Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_1029_Библиотеки_им_академика_М_И_Перельмана

General approach to the management of the head and neck cancer should be explained as most patients will very likely hear the words “tumor board,” “adjuvant therapy,” etc. for the rst time

Patients should be advised that once the neces­sary diagnostic information is available, their case will be discussed at a multidisciplinary head and neck tumor board, where a consensus treatment recommendation specic for the patient will be made. Explanation of peer-reviewed qual­ity practices such as tumor boards is likely to ease patient’s concerns about a sole decision maker given the life-changing choices that they will need to make [5]. Currently, head and neck cancer patient management relies on surgical interventions, radiation therapy, and/or chemo­therapy and immunotherapy. Patients should be educated that in some instances, they may be treated with surgery alone, or radiation therapy alone, or a combination of these modalities and addition of chemotherapy. The amount of infor­mation given to the patient may be overwhelm­ing; thus, breaking down the possible options into a nite number of solutions is likely to be helpful. Expressing to the patient that there are three treatment modalities with the most effective being surgery or radiation initially with addition of chemoradiation or chemotherapy/immuno­therapy, if necessary, conveys a clear message and helps patients have set expectations. Additionally, it alerts the patient that they will be navigating their cancer journey with various pro­viders during different phases. In those instances where surgery is the initial recommended approach, patients must be advised that need for adjuvant therapy, i.e., radiation and/or chemo, will be assessed after nal pathology evaluation is available. Explaining to the patient that cancer treatment is not a sprint race but a relay marathon where different phases of treatment are headed by different providers is essential in preparing them for a lengthy and often challenging journey.

and difculty identifying important anatomic landmarks render surgery also higher risk for iat­rogenic injury during dissection [9, 10]. Increased risk of intra-op difculties, post-op surgical site breakdown, infections, pharyngocutaneous and orocutaneous stulas, and need for additional surgical procedures should be emphasized. Despite postoperative course likely to be fraught with local wound complications, numerous stud­ies have demonstrated that overall free tissue transfer survival outcomes are comparable to non-radiated patients and are safe to perform [11–14]. Therefore, a realistic conversation of anticipated complicated post-op recovery is highly encouraged. Discussions about the possi­ble need for additional surgical procedure, pro­longed local wound care with various types of dressings, or negative-pressure wound VAC ther­apy should be made.