Head and neck surgery in the era of organ preservation therapy

The role of surgery in the treatment of head and neck cancer has evolved over the past few decades. Surgery continues to be the primary treatment modality for early disease and for lesions in which extirpation provides a high rate of disease control without substantial loss of function (eg, oral cavity). Despite nonsurgical approaches aimed at organ preservation (ie, combined chemotherapy and radiation therapy), surgery continues to have a role in chemoradiation treatment strategies as salvage therapy and as a part of a treatment modality designed to preserve vital organ function. Salvage surgery is generally used after disease failure following a nonsurgical treatment approach and includes primary persistent disease and neck recurrence. Several function-sparing surgical options are available for the larynx, oral cavity, hypopharynx, and tongue base, including laser excision, supraglottic and vertical hemilaryngectomy, Pearson near-total laryngectomy, and various reconstruction methods. Function-sparing surgery combined with chemotherapy is currently under investigation and may provide optimal survival and function in selected patients with head and neck cancer.