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October 2016

Removing the Taboo on the Surgical Violation (Cut-Through) of Cancer

Author Affiliations
  • 1Division of Otolaryngology–Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield
  • 2Department of Otolaryngology–Head and Neck Surgery, University of Michigan Health System, Ann Arbor
  • 3Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
  • 4Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, Oviedo, Spain
  • 5Fundación de Investigación e Innovación Biosanitaria del Principado de Asturias, Oviedo, Spain
  • 6Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands
  • 7Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, Sao Paulo, Brazil
  • 8University of Udine School of Medicine, Udine, Italy
  • 9Department of Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
  • 10Department of Otolaryngology–Head and Neck Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
  • 11Professorial Unit, Ear Institute, University College London, London, United Kingdom
  • 12Department of Otolaryngology–Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
  • 13Coordinator of the International Head and Neck Scientific Group
JAMA Otolaryngol Head Neck Surg. 2016;142(10):1010-1013. doi:10.1001/jamaoto.2016.1826

Importance  The surgical dictum of en bloc resection without violating cancer tissue has been challenged by novel treatments in head and neck cancer.

Observations  An analysis of treatment outcomes involving piecemeal removal of sinonasal, laryngeal, oropharyngeal, and hypopharyngeal cancer shows that it did not compromise tumor control. The rationale for the evolution toward use of this technique is outlined.

Conclusions and Relevance  While complete resection with clear margins remains a key end point in surgical oncology, we believe it is time to acknowledge that this time-honored dictum of avoiding tumor violation is no longer valid in selected situations.

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    1 Comment for this article
    Luiz R. Medina dos Santos, MD, PhD | Oncologic Research Center - Florianopolis - SC - Brazil
    This is a very important change of paradigm and evolution, that will contribute for treatment of our cancer patients.