Background and Context:
Surgical management of head and neck malignancies in a low resource setting has become increasingly challenging with the advancement in the scope of surgical resections, reconstructive techniques and advent of nonsurgical organ preservation strategies. Thanks to the UICC's ICRETT programme the author and colleagues have been able to systematically update the surgical expertise at Regional Cancer Centre (RCC) Trivandrum,India
To prospectively study the service delivery of 4 distinct expertise acquired by the author with 3 ICRETT programs over a decade at the RCC.
Consecutive cases of head and neck ablative surgery and microvascular reconstructions at the RCC from October 2004 onwards were prospectively studied for the flap viability, cosmesis, function (speech and swallowing) and locoregional recurrence (Group 1). Patients who had laryngectomy or laryngopharyngectomy from January, 2006 onwards were prospectively studied for morbidity,tumor recurrence,voice preservation and rehabilitation and survival.( group 2). A prospective audit of CO2 laser ablation ( group 3) and endonasal approaches to skull base(group 4) was also under taken from August 2006 and March 2011 respectively.
Programme/Policy Process:Judicious case selection,liberal use of conventional reconstructive techniques and optimal use of reconstructive microsurgery has enhanced our outcomes of Head and Neck surgeries over the past decade.
Outcomes/What was learned:
Fifty accrued patients in group 1 and one fifty four patients in group 2, 35 in group 3 and 10 in group 4 were studied. With the current recruitment strategy a flap success rate of 80% was observed in group 1 and survival figures matched the international standards in group1, 2,3 &4 with an overall improvement in voice preservation and voice rehabilitation in group 2.There is a trend towards superior overall laryngeal preservation rate in early glottic cancers and better cosmetic outcomes in early oral cancers when co2 laser is used judiciously.