title: Is open surgery for head and neck cancers truly declining?
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.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Institut Gustave Roussy, Villejuif Cedex, France.
authors.forename: Dana M
authors.initials: DM
authors.lastname: Hartl
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Brasnu
authors.forename: Jatin P
authors.initials: JP
authors.lastname: Shah
authors.forename: Michael L
authors.initials: ML
authors.lastname: Hinni
authors.forename: Robert P
authors.initials: RP
authors.lastname: Takes
authors.forename: Kerry D
authors.initials: KD
authors.lastname: Olsen
authors.forename: Luiz P
authors.initials: LP
authors.lastname: Kowalski
authors.forename: Juan P
authors.initials: JP
authors.lastname: Rodrigo
authors.forename: Primož
authors.initials: P
authors.lastname: Strojan
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Wolf
authors.forename: Alessandra
authors.initials: A
authors.lastname: Rinaldo
authors.forename: Carlos
authors.initials: C
authors.lastname: Suárez
authors.forename: William M
authors.initials: WM
authors.lastname: Mendenhall
authors.forename: Vinidh
authors.initials: V
authors.lastname: Paleri
authors.forename: Arlene A
authors.initials: AA
authors.lastname: Forastiere
authors.forename: Jochen A
authors.initials: JA
authors.lastname: Werner
authors.forename: Alfio
authors.initials: A
authors.lastname: Ferlito
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D004724:Endoscopy / Q000639:trends*; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D053685:Laser Therapy / Q000639:trends; D019060:Minimally Invasive Surgical Procedures / Q000639:trends; D037981:Neck Dissection