Role of surgery in the management of head and neck cancer: a contemporary view of the data in the era of organ preservation

Objective: Review of the literature on the role of surgery in the management of head and neck cancer in the era of organ preservation. Method: Literature search based on the essential practice guidelines set out by the US National Comprehensive Cancer Network. Results: Despite the increasing popularity of non-surgical treatment options, the surgeon remains a key figure in the multidisciplinary head and neck cancer team, along with the radiation oncologist, the medical oncologist and the speech and swallowing therapist. Even when organ preservation is successful, early and late toxicity may cause serious complications, including laryngeal dysfunction with a 'frozen larynx'. When organ preservation fails, salvage surgery is often associated with increased complications and reduced survival. Conclusion: There is a definite need to apply more rigorous standards to the use of organ preservation strategies, and to re-evaluate the role of surgery in head and neck cancer treatment.