SURGICAL MANAGEMENT OF HEAD AND NECK CANCER

Surgery has been the mainstay of therapy for head and neck cancer since the introduction of the radical neck dissection by Crile at the turn of the century. To date, with the notable exception of nasopharyngeal carcinoma, surgical resection remains the gold standard for treatment of head and neck cancer. As chemotherapy has developed over the last 15 years, nonsurgical modalities have been increasingly used in initial as well as salvage therapy. Head and neck surgery, however, is a quickly developing field. Even as multicenter national trials document the possibility of nonsurgical organ preservation, surgical techniques are being pioneered that may offer dramatically improved chances for organ preservation compared with that achieved by chemotherapy and radiation. Innovative surgical resection and reconstruction techniques have been developed for head and neck cancer surgery during the past few years. This article summarizes the state of the art in head and neck cancer surgery. For each major subsite of the head and neck, the current surgical options are presented with discussion of the indications and expected outcomes. This article presenting the management of head and neck cancer from the surgeon's perspective can serve as a surgical guide for the medical oncologist interested in head and neck cancer.