title: Removing the Taboo on the Surgical Violation (Cut-Through) of Cancer.
abstract: The surgical dictum of en bloc resection without violating cancer tissue has been challenged by novel treatments in head and neck cancer.
  
  
  
  An analysis of treatment outcomes involving piecemeal removal of sinonasal, laryngeal, oropharyngeal, and hypopharyngeal cancer shows that it did not compromise tumor control. The rationale for the evolution toward use of this technique is outlined.
  
  
  
  While complete resection with clear margins remains a key end point in surgical oncology, we believe it is time to acknowledge that this time-honored dictum of avoiding tumor violation is no longer valid in selected situations.
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield.
authors.forename: K Thomas
authors.initials: KT
authors.lastname: Robbins
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor.
authors.forename: Carol R
authors.initials: CR
authors.lastname: Bradford
authors.affiliation: Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain4Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, Oviedo, Spain.
authors.forename: Juan P
authors.initials: JP
authors.lastname: Rodrigo
authors.affiliation: Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, Oviedo, Spain5Fundación de Investigación e Innovación Biosanitaria del Principado de Asturias, Oviedo, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Suárez
authors.affiliation: Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Remco
authors.initials: R
authors.lastname: de Bree
authors.affiliation: Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, Sao Paulo, Brazil.
authors.forename: Luiz P
authors.initials: LP
authors.lastname: Kowalski
authors.affiliation: University of Udine School of Medicine, Udine, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Rinaldo
authors.affiliation: Department of Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York10Department of Otolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York.
authors.forename: Carl E
authors.initials: CE
authors.lastname: Silver
authors.affiliation: Professorial Unit, Ear Institute, University College London, London, United Kingdom.
authors.forename: Valerie J
authors.initials: VJ
authors.lastname: Lund
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Ken-Ichi
authors.initials: KI
authors.lastname: Nibu
authors.affiliation: Coordinator of the International Head and Neck Scientific Group.
authors.forename: Alfio
authors.initials: A
authors.lastname: Ferlito
mesh_terms: D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D013609:Taboo; D016896:Treatment Outcome