Role of surgery in head and neck palliation

Abstract

The aim of management of head and neck cancer is the eradication of tumour while at the same time restoring form and function for the patient. This is not always possible, especially when the patient presents with advanced stage disease. Surgery however still contributes to the palliation of symptoms under some situations. Palliative surgical resection of the primary pathology with close margins might be carried out to relief the symptoms of dysphagia and airway obstruction. With the appropriate reconstruction and other adjuvant therapy, the duration of symptom-free period achieved could be significant. Tracheostomy could be performed to bypass airway obstruction or to decrease aspiration. Vascular reconstruction could be carried out to create access for intraarterial chemotherapy for non-resectable tumour. Significant palliation might be achieved for some tumours. When a non-resectable and fungating tumour starts bleeding, the tumour mass could be removed and the raw area covered with a flap to reduce discharge and further bleeding. Sometimes debulking surgery is done to reduce the deformity and restore dignity for these unfortunate patients. In contrast with other malignancies, patients with advanced head and neck cancer frequently have a clear understanding of their disease. Their suffering physically and psychologically are sometimes much more than other patients with advanced cancer. Surgery should be carried out whenever appropriate to reduce their symptoms.