Head and Neck Surgery: Meeting the Needs of the 21st Century

SAN DIEGO-How can head and neck surgeons best meet the changing needs of patients and trainees in the 21st century? Where do they start, and will they be able to overcome tradition-induced inertia and natural objections to change?

These were among the issues addressed by Jesus E. Medina, MD, Chair of the Department of Otolaryngology at Oklahoma University Health Sciences Center (OUHSC), in the annual American Head and Neck Society’s Hayes Martin Lecture presented April 29 at the Combined Otolaryngology Spring Meetings. At the end of his presentation, Dr. Medina received a standing ovation for his comprehensive, thoughtful remarks and suggestions.

He began with a look at recent trends found in World Health Organization (WHO) databases covering 54 countries on five continents. He noted a decreasing trend in the incidence of cancer of the larynx in males and females and a similar statistically significant trend in the combined incidence of oral and oropharyngeal cancer. On the other hand, thyroid cancer is on the rise in males but decreasing in females. There has been a significant decrease in the incidence of melanoma in females, but an increase in males.

Based on these observations and on the recent downward trends in the global use of tobacco, he said, it is reasonable to anticipate that the future will bring fewer patients with squamous cell cancers of the upper aerodigestive tract and more patients with thyroid cancer and melanoma.

In addition to studying the WHO statistics, his colleagues in the Department of Statistics and Epidemiology at OUHSC analyzed data from the National Cancer Database, where they determined there is an increasing trend in the number of head and neck operations, which seem to be driven by a steep increase in the number of thyroidectomies.

Meanwhile, reports from the American Board of Otolaryngology and the American Head and Neck Society pointed to a slight upward trend in procedures performed by fellows and residents, although there is possibly the beginning of a downward trend (regarding residents) in the last two years, which merits keeping an eye on, Dr. Medina said.

Another important point to consider, Dr. Medina said, is the recommendations from multiple recent studies that quality cancer care ought to be provided in facilities by highly experienced surgeons with with large volumes of patients. With predictions that the head and neck surgeon workforce is decreasing, Dr. Medina said it is not unreasonable to anticipate that the surgical care of head cancer patients will increasingly be provided by fewer head and neck surgeons, mostly in centers recognized for their ability to provide excellent care.