The Multidisciplinary Team in Head and Neck Cancer Reconstruction: A Reference Manual for the Plastic Surgeon

Benjamin D. W. Belfort; Winston R. Owens; Olivia G. Leonovicz; Amjed Abu-Ghname; Josephine L. Schmidt; Edward P. Buchanan; Amy S. Xue

doi:10.1055/s-0045-1808273

Seminars in Plastic Surgery, Inhaltsverzeichnis

Semin Plast Surg 2025; 39(02): 103-112
DOI: 10.1055/s-0045-1808273

Review Article

The Multidisciplinary Team in Head and Neck Cancer Reconstruction: A Reference Manual for the Plastic Surgeon

Benjamin D. W. Belfort

¹Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas

²Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas

³Medical Scientist Training Program, Baylor College of Medicine, Houston, Texas

,

Winston R. Owens

¹Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas

²Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas

,

Olivia G. Leonovicz

¹Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas

²Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas

,

Amjed Abu-Ghname

¹Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas

²Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas

,

Josephine L. Schmidt

¹Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas

²Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas

,

Edward P. Buchanan

¹Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas

²Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas

,

Amy S. Xue

¹Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas

²Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas

› Institutsangaben

Abstract

Head and neck cancers (HNCs) require a multidisciplinary team (MDT) approach to address their complex functional, aesthetic, and psychological impacts. This manuscript highlights the central role of plastic surgeons in the MDT, emphasizing their collaboration with other MDT members to align aesthetic and functional surgical outcomes with oncologic and rehabilitative goals. Our intention is for this to be used as a practical guide for plastic surgeons detailing the roles of key MDT members and their contributions across the preoperative, intraoperative, and postoperative phases. We will also highlight how MDTs improve survival, functional outcomes, and quality of life for HNC patients.

Keywords

multidisciplinary teams - head and neck cancer - reconstructive - surgery - free-flap repair

Volltext

Referenzen

References
1 Bray F, Laversanne M, Sung H. et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2024; 74 (03) 229-263
2 Siegel RL, Kratzer TB, Giaquinto AN, Sung H, Jemal A. Cancer statistics, 2025. CA Cancer J Clin 2025; 75 (01) 10-45
3 Semple C, Parahoo K, Norman A, McCaughan E, Humphris G, Mills M. Psychosocial interventions for patients with head and neck cancer. Cochrane Database Syst Rev 2013; 2013 (07) CD009441
4 Licitra L, Keilholz U, Tahara M. et al. Evaluation of the benefit and use of multidisciplinary teams in the treatment of head and neck cancer. Oral Oncol 2016; 59: 73-79
5 Hosemann W, Schroeder HWS. Comprehensive review on rhino-neurosurgery. GMS Curr Top Otorhinolaryngol Head Neck Surg 2015; 14: Doc01
6 Iwami K, Fujii M, Nishio N. et al. Skull base invasion patterns of malignant head and neck tumors: a neurosurgical perspective. J Neurol Surg B Skull Base 2021; 82 (Suppl. 03) e120-e130
7 Samara L, Alobid I, Enseñat J, De Notaris M, Bernal-Sprekelsen M. Neurosurgeon-otolaryngologist collaboration in endonasal approaches to the clivus and suprasellar region. B-ENT 2011; 7 (Suppl. 17) 33-39
8 Scholfield DW, Levyn H, Tabar VS, Ganly I, Della Rocca D, Cohen MA. The medial transorbital approach in cranioendoscopic skull base tumor resections for locally advanced tumors. J Clin Neurosci 2024; 119: 198-204
9 Amin AAW, Bassiouny M, Elsebai H. et al. Fasciocutaneous free flaps for hypopharyngeal reconstruction. J Reconstr Microsurg 2002; 18 (01) 1-5
10 Barzin A, Norton JA, Whyte R, Lee GK. Supercharged jejunum flap for total esophageal reconstruction: single-surgeon 3-year experience and outcomes analysis. Plast Reconstr Surg 2011; 127 (01) 173-180
11 Mays AC, Yu P, Hofstetter W. et al. The supercharged pedicled jejunal flap for total esophageal reconstruction: a retrospective review of 100 cases. Plast Reconstr Surg 2019; 144 (05) 1171-1180
12 Simon C, Nicolai P, Paderno A, Dietz A. Best practice in surgical treatment of malignant head and neck tumors. Front Oncol 2020; 10: 140
13 Dort JC, Farwell DG, Findlay M. et al. Optimal perioperative care in major head and neck cancer surgery with free flap reconstruction: a consensus review and recommendations from the enhanced recovery after surgery society. JAMA Otolaryngol Head Neck Surg 2017; 143 (03) 292-303
14 Bertazzoni G, Testa G, Tomasoni M. et al. The Enhanced Recovery After Surgery (ERAS) protocol in head and neck cancer: a matched-pair analysis. Acta Otorhinolaryngol Ital 2022; 42 (04) 325-333
15 Hung TKW, Gelblum DY, Kuwada CA. et al. Virtual tumor board to foster interinstitutional head and neck cancer subspecialty care. JAMA Otolaryngol Head Neck Surg 2023; 149 (12) 1153-1154
16 Thiagarajan S, Poojari V, Tuljapurkar V. et al. National cancer grid virtual tumor boards of head and neck cancers: an innovative approach to multidisciplinary care. JCO Glob Oncol 2023; 9 (09) e2200348
17 Tumuluri V, Leinkram D, Froggatt C. et al. Outcomes of immediate dental implants in vascularised bone flaps for mandibular reconstruction. ANZ J Surg 2023; 93 (06) 1682-1687
18 Thiem DGE, Siegberg F, Vinayahalingam S. et al. The perfect timing-immediate versus delayed microvascular reconstruction of the mandible. Cancers (Basel) 2024; 16 (05) 974
19 Shugaa-Addin B, Al-Shamiri HM, Al-Maweri S, Tarakji B. The effect of radiotherapy on survival of dental implants in head and neck cancer patients. J Clin Exp Dent 2016; 8 (02) e194-e200
20 Shokouhi B, Cerajewska T. Radiotherapy and the survival of dental implants: a systematic review. Br J Oral Maxillofac Surg 2022; 60 (04) 422-429
21 Cohen EEW, Bell RB, Bifulco CB. et al. The Society for Immunotherapy of Cancer consensus statement on immunotherapy for the treatment of squamous cell carcinoma of the head and neck (HNSCC). J Immunother Cancer 2019; 7 (01) 184
22 Valentini V, Boldrini L, Mariani S, Massaccesi M. Role of radiation oncology in modern multidisciplinary cancer treatment. Mol Oncol 2020; 14 (07) 1431-1441
23 Anderson G, Ebadi M, Vo K, Novak J, Govindarajan A, Amini A. An updated review on head and neck cancer treatment with radiation therapy. Cancers (Basel) 2021; 13 (19) 4912
24 Caudell JJ, Gillison ML, Maghami E. et al. NCCN Guidelines® Insights: Head and Neck Cancers, Version 1.2022. J Natl Compr Canc Netw 2022; 20 (03) 224-234
25 Urken ML, Yun J, Saturno MP. et al. Frozen section analysis in head and neck surgical pathology: a narrative review of the past, present, and future of intraoperative pathologic consultation. Oral Oncol 2023; 143: 106445
26 Singh A, Qayyumi B, Chaturvedi P. An update on surgical margins in the head neck squamous cell carcinoma: assessment, clinical outcome, and future directions. Curr Oncol Rep 2020; 22 (08) 82
27 Thomas Robbins K, Triantafyllou A, Suárez C. et al. Surgical margins in head and neck cancer: Intra- and postoperative considerations. Auris Nasus Larynx 2019; 46 (01) 10-17
28 Meier JD, Oliver DA, Varvares MA. Surgical margin determination in head and neck oncology: current clinical practice. The results of an International American Head and Neck Society Member Survey. Head Neck 2005; 27 (11) 952-958
29 Chung JH, Kim KJ, Jung KY, Baek SK, Park SH, Yoon ES. Recipient vessel selection for head and neck reconstruction: a 30-year experience in a single institution. Arch Craniofac Surg 2020; 21 (05) 269-275
30 Aycock JK, Stenson KM, Gottlieb LJ. The thoracoacromial trunk: alternative recipient vessels in reoperative head and neck reconstructive microsurgery. Plast Reconstr Surg 2008; 121 (01) 88-94
31 Dempsey L, Orr S, Lane S, Scott A. The clinical nurse specialist's role in head and neck cancer care: United Kingdom National Multidisciplinary Guidelines. J Laryngol Rhinol Otol 2016; 130 (S2): S212-S215
32 Larsson M, Hedelin B, Athlin E. A supportive nursing care clinic: conceptions of patients with head and neck cancer. Eur J Oncol Nurs 2007; 11 (01) 49-59
33 Wiederholt PA, Connor NP, Hartig GK, Harari PM. Bridging gaps in multidisciplinary head and neck cancer care: nursing coordination and case management. Int J Radiat Oncol Biol Phys 2007; 69 (2, suppl): S88-S91
34 Greedy J. The role of the clinical nurse specialist in head and neck cancer care. Br Dent J 2022; 233 (09) 806-811
35 Cruz CSR, Baixinho CL, Bernardes RA, Ferreira ÓR. Nursing interventions for head and neck cancer patients that promote embracement in the operating room/surgery unit: a near-empty scoping review. Nurs Rep 2022; 12 (04) 912-921
36 Varkey P, Tang WR, Tan NC. Nutrition in head and neck cancer patients. Semin Plast Surg 2010; 24 (03) 325-330
37 Muthanandam S, Muthu J. Understanding cachexia in head and neck cancer. Asia Pac J Oncol Nurs 2021; 8 (05) 527-538
38 Martinovic D, Tokic D, Puizina Mladinic E. et al. Nutritional management of patients with head and neck cancer-a comprehensive review. Nutrients 2023; 15 (08) 1864
39 Hersberger L, Bargetzi L, Bargetzi A. et al. Nutritional risk screening (NRS 2002) is a strong and modifiable predictor risk score for short-term and long-term clinical outcomes: secondary analysis of a prospective randomised trial. Clin Nutr 2020; 39 (09) 2720-2729
40 Trollebø MA, Skeie E, Revheim I. et al. Comparison of nutritional risk screening with NRS2002 and the GLIM diagnostic criteria for malnutrition in hospitalized patients. Sci Rep 2022; 12 (01) 19743
41 Mäkitie AA, Alabi RO, Orell H. et al. Managing cachexia in head and neck cancer: a systematic scoping review. Adv Ther 2022; 39 (04) 1502-1523
42 Gorenc M, Kozjek NR, Strojan P. Malnutrition and cachexia in patients with head and neck cancer treated with (chemo)radiotherapy. Rep Pract Oncol Radiother 2015; 20 (04) 249-258
43 Kristensen MB, Mikkelsen TB, Beck AM, Zwisler AD, Wessel I, Dieperink KB. To eat is to practice-managing eating problems after head and neck cancer. J Cancer Surviv 2019; 13 (05) 792-803
44 Vester S, Muhr A, Meier J, Süß C, Kummer P, Künzel J. Prehabilitation of dysphagia in the therapy of head and neck cancer- a systematic review of the literature and evidence evaluation. Front Oncol 2023; 13: 1273430
45 Almeida KAM, Rocha AP, Carvas N, Pinto ACPN. Rehabilitation interventions for shoulder dysfunction in patients with head and neck cancer: systematic review and meta-analysis. Phys Ther 2020; 100 (11) 1997-2008
46 Guru K, Manoor UK, Supe SS. A comprehensive review of head and neck cancer rehabilitation: physical therapy perspectives. Indian J Palliat Care 2012; 18 (02) 87-97
47 Passchier E, Stuiver MM, van der Molen L, Kerkhof SIC, van den Brekel MWM, Hilgers FJM. Feasibility and impact of a dedicated multidisciplinary rehabilitation program on health-related quality of life in advanced head and neck cancer patients. Eur Arch Otorhinolaryngol 2016; 273 (06) 1577-1587
48 Ringash J, Bernstein LJ, Devins G. et al. Head and neck cancer survivorship: learning the needs, meeting the needs. Semin Radiat Oncol 2018; 28 (01) 64-74
49 Clarke P, Radford K, Coffey M, Stewart M. Speech and swallow rehabilitation in head and neck cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Rhinol Otol 2016; 130 (S2): S176-S180
50 Starmer HM, Ayoub N, Byward C. et al. The impact of developing a speech and swallow rehab program: Improving patient satisfaction and multidisciplinary care. Laryngoscope 2017; 127 (11) 2578-2581
51 Starmer H, Sanguineti G, Marur S, Gourin CG. Multidisciplinary head and neck cancer clinic and adherence with speech pathology. Laryngoscope 2011; 121 (10) 2131-2135
52 Burns CL, Ward EC, Hill AJ, Kularatna S, Byrnes J, Kenny LM. Randomized controlled trial of a multisite speech pathology telepractice service providing swallowing and communication intervention to patients with head and neck cancer: evaluation of service outcomes. Head Neck 2017; 39 (05) 932-939
53 Mesolella M, Allosso S, D'aniello R. et al. Subjective perception and psychoacoustic aspects of the laryngectomee voice: the impact on quality of life. J Pers Med 2023; 13 (03) 570
54 Webster KT, Tippett D, Simpson M. et al. Speech-language pathology care and short- and long-term outcomes of oropharyngeal cancer treatment in the elderly. Laryngoscope 2018; 128 (06) 1403-1411
55 Vosselman N, Alberga J, Witjes MHJ. et al. Prosthodontic rehabilitation of head and neck cancer patients-challenges and new developments. Oral Dis 2021; 27 (01) 64-72
56 Salinas TJ. Prosthetic rehabilitation of defects of the head and neck. Semin Plast Surg 2010; 24 (03) 299-308
57 Vladić MB, Andabak-Rogulj A, Gršić K. et al. Dentist involvement in the treatment of radiation-induced oral mucositis-a pilot cross-sectional study. Dent J 2024; 12 (05) 134
58 Bertl K, Savvidis P, Kukla EB. et al. Including dental professionals in the multidisciplinary treatment team of head and neck cancer patients improves long-term oral health status. Clin Oral Investig 2022; 26 (03) 2937-2948
59 Byrne H, Curtin C, Weadick CS, Riordáin RN, O'Reilly S. Bridging the gap - establishing a dental-oncology service in a cancer centre. Support Care Cancer 2024; 32 (10) 693
60 Barber B, Dergousoff J, Nesbitt M. et al. Depression as a predictor of postoperative functional performance status (PFPS) and treatment adherence in head and neck cancer patients: a prospective study. J Otolaryngol Head Neck Surg 2015; 44 (01) 38
61 Humphris G. Psychological management for head and neck cancer patients: United Kingdom National Multidisciplinary Guidelines. J Laryngol Rhinol Otol 2016; 130 (S2): S45-S48
62 Jansen F, Witte BI, van Uden-Kraan CF, Braspenning AM, Leemans CR, Verdonck-de Leeuw IM. The need for supportive care among head and neck cancer patients: psychometric assessment of the Dutch version of the Supportive Care Needs Survey Short-Form (SCNS-SF34) and the newly developed head and neck cancer module (SCNS-HNC). Support Care Cancer 2016; 24 (11) 4639-4649
63 Townsend M, Kallogjeri D, Scott-Wittenborn N, Gerull K, Jansen S, Nussenbaum B. Multidisciplinary clinic management of head and neck cancer. JAMA Otolaryngol Head Neck Surg 2017; 143 (12) 1213-1219
64 Beeram M, Kennedy A, Hales N. Barriers to comprehensive multidisciplinary head and neck care in a community oncology practice. Am Soc Clin Oncol Educ Book 2021; 41 (41) 1-10
65 Windon MJ, D'Souza G, Faraji F. et al. Priorities, concerns, and regret among patients with head and neck cancer. Cancer 2019; 125 (08) 1281-1289
66 Pillai S, Kwan JC, Yaziji F, Yu H, Tran SD. Mapping the potential of microfluidics in early diagnosis and personalized treatment of head and neck cancers. Cancers (Basel) 2023; 15 (15) 3894
67 Kabzinski J, Kucharska-Lusina A, Majsterek I. RNA-based liquid biopsy in head and neck cancer. Cells 2023; 12 (14) 1916
68 Ballatore Z, Bozzi F, Cardea S. et al. Molecular Tumour Board (MTB): from standard therapy to precision medicine. J Clin Med 2023; 12 (20) 6666
69 Yang P, Ju Y, Hu Y, Xie X, Fang B, Lei L. Emerging 3D bioprinting applications in plastic surgery. Biomater Res 2023; 27 (01) 1
70 Falco M, Tammaro C, Takeuchi T. et al. Overview on molecular biomarkers for laryngeal cancer: looking for new answers to an old problem. Cancers (Basel) 2022; 14 (07) 1716
71 Jeong EJ, Kim E, Kim YS. Identification of novel therapeutic targets for head and neck squamous cell carcinoma through bioinformatics analysis. Sci Rep 2024; 14 (01) 32102