Voice Box Preserving Surgery Technique
Dear OncoLink "Ask the Experts,"
How can one be certain that his surgeon is familiar with the voice box preserving surgery technique?
Gregory S. Weinstein, MD, FACS, Founding Member and Associate Director of the center for Head and Neck Cancer, at the University of Pennsylvania Medical Center, responds:
Simply put, you can never really know the expertise of your surgeon with certainty. However, there are some indicators, which may point you in the right direction. Firstly, ask the surgeon if they have the expertise and how they attained that expertise. For instance how many patients do they see with voice box cancer per year? You might also ask them if they are not only familiar with laser techniques, and the older vertical hemilaryngectomy and supraglottic laryngectomy, but also the newer supracricoid partial laryngectomy. Secondly, do a literature search on the internet, in particular, utilizing a search engine such as PubMed. See who is writing about surgical treatment of laryngeal cancer in the medical literature. Although, this does not guarantee surgical expertise, it may point you in the right direction. If you are not capable of doing this search yourself, ask your family doctor to do it, or perhaps his/her nurse practitioner.
While not every head and neck surgeon has special expertise in organ preservation surgery techniques, most cities around the country have individual surgeons who practice the full spectrum of organ preservation surgery techniques. The key is that you want to be with a surgeon who has the expertise not only with the full spectrum of open and endoscopic organ preservation surgery, but who also knows the appropriate indications for radiation therapy and chemotherapy. Although many times radiation with or without chemotherapy is the optimal treatment for a particular situation, it should not simply be recommended because the team that is assessing the patient lacks the expertise to offer organ preservation surgery. So the most important point is that the patient be with a head and neck oncology team that is able to offer the best treatment for their laryngeal cancer, including a surgeon with special expertise in the full spectrum of organ preservation surgery techniques as well as experienced chemotherapists and radiation therapists.
So in a nutshell, get some help from your family doctor, or the otolaryngologist (head and neck surgeon) that diagnosed the cancer, and make sure they send you to a physician who is part of team that has the expertise in the full gamut of surgical and non-surgical organ preservation approaches. Frankly, if that means traveling to a nearby city or even across the country to obtain an opinion, you may need to do it.