during its initial stage. Identifying the clinical characteristics of ENKL may aid otorhinolaryngologists in indicating cases early for a pathologic examination. In this study, we aimed to investigate the clinical characteristics of ENKL compared with that of diffuse large B-cell lymphoma (DLBCL), which is the most common nasal malignant lymphoma. Methods:The backgrounds, clinical symptoms, blood test results, and computed tomography images of patients with nasal/paranasal malignant lymphoma in our hospital between 2012 and 2017 were investigated. The characteristics of ENKL and nasal DLBCL were compared to differentiate them. Results:A total of 27 patients with nasal cavity and/or paranasal sinus lymphoma were included. Extranodal NK/T-cell lymphoma, nasal type, was diagnosed in 10 patients, while DLBCL was diagnosed in 17 patients. The median age of patients with ENKL was significantly lower than that of patients with DLBCL. All patients with ENKL had a unilateral lesion in the nasal cavity, with most located at the inferior turbinate. They also experienced nasal symptoms with significantly higher incidence of nasal obstruction and tendency of bleeding. Conclusion:ENKL was often unilateral and caused nasal obstruction, unlike DLBCL. Those who are younger in age and have sinonasal tumour with unilateral nasal obstruction and bleeding should be considered for early and repeated biopsies at multiple sites, with ENKL taken into consideration.

IMPORTANCE Recent meta-analyses of randomized clinical trials found that daily vitamin D3 supplementation had beneficial effects on cancer mortality, although the results are still controversial.OBJECTIVE To examine whether vitamin D supplementation reduces the risk of relapse or death in a supgroup of patients with digestive tract cancer who were p53 immunoreactive.DESIGN, SETTING, AND PARTICIPANTS This was a post hoc subgroup analysis of the AMATERASU randomized, double-blind, placebo-controlled clinical trial. This trial included patients at a single university hospital in Japan with digestive tract cancers between January 2010 and February 2018 followed up for a median (IQR) of 3.5 (2.5-5.3) years to compare the effects of vitamin D supplementation with placebo and was reported in 2019. Patients from among 417 participants in the AMATERASU trial whose residual serum samples were available were included. Data were analyzed from October 20 to November 24, 2022. INTERVENTIONS Vitamin D3 (2000 IU/d) supplementation or placebo.MAIN OUTCOMES AND MEASURES The primary outcome was 5-year relapse or death. The subgroup of patients who were p53 immunoreactive was defined by positivity for anti-p53 antibodies in serum and nuclear accumulation of p53 oncosuppressor protein in more than 99% of cancer cells, which is considered a biomarker for p53 missense mutations. Anti-p53 antibody levels were measured using chemiluminescent enzyme immune assay. Immunohistochemical staining data of p53 protein in cancer tissue in pathologic specimens were obtained from a previous study and divided into 4 grades.RESULTS Among 392 patients with digestive tract cancer (mean [SD] age, 66 [10.7] years; 260 males [66.3%]), there were 37 patients with esophageal cancer (9.4%), 170 patients with gastric cancer (43.4%), 2 patients with small bowel cancer (0.5%), and 183 patients with colorectal cancer (46.7%). Serum anti-p53 antibody was detectable in 142 patients (36.2%), and p53-immunohistochemistry grade showed a positive association with serum anti-p53 antibody levels (coefficient = 0.19; P < .001). In the p53-immunoreactive subgroup (80 patients), relapse or death occurred in 9 of 54 patients (16.7%) in the vitamin D group and 14 of 26 patients (53.8%) in the placebo group; 5-year relapse-free survival (RFS) was significantly higher in the vitamin D group (13 patients [80.9%]) than the placebo group (1 patient [30.6%]; hazard ratio [HR], 0.27; 95% CI, 0.11-0.61; P = .002). This was significantly different from 272 patients in the non-p53 immunoreactive subgroup, in which vitamin D had no effect on 5-year RFS (vitamin D: 35 of 158 patients [22.2%] vs placebo: 24 of 114 patients [21.1%]; HR, 1.09; 95% CI, 0.65-1.84) (P for interaction = .005).CONCLUSIONS AND RELEVANCE This study found that vitamin D supplementation reduced the risk of relapse or death in the subgroup of patients with digestive tract cancer who were p53 immunoreactive.

This cross-sectional study investigates the association between life expectancy before COVID-19 and excess mortality during the pandemic in aging countries.