Atlas of Head and Neck Cancer Surgery: The Compartment Surgery for Resection in 3-D

308 Pages·2015·61.64 MB·English

by  Nirav Trivedi

Nirav Trivedi
Atlas of
Head and Neck Cancer
Surgery
The Compartment Surgery
for Resection in 3-D
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Atlas of Head and Neck Cancer Surgery

Nirav Trivedi
Atlas of Head and Neck
Cancer Surgery
The Compartment Surgery
for Resection in 3-D
Nirav Trivedi
Narayana Hridayalaya Multispeciality
Bangalore
India
ISBN 978-81-322-2049-7 ISBN 978-81-322-2050-3 (eBook)
DOI 10.1007/978-81-322-2050-3
Springer New Delhi Heidelberg Dordrecht London New York
Library of Congress Control Number: 2014956272
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Patients Who Suffer From Cancer
Teachers & Colleagues
Parents and Family Whom I Owe Everything
&
To My Loving Wife Nirali and Daughters Anvi and Stuti

Foreword
I have had the privilege and honor of reviewing the book “Atlas for Head and Neck Cancer
Surgery – The Compartment Surgery for Resection in 3-D” written and edited by Dr. Nirav P
Trivedi. Head and neck cancer is increasing worldwide, representing an important cause of
morbidity, mortality, pain, suffering, and use of resources. Few cancers can match such a dis-
turbing and unfortunate interruption to life.
T his is a surgical atlas that essentially covers an entire spectrum of open head and neck
cancer surgeries. Each section deals with different subsites and focuses on each aspect of abla-
tive and reconstructive surgery. This is a pictorial book where text is kept to a minimum and all
the procedures are demonstrated with series of photographs. This gives an impression of actu-
ally watching an edited video of procedures, and I am sure that readers will fi nd this experience
satisfying. The atlas contains few chapters (surgery for very advanced cancer, surgery in
resource-constrained setup) that are completely new and relevant to our clinical practice. The
chapter of infratemporal fossa provides clear insight to a diffi cult area, and the new classifi ca-
tion and detailed surgical procedure have a great potential for treating such patients. The pho-
tographs are of high quality, very clean, detailed, and systemically arranged.
The basic concept in surgical management of malignant soft tissue tumor is complete en
bloc removal of primary tumor with microscopically negative margins. This means removal of
primary tumor without visualizing the tumor during the surgical excision by keeping some
normal soft tissue all around the tumor. This book’s author has conceptualized and practiced
the same principle in head and neck cancers. He has coined the word “3-D resection” for the
same and proposed a concept of surgical removal of tumor by excising the entire anatomical
compartment. This surgical principle to operate exclusively within the normal tissues is to my
mind quite unique, innovative, radical, logical, appealing, and most effective in eradicating the
disease locally. This concept is also effective for surgically diffi cult areas like infratemporal
fossa and skull base, and I am very impressed with such an approach to remove soft tissues in
depth.
Overall, I believe the readers, i.e., both veterans as well as those getting introduced to this
specialty as beginners, will fi nd this monogram an easy read. This is an excellent immediate
resource of comprehensive, authoritative, well-organized and cleverly written information
backed by excellent photographs. The “compartment surgery for resection in 3-D” certainly
meets these criteria and is a meaningful work.
Mehsana, India Pravin H. Trivedi
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Foreword
A lthough there are specifi c roles for chemoradiotherapy in the overall management of head
and neck cancer, the treatment modality that has an overarching bearing in the comprehensive
management of head and neck cancer is surgery. It plays a critical role in diagnosis, defi nitive
and salvage treatment, as well as reconstruction and rehabilitation. The discipline of surgery,
which is the oldest cancer treatment modality, also has undergone tremendous changes in the
recent past: moving from a Halstedian philosophy of “supraradical” to conservative surgery to
the present concept of “selective-radical” approach. It is important to recognize that basic sur-
gical principles laid out by William Halsted over a century ago remain the hallmark of surgery
even today. That includes (1) gentle handling of tissue, (2) meticulous hemostasis, (3) preser-
vation of blood supply, (4) strict aseptic technique, (5) minimum tension on tissues, (6) accu-
rate tissue apposition, and (7) obliteration of dead space. In oncology surgery, one needs to add
the additional fundamental principle of obtaining resection with uninvolved margin. An onco-
logical resection with positive margin cannot be considered more than a “grand biopsy.” The
principle of obtaining R0 resection cannot be violated. The use of induction chemotherapy
prior to surgery to downstage the cancer and the overdependency of chemo-radiotherapy to
manage positive surgical margin has not improved the oncological outcome over traditional
surgery with uninvolved margin and appropriate adjuvant treatment. Moreover, there are
emerging reports to suggest that the surgical ablation following compartmental resection can
have improved outcomes.
D r. Trivedi has to be congratulated for brining out a practical manual that outlines step-by-
step principles of head and neck surgical procedures. This should serve as an important refer-
ence for head and neck surgeons from trainees to practicing surgeons. He has standardized the
common surgical procedures to well-defi ned steps so that the surgeons do not have to invent a
“new technique” but rather follow a proven series of steps that will give predictable results.
The surgical procedures once performed in the “operation theater” as an artistic endeavor
when the procedure needs to be discovered and improvised is no longer valid. Each surgical
procedure can now be considered as a process where one undertakes procedures following
well-defi ned steps, similar to fl ying an airplane by a well-trained pilot. In this respect, Dr.
Trivedi’s “surgical manual” may serve similar to the “fl ight manual” for head and neck sur-
geons. Once again, I would like to congratulate Dr. Trivedi for simplifying and demystifying
head and neck surgery. I am very confi dent that this book will bring in the much-needed stan-
dardization of surgical procedures with long-term goals of embracing a mastery of head and
neck surgery by many and improving the outcome of head and neck cancer.

Bangalore , India Moni Abraham Kuriakose , MD, FRCS, FDSRCS,
FFDRCS, Dip AB

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