How my philosophy has changed over the past two decades

Abstract

In the sixties and the seventies, the optimal surgical treatment for advanced cancer in the head and neck region was radical surgery followed by radiotherapy. The concept of surgical treatment was wide exposure of the primary pathology followed by radical resection of the tumour. Metastatic neck disease was managed invariably with radical neck dissection. Thus the standard treatment for advanced oral cavity cancer was the commando operation and for most patients with hypopharyngeal cancer, pharyngolaryngo-oesophagectomy and gastric pull-up procedure was done. Although these extensive procedures eradicated the cancer for many patients, the operative mortality was significant. More importantly, the associated morbidity, aesthetically and functionally contributed to the poor quality of life among those patients who survived the operation. In the recent two decades, with the more effective chemotherapy and radiotherapy, many patients with advanced head and neck cancer could be managed successfully with preservation of the organ. The various studies on the behaviour of the primary tumour and their metastatic pattern also guided us to carry out less extensive resections while producing similar tumour clearance. Even when radical resection has to be performed; we can employ the less invasive approaches. This together with the more effective reconstruction and better perioperative support have greatly reduced the mortality, morbidity of patients. This changing philosophy of performing less extensive procedure more effectively and achieve better results, is based on our understanding of the disease and the technological development. These contribute towards better form and functional outcome for our patients.