Transoral surgery for hypopharyngeal and laryngeal cancers in Japan: Current status from a nationwide multicenter retrospective study

Koji Araki; Seiichi Yoshimoto; Takashi Fujii; Hiroki Mitani; Takashi Mukaigawa; Takahiro Asakage; Akihito Watanabe; Koichi Kano; Kenji Okami; Shigemichi Iwae; Takahiro Tsujikawa; Daisuke Sano; Masami Osaki; Naoki Nishio; Nobuhiro Hanai; Tomoyuki Arai; Mitsuhiko Nakahira; Yuki Saito; Kenzo Ohara; Takayuki Imai; Ryo Asato; Chieko Yokota; Masahiro Kikuchi; Shun-Ichi Chitose; Daizo Murakami; Masayuki Tomifuji; Kosuke Uno; Ichiro Tateya; Kazunori Fujiwara; Kazuto Matsuura; Hirohito Umeno; Munenaga Nakamizo; Ryuichi Hayashi; Megumi Kitayama; Daisuke Kawakita; Akihiro Shiotani; Ken-Ichi Nibu

doi:10.1016/j.anl.2025.12.015

Transoral surgery for hypopharyngeal and laryngeal cancers in Japan: Current status from a nationwide multicenter retrospective study

Auris Nasus Larynx. 2026 Jan 20;53(2):188-200. doi: 10.1016/j.anl.2025.12.015. Online ahead of print.

Authors

Koji Araki¹, Seiichi Yoshimoto², Takashi Fujii³, Hiroki Mitani⁴, Takashi Mukaigawa⁵, Takahiro Asakage⁶, Akihito Watanabe⁷, Koichi Kano⁸, Kenji Okami⁹, Shigemichi Iwae¹⁰, Takahiro Tsujikawa¹¹, Daisuke Sano¹², Masami Osaki¹³, Naoki Nishio¹⁴, Nobuhiro Hanai¹⁵, Tomoyuki Arai¹⁶, Mitsuhiko Nakahira¹⁷, Yuki Saito¹⁸, Kenzo Ohara¹⁹, Takayuki Imai²⁰, Ryo Asato²¹, Chieko Yokota²², Masahiro Kikuchi²³, Shun-Ichi Chitose²⁴, Daizo Murakami²⁵, Masayuki Tomifuji²⁶, Kosuke Uno²⁶, Ichiro Tateya²⁷, Kazunori Fujiwara²⁸, Kazuto Matsuura²⁹, Hirohito Umeno²⁴, Munenaga Nakamizo³⁰, Ryuichi Hayashi²⁹, Megumi Kitayama³¹, Daisuke Kawakita³², Akihiro Shiotani²⁶, Ken-Ichi Nibu³³

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, National Defense Medical College, Tokorozawa, Japan. Electronic address: kojaraki@ndmc.ac.jp.
² Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan.
³ Department of Head and Neck Surgery, Osaka International Cancer Institute, Osaka, Japan.
⁴ Department of Head and Neck Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
⁵ Division of Head and Neck Surgery, Shizuoka Cancer Center, Nagaizumi, Japan.
⁶ Department of Head and Neck Surgery, Institute of SCIENCE TOKYO, Tokyo, Japan.
⁷ Department of Otorhinolaryngology-Head and Neck Surgery, Keiyukai Sapporo Hospital, Sapporo, Japan.
⁸ Department of Otorhinolaryngology-Head and Neck Surgery, Kitasato University School of Medicine, Sagamihara, Japan.
⁹ Department of Otorhinolaryngology-Head and Neck Surgery, Tokai University, Isehara, Japan.
¹⁰ Department of Head and Neck Surgery, Hyogo Cancer Center, Akashi, Japan.
¹¹ Department of Otorhinolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
¹² Department of Otorhinolaryngology-Head and Neck Surgery, Yokohama City University, Yokohama, Japan.
¹³ Department of Otorhinolaryngology-Head and Neck Surgery, Ageo Central General Hospital, Ageo, Japan.
¹⁴ Department of Otorhinolaryngology, Nagoya University, Nagoya, Japan.
¹⁵ Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.
¹⁶ Department of Otorhinolaryngology-Head and Neck Surgery, Chiba University, Chiba, Japan.
¹⁷ Department of Head and Neck Surgery, Saitama Medical University International Medical Center, Hidaka, Japan.
¹⁸ Department of Otolaryngology, Head and Neck Surgery, The University of Tokyo, Tokyo, Japan.
¹⁹ Department of Otorhinolaryngology-Head and Neck Surgery, Asahikawa Medical University, Asahikawa, Japan.
²⁰ Department of Head and Neck Surgery, Miyagi Cancer Center, Natori, Japan.
²¹ Department of Otolaryngology - Head & Neck Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
²² Department of Otolaryngology and Head & Neck Surgery, Osaka Metropolitan University, Osaka, Japan.
²³ Department of Otorhinolaryngology-Head and Neck Surgery, Kobe City Medical Center General Hospital, Kobe, Japan.
²⁴ Department of Otorhinolaryngology-Head and Neck Surgery, Kurume University School of Medicine, Kurume, Japan.
²⁵ Department of Otolaryngology-Head and Neck Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
²⁶ Department of Otolaryngology-Head and Neck Surgery, National Defense Medical College, Tokorozawa, Japan.
²⁷ Department of Otorhinolaryngology-Head and Neck Surgery, Fujita Health University, Toyoake, Japan.
²⁸ Department of Otorhinolaryngology-Head and Neck Surgery, Tottori University, Yonago, Japan.
²⁹ Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan.
³⁰ Department of Otorhinolaryngology-Head and Neck Surgery, Nippon Medical School, Tokyo, Japan.
³¹ Clinical Study Support Center, Data Center Department, Wakayama Medical University Hospital, Wakayama, Japan.
³² Department of Otorhinolaryngology-Head and Neck Surgery, Nagoya City University, Nagoya, Japan.
³³ Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.

PMID: 41564458
DOI: 10.1016/j.anl.2025.12.015

Abstract

Objective: In this nationwide retrospective study, we sought to evaluate the oncologic and functional outcomes and safety of transoral surgery (TOS) for hypopharyngeal and laryngeal squamous cell carcinomas in Japan and to clarify the appropriate indications for various TOS modalities.

Methods: Data were obtained from the Head and Neck Cancer Registry of Japan. Patients who underwent transoral or endoscopic resection between 2011 and 2016 were selected. Detailed clinical information was collected from 55 institutions using web-based case report forms. Surgical modalities analyzed included endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), endoscopic laryngopharyngeal surgery (ELPS), transoral laser microsurgery (TLM), and transoral videolaryngoscopic surgery (TOVS).

Results: In total, 1825 patients were included (hypopharyngeal cancer, 62.5 %; laryngeal cancer, 37.5 %). Most cases (77.5 %) were T1 or lower, and 90.8 % were Stage II or earlier. TLM is predominantly used for glottic cancers, ELPS/ESD for superficial hypopharyngeal lesions, and TOVS for more advanced tumors, reflecting distinct indications for each modality. The 5-year disease-specific survival (DSS), recurrence-free survival (RFS), and overall survival (OS) were 97.1 %, 84.3 %, and 85.4 %, respectively. The laryngeal preservation rate was 98.2 %. Tracheostomy was performed in 5.0 % of cases, mainly for airway protection; major complications, including pneumonia (2.4 %), hemorrhage (1.1 %), fistula formation (0.4 %), and vocal cord fixation (2.6 %), occurred in <3 % of patients. Postoperative functional outcomes were favorable, with persistent dysphagia (Functional Outcome Swallowing Scale stage ≥ 3) in 1.6 % and tube feeding dependence in 1.8 %.

Conclusion: Non-robot-assisted TOS demonstrated excellent oncologic control and functional preservation of the larynx with low complication rates in early-stage hypopharyngeal and laryngeal cancers. Each surgical modality has distinct indications depending on the tumor site, depth of invasion, and institutional expertise. These findings support the use of TOS as a safe and effective treatment option for selected patients. Further procedural standardization and data accumulation are required to refine the indications and facilitate their broader adoption in clinical practice.

Keywords: Endoscopic laryngopharyngeal surgery; Endoscopic submucosal dissection; Hypopharyngeal cancer; Laryngeal cancer; Transoral laser microsurgery; Transoral videolaryngoscopic surgery.