Integrated minimally invasive treatments in head and neck oncology: indications, perspectives and functional outcomes| ACTA Otorhinolaryngologica Italica

Article

Otolaryngology is a discipline concerned with diagnosing and treating a vast number of pathologies affecting anatomical structures responsible for vital functions. The pathologies treated are both functional and oncologic. The latter can affect all anatomical areas of otolaryngological relevance. In the treatment of the aforementioned pathology, the interaction between professional figures belonging to different medical specialties is fundamental. These figures provide their specific expertise in a given field, therefore allow a multidisciplinary framing of the clinical case and the creation of a personalised treatment plan for each patient. As part of the multidisciplinary approach to oncologic pathology, the role of the otolaryngologist is to provide surgical treatment. This, along with medical therapy, is the cornerstone of the modern treatment pathway for cancer. The fundamental goal of oncologic surgery, when practicable, was, and always will remain, to achieve complete removal of the neoplasm. Indeed, oncologic radicality represents the main target to be pursued in order to allow the patient to be cured, with the possible aid of integrated therapies. With progress in this field, attention has increasingly focused on flanking oncologic radicality with adequate function of the organs undergoing surgical treatment. This is crucial in a district that holds such complex functions (breathing, phonation, swallowing, hearing) that are fundamental for the patient’s quality of life. For example, during the second half of the last century, the classic total laryngectomy for treatment of laryngeal carcinoma has been partially substituted by partial laryngectomies, which in addition to achieving complete removal of the neoplasm, allow the patient to preserve the main functions of the larynx (phonation, oro-nasal respiration). This example is complemented by various innovations concerning all areas of our discipline (radiotherapy in the treatment of sinonasal tumours, electrochemotherapy in the treatment of superficial neoplasms of the head and neck areas, reconstructive surgery with pedicled and free flaps following demolitive oncological procedures, specific surgical approaches for hearing preservation in the field of otoneurosurgery). Advances in science and technology in recent years, however, pursue also an adequate outcome from an aesthetic point of view, in addition to oncologic radicality and functionality. In fact, the study and application of integrated minimally-invasive approaches to neoplasms of the head and neck is under great development. Such approaches, made possible by new technologies in the medical-surgical field and supported by a multidisciplinary appoach, allow the cancer patient to receive radical treatment, but with a focus on functional and aesthetic aspects. In fact, patients undergoing minimally-invasive treatments do not have noticeable scarring, an inevitable consequence of traditional “open” surgeries, have, in addition, a shorter post-operative course and preserve, in almost all cases, all organ functions.

The objective of the SIO Official Report 2024 is to bring together in a single issue the latest innovations in the field of minimally invasive integrated treatments in head and neck oncology, thanks to the experience and research of the most representative Italian centres, with the aim of informing all specialists about the latest innovations in the field of oncological treatments and with the awareness that the rapid technological progress will, in few years, bring further innovations that will guarantee the patient a more targeted and tolerable therapeutic approach. Finally, with much gratitude, I extend my heartfelt thanks to all the professionals who collaborated with commitment, dedication and expertise in the drafting of the SIO Official Report 2024, and made it possible to produce a comprehensive and up-to-date scientific work.

Michele Barbara