The evolving role of surgery in the management of head and neck tumors.

PURPOSE OF REVIEW: This paper reviews recent surgical contributions to the multidisciplinary approach to head and neck cancer treatment as well as published data on pertinent questions in the field.

RECENT FINDINGS: The role of surgery in the strategy of organ preservation via chemoradiation, including treatments of complications and locoregional recurrences, such as when N1-N3 necks should be operated on and the role of CT and positron emission tomography (PET) scanning. Also covered are the role of sentinel lymph node biopsy for the detection of occult micrometastases in the N0 neck and the value of fluorodeoxyglucose PET scanning combined with the former. Transoral laser surgery for tumors of the larynx or of the hypopharynx is discussed, as is a new technique of reconstruction involving the anterolateral thigh free flap. Also included are quality of swallowing after resections and reconstruction of the oral cavity and orpharyngeal tumors.

SUMMARY: Surgery must define its role in the multidisciplinary treatment of advanced cancers, which currently often favors (chemo)radiotherapy protocols. Organ sparing by transoral laser surgery for laryngeal and hypopharyngeal cancer has established itself within our armamentarium and its exact role will be further refined. Larger and well-executed studies on sentinel lymph node biopsy in the clinically negative neck are needed before this procedure can be implemented in our routines. The latest addition, the anterolateral thigh flap, to further decrease patients' morbidity is unlikely to completely replace the currently favored radial forearm flap in soft tissue replacement of the head and neck. Outcome analysis, including swallowing, is a major step that surgeons should further investigate.