Oncological surgery is one of the most important branches of Plastic and Reconstructive Surgery, focusing on the management of neoplastic disease. This field explores ways that can lead to the treatment and cure of cancer when feasible.
The practice of oncological surgery is based on two pillars: identification and staging. First, an accurate diagnosis of the nature of the neoplasm is performed. Then the location, extent, and stage of the disease are evaluated. The treatment can be surgical, radiation, chemotherapy, and/or targeted therapy.
Cervical lymphadenectomy is indicated for patients with positive lymph nodes and for cancers with a high risk of regional spread.
Where Head and Neck Cancer Occurs
Head and neck cancers occur in two general areas:
- Those located on the skin of the head, such as the scalp (especially when hair is sparse), nose, upper and lower lip, cheeks, and ears—in areas that are constantly exposed to the sun.
- Those located in the upper airways and upper digestive tract (UADT), including the nasopharynx (the area where the nasal cavity connects with the upper part of the throat), the oral cavity (extending from the lips to the first two-thirds of the tongue, including the roof, floor, and sides), and the oropharynx (the area where the oral cavity connects with the pharynx, hypopharynx, and larynx). This category also includes cancers of the salivary glands.
The two primary causes implicated in these cancers are alcohol and tobacco use. In recent years, HPV (human papillomavirus) has increasingly become a predisposing factor as well.
Head and neck cancers account for approximately 4% of all malignancies worldwide. They occur most frequently in the oral cavity, making up 41% of head and neck cancers, followed by cancers of the pharynx and larynx, accounting for 22% and 24%, respectively.
The main skin cancer types are basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and malignant melanoma (MM). Meanwhile, cancers arising in the upper airways and the upper gastrointestinal tract (UADT) are 95% squamous cell carcinomas (SCC), salivary gland cancers, sarcomas, mucosal melanomas, and lymphomas.
Therapeutic Intervention – Oncological Surgery
Depending on the location, type, and extent of the cancer, as well as other characteristics, possible metastases, or the patient’s overall health, the surgical approach is determined accordingly.
For initial treatment of carcinomas, surgical therapy and radiotherapy are most commonly used. In modern Plastic and Reconstructive Surgery, microsurgery provides extraordinary capabilities. Microsurgical interventions are now routinely applied to treat problems across the entire range of reconstructive surgeries.
The goal of treatment is to remove the tumor, preserve the functionality of adjacent tissue, and achieve satisfactory cosmetic outcomes. Skin defects on the face following the surgical excision of tumors or benign lesions that cannot be closed primarily require special plastic reconstruction. Here, the role of a specialized Plastic and Reconstructive Surgeon is vital for achieving an effective solution.
Use of Free Flaps
The most common technique providing a high success rate is the use of free flaps (composite or simple) for the reconstruction of large craniofacial defects following oncological excisions. The placement and survival of the free flap in its new site are ensured by restoring blood circulation, i.e., connecting the flap’s vessels to nearby vessels using specialized microsurgical techniques. In some cases, the flap is transferred along with its sensory or motor nerve, and this is connected to a corresponding nerve at the recipient site. Such a procedure is challenging and requires collaboration between medical professionals from different disciplines.
Head and neck cancers necessitate multidisciplinary team meetings due to the disease’s complexity, making it a prime example of an interdisciplinary approach. Because these tumors occur in areas affecting vital functions such as breathing, swallowing, and speech, combined therapeutic approaches across multiple medical specialties are often required. The goal is to recommend, select, and implement the best treatments for the patient, achieving the best possible outcome.
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Remember, modern plastic and reconstructive surgery can make a difference in the outcomes of complex oncological surgeries that were once considered impossible. Today, with advanced surgical techniques available, we can be hopeful for a successful recovery and quality of life for our patients.
References
- Thariat J, Simon C, Dassonville O, Poissonnet G, Chamorey E, Bozec A. (2024). Reconstructive flap surgery in head and neck cancer patients. Journal of Reconstructive Microsurgery, 40(3):191-200.
https://pmc.ncbi.nlm.nih.gov/articles/PMC11043495/ - Mark M, Subramanian R, O’Hara J, Paleri V. (2022). Designing an evidence-based free-flap pathway in head and neck cancer. World Journal of Otorhinolaryngology – Head and Neck Surgery, 8(4):278-285.
https://pmc.ncbi.nlm.nih.gov/articles/PMC9242419/ - Xu H, Zhang W, Wang Y, Li D, Liu F. (2024). Combination of radiotherapy and flap reconstruction for head and neck tumors. Molecular and Clinical Oncology, 20(5):150.
https://www.spandidos-publications.com/10.3892/mco.2024.2732
