The sixth most common type of cancer, head and neck cancer carries with it troubling side effects from treating tumors in the mouth, throat, larynx, sinuses, lymph nodes, salivary glands, and thyroid gland. Preserving patients’ quality of life and minimizing side effects using a variety of tools and technologies are primary goals of Duke Cancer Institute's (DCI) Head and Neck Cancer program.
Walter T. Lee, MD, MHS, head and neck surgeon and co-director of DCI’s Head and Neck Cancer Program, says Duke specialists are particularly thoughtful about what treatment is best for each individual patient.
“Some centers are known for their expertise with a certain treatment and favor certain therapies for everyone. But we collectively seek therapies in terms of quality of life, not just treating the disease,” he says. “We could have two patients with exactly the same cancer, but we might treat them differently because quality of life means different things to different people.”
The newest surgical option for Duke patients is the da Vinci SP® Single Port Surgical System (Intuitive Surgical, Sunnyvale, CA), recently approved by the FDA for robotic-assisted resection of oropharyngeal, hypopharyngeal, and laryngeal T1 and T2 tumors, and benign base-of-tongue resection. Duke University Hospital was the first hospital in the Carolinas and remains one of only a few in the Southeast region with the system, which provides improved visualization and retraction over previous systems and has multijointed instruments for improved dexterity in tight surgical spaces—making it ideal for accessing tumors through the mouth.
Lee and colleague Russel Kahmke, MD, MMCi, head and neck surgeon, underwent extensive training for the robotic-assisted procedure and are the only two head and neck surgeons in the region currently using the system. “It’s an exciting opportunity to offer this technology to our patients; if we can safely impact tangible aspects of care—like reduce their time in the hospital or improve their swallowing after surgery—then I think we’re truly at the forefront of surgical innovation,” says Kahmke.
“This system has been a game-changer in terms of improving access and providing better instrumentation to do what we do,” says Lee, who has already performed several surgeries with the single-port system, including the removal of a tumor at the base of a patient’s tongue. “Getting access to that tumor in the traditional way would have been challenging because the tumor was so far down and visualization would likely have been compromised, but using the SP system helped us to remove it with negative margins.”
Robotic-assisted surgery is not new for Lee and Kahmke, who have been performing it for years. What’s new, Lee says, is understanding new ways to use whatever the most current technology is: “We have more surgical options than we’ve ever had, and we carefully consider the best option for each patient.” For example, the best option for a patient with advanced-stage head and neck cancer might be a combination of intensive radiation therapy and simultaneous chemotherapy, which could result in better function and more tolerable side effects than surgery.
“The robot is a great tool, but having a team of people who are trained to care for complex neck cases with different sets of tools is more important than any single technology,” Lee says. We have experience with multiple tools, multiple specialties, and a multidisciplinary team to help patients achieve the best outcomes possible, regardless of which tools we use.”