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Is open surgery for head and neck cancers truly declining?
Dana M Hartl1, Daniel F Brasnu, Jatin P Shah
1Department of Otolaryngology-Head and Neck Surgery, Institut Gustave Roussy, Villejuif Cedex, France.
Abstract:
In the past two decades, major modifications in the way we treat head and neck cancers, due to advances in technology and medical oncology, have led to a decline in the use of open surgery as first-line treatment of cancers arising from several primary tumor sites. The incidence of tobacco- and alcohol-related squamous cell carcinoma of the pharynx and larynx has been steadily decreasing, with a rise in the incidence of human papillomavirus-related oropharyngeal tumors and the use of minimally invasive endoscopic surgery and non-surgical treatment modalities has increased in the treatment of all of these tumors. However, open surgery remains the initial definitive treatment modality for other tumors, including tumors of the skin, oral cavity, sinonasal cavities and skull base, salivary glands, thyroid and sarcomas. Selected group of nasal, paranasal, base of the skull and thyroid tumors are also candidates for minimally invasive procedures. For some indications, the rate of open surgery has actually increased in the past decade, with an increase in the incidence of oral cavity, thyroid and skin cancer, an increase in the number of neck dissections performed, and an increase in salvage surgery and free flap reconstruction. The use of minimally invasive, technology-based surgery-with the use of lasers, operating microscopes, endoscopes, robots and image guidance-has increased. Technology, epidemiology and advances in other domains such as tissue engineering and allotransplantations may further change the domains of competencies for future head and neck surgeons.
Insights
Head and neck cancer treatment has shifted, with less open surgery for some tumors but increased use of minimally invasive techniques and open surgery for others. Future surgical competencies will be shaped by technology and epidemiology.
Area of Science:
- Oncology
- Surgical Oncology
- Head and Neck Surgery
Background:
- Major advancements in medical oncology and technology have altered head and neck cancer treatment over the past two decades.
- A decrease in tobacco/alcohol-related squamous cell carcinoma of the pharynx and larynx is observed, alongside an increase in human papillomavirus-related oropharyngeal tumors.
Purpose of the Study:
- To analyze the evolving trends in surgical treatment modalities for head and neck cancers.
- To identify the impact of technological and epidemiological shifts on surgical approaches.
Main Methods:
- Review of treatment trends over the past two decades.
- Analysis of changes in the incidence of various head and neck tumors.
- Assessment of the adoption of minimally invasive and technology-based surgical techniques.
Main Results:
- Open surgery use has declined as first-line treatment for certain head and neck cancers.
- Minimally invasive endoscopic surgery and non-surgical options have increased.
- Open surgery remains primary for skin, oral cavity, sinonasal, skull base, salivary gland, thyroid, and sarcoma tumors.
- Rates of open surgery have increased for oral cavity, thyroid, and skin cancers, with more neck dissections and reconstructive procedures.
- Use of technology-assisted surgery (lasers, robots, etc.) has risen.
Conclusions:
- Head and neck cancer treatment is dynamic, with a trend towards less invasive procedures for some sites.
- Open surgery remains crucial for specific tumor types, and its application has increased in certain areas.
- Future head and neck surgeons' skills will be influenced by ongoing technological, epidemiological, and biological advancements.
