The Next Generation of Head and Neck Surgeons: Opportunities and Challenges
Mark E. Zafereo, MD Chair, Section for Residents and Fellows MD Anderson, Houston The early 21st century represents an exciting time to train in the art and science of head and neck surgery. While the incidence of tobacco-associated head and neck cancers continues to decrease, increasing incidence of other head and neck malignancies, including thyroid carcinoma, non-melanoma and melanoma cutaneous malignancies, and HPV-associated oropharyngeal squamous cell carcinoma, present new challenges in patient care and research. Treatment strategies for mucosal head and neck malignancies over the last half century have largely shifted from surgery to radiation and chemotherapy, but despite advances in treatment, mortality from mucosal head and neck cancer remains unchanged. Surgical innovation in head and neck surgery during the 1980s and 1990s came largely from advances in microvascular reconstructive techniques.1 But overall surgical innovation has declined over the last several decades.2 This may be changing as endoscopic head and neck surgery, including minimally invasive and robotic surgery, has emerged as an important new aspect within the specialty during the past five years.3 These novel technologies and innovative techniques must be examined in the context of rising healthcare costs and perhaps the future prospect of limited healthcare dollars to care for each individual patient. In the midst of this excitement about surgical innovation in head and neck surgical oncology is a recent increase in applicants to head and neck surgery fellowships, following a decline in the late 1990s. Head and neck surgery fellowships in the United States are generally one to three years and offer a variety of combinations of ablative surgery, reconstructive surgery, and research. Within the future of the specialty, there remains a role for the ablative surgeon, the reconstructive surgeon, and the scientist. The term “scientist” includes those who: develop basic sciences; translate basic sciences into clinical applications; study epidemiology of disease; study outcomes and develop quality improvement measures; study the cost effectiveness of medicine within a societal context; and develop and implement clinical trials. Head and neck surgeons have developed successful careers with many combinations of these clinical and research interests. An important aspect of discovery in clinical and translational research is enrollment in clinical trials. Less than 5 percent of cancer patients nationally participate in clinical trials. As care of the head and neck cancer patient continues to shift to regional and tertiary care centers where patients can be availed of the expertise of multidisciplinary teams and clinical trials, both individual patients and society will benefit in terms of cost effectiveness, greater discovery, and more specialized care. The role of the head and neck surgeon within the house of medicine continues to evolve. The head and neck surgeon of the future will be enhanced by the wisdom and accomplishments of an older generation, coupled with the enthusiasm and ideas of a younger generation. Important aspects of fellowship in head and neck surgery include not only learning surgical techniques, but perhaps more importantly, learning surgical decision-making and multidisciplinary care. There are roles for many different types of head and neck surgeons, but they should remain leaders in the field of surgical oncology, understanding and coordinating multidisciplinary care for their patients. Through a combination of discovery in the basic sciences, translational research, surgical innovation, and leadership in multidisciplinary care, it is hoped that the next generation of head and neck surgeons can continue to “stand tall on the shoulders of giants.” References Gilbert, RW. Innovation in the surgical management of head and neck tumors. Hematol Oncol Clin North Am. 2008 Dec;22(6):1181-91. Rosow DE, Likhterov I, Stewart MG, April MM. Reduction in surgical innovation, 1988 to 2006. Otolaryngology Head Neck Surg. 2009;140:657-60. Holsinger FC, Sweeney AD, Jantharapattana AS, Weber RS, Chung WY, Lewis DM, Grant DG. The emergence of endoscopic head and neck surgery. Curr Oncol Rep. 2010;12:216-22.
Chair, Section for Residents and Fellows
MD Anderson, Houston
The early 21st century represents an exciting time to train in the art and science of head and neck surgery. While the incidence of tobacco-associated head and neck cancers continues to decrease, increasing incidence of other head and neck malignancies, including thyroid carcinoma, non-melanoma and melanoma cutaneous malignancies, and HPV-associated oropharyngeal squamous cell carcinoma, present new challenges in patient care and research. Treatment strategies for mucosal head and neck malignancies over the last half century have largely shifted from surgery to radiation and chemotherapy, but despite advances in treatment, mortality from mucosal head and neck cancer remains unchanged.
Surgical innovation in head and neck surgery during the 1980s and 1990s came largely from advances in microvascular reconstructive techniques.1 But overall surgical innovation has declined over the last several decades.2 This may be changing as endoscopic head and neck surgery, including minimally invasive and robotic surgery, has emerged as an important new aspect within the specialty during the past five years.3 These novel technologies and innovative techniques must be examined in the context of rising healthcare costs and perhaps the future prospect of limited healthcare dollars to care for each individual patient.
In the midst of this excitement about surgical innovation in head and neck surgical oncology is a recent increase in applicants to head and neck surgery fellowships, following a decline in the late 1990s. Head and neck surgery fellowships in the United States are generally one to three years and offer a variety of combinations of ablative surgery, reconstructive surgery, and research. Within the future of the specialty, there remains a role for the ablative surgeon, the reconstructive surgeon, and the scientist. The term “scientist” includes those who:
- develop basic sciences;
- translate basic sciences into clinical applications;
- study epidemiology of disease;
- study outcomes and develop quality improvement measures;
- study the cost effectiveness of medicine within a societal context; and
- develop and implement clinical trials.
Head and neck surgeons have developed successful careers with many combinations of these clinical and research interests. An important aspect of discovery in clinical and translational research is enrollment in clinical trials. Less than 5 percent of cancer patients nationally participate in clinical trials. As care of the head and neck cancer patient continues to shift to regional and tertiary care centers where patients can be availed of the expertise of multidisciplinary teams and clinical trials, both individual patients and society will benefit in terms of cost effectiveness, greater discovery, and more specialized care.
The role of the head and neck surgeon within the house of medicine continues to evolve. The head and neck surgeon of the future will be enhanced by the wisdom and accomplishments of an older generation, coupled with the enthusiasm and ideas of a younger generation. Important aspects of fellowship in head and neck surgery include not only learning surgical techniques, but perhaps more importantly, learning surgical decision-making and multidisciplinary care. There are roles for many different types of head and neck surgeons, but they should remain leaders in the field of surgical oncology, understanding and coordinating multidisciplinary care for their patients. Through a combination of discovery in the basic sciences, translational research, surgical innovation, and leadership in multidisciplinary care, it is hoped that the next generation of head and neck surgeons can continue to “stand tall on the shoulders of giants.”
References
- Gilbert, RW. Innovation in the surgical management of head and neck tumors. Hematol Oncol Clin North Am. 2008 Dec;22(6):1181-91.
- Rosow DE, Likhterov I, Stewart MG, April MM. Reduction in surgical innovation, 1988 to 2006. Otolaryngology Head Neck Surg. 2009;140:657-60.
- Holsinger FC, Sweeney AD, Jantharapattana AS, Weber RS, Chung WY, Lewis DM, Grant DG. The emergence of endoscopic head and neck surgery. Curr Oncol Rep. 2010;12:216-22.