Head and Neck Cancer and Reconstructive Surgery

The Mayo Clinic Department of Otolaryngology — Head and Neck Surgery's Division of Head and Neck Cancer and Reconstructive Surgery investigates solutions to cure patients of their disease and help them return to full and healthy lives after their cancer care.

Oral cavity cancer and reconstruction

The Division of Head and Neck Cancer and Reconstructive Surgery strives to provide state-of-the-art, comprehensive care for patients with oral cavity cancer. The division evaluates patients to ensure they receive multidisciplinary expertise as well as access to and potential enrollment in clinical trials. The clinic streamlines the process of evaluating patients and gathering information such as medical history and exam, lab tests and imaging results. It also expedites treatment. The oral cavity cancer clinic includes Mayo Clinic experts in:

• Maxillofacial prosthodontics.
• Medical oncology.
• Pathology.
• Radiation oncology.
• Radiology.
• Research coordination.

Through collaboration with Mayo Clinic's Department of Radiology, the Division of Head and Neck Cancer and Reconstructive Surgery was an early adopter in developing in-house 3D modeling and virtual surgical planning to improve surgery and reconstruction options for patients with oral cavity cancer.

With Mayo Clinic radiologists and 3D anatomical engineers, division researchers have developed individualized surgical reconstructive guides, anatomical models for intraoperative reference, education materials and simulation exercises. These innovations have resulted in shorter operative times, more precise bone reconstruction and improved outcomes for patients. They are now readily available and routinely used in the surgical care of patients with oral cavity cancer.

As with many of the diseases treated in the Department of Otolaryngology — Head and Neck Surgery, there is much to be learned from the realities of patient care. The department therefore maintains a detailed database to study patient outcomes. This is a significant resource for researchers interested in oral cavity cancer and reconstruction and for current and future patients who benefit from their findings.

Salivary disease and cancer

The Division of Head and Neck Cancer and Reconstructive Surgery has a significant interest in advancing the understanding of and driving the science behind the management of salivary disease by studying tumor markers, imaging findings and patient outcomes.

Mayo Clinic's high surgical volumes allow the division to meaningfully investigate and learn from patients receiving treatment — even those with rare diseases. Additionally, these high volumes and the resulting depth of experience have allowed the division's physician-scientists to perfect minimally invasive incisions and surgery while simultaneously providing excellent rates of tumor cure. Multidisciplinary surgical and reconstructive teams excel in facial nerve preservation, parotid bed reconstruction and surgical removal of complex tumors with rehabilitation of the facial nerve.

Developing diagnostic tools

Collaboration with other teams, such as the Department of Laboratory Medicine and Pathology and the Department of Radiology, allows the Division of Head and Neck Cancer and Reconstructive Surgery to delve into the molecular makeup of salivary tumors and learn more about their imaging presentation. Diagnosis is a unique challenge in these tumors due to the difficulty in interpreting fine-needle aspiration biopsies. The division is leading novel clinical trials investigating the use of a simple saliva test to diagnose patients who may have salivary disease.

Measuring and improving patient-reported outcomes

The Division of Head and Neck Cancer and Reconstructive Surgery is focused on patient-reported outcomes after surgery on the parotid gland for salivary tumors. The division uses artificial intelligence tools to populate and maintain a registry of over 4,000 patients with salivary tumors who have undergone surgery at Mayo Clinic. Researchers study the registry's patient-reported outcomes to better understand how to improve the quality of life of patients undergoing parotidectomy.

This passion for understanding the patient perspective in parotid surgery inspired division experts to develop the Parotidectomy Quality of Life Index, the first patient-reported outcome instrument for parotid surgery. The division is prospectively collecting data on this measure from its surgical patients to understand how surgery impacts short- and long-term quality of life and which domains can be improved to create a better patient experience.

Skin cancer

The Division of Head and Neck Cancer and Reconstructive Surgery is improving the understanding of high-risk skin cancers. This work includes finding new ways to identify the "bad actors" hidden as indolent tumors as well as treating advanced tumors with novel approaches, minimal surgery and maximal impact.

Division researchers have recently investigated sentinel lymph node biopsy outcomes in both patients with Merkel cell carcinoma and patients who have previously undergone wide local excision of their melanomas. Studies using neoadjuvant immunotherapy in advanced resectable melanoma and Merkel cell carcinoma are ongoing.

The division's skin cancer research is carried out in cooperation with the Mayo Clinic Division of Medical Oncology and Department of Radiation Oncology and Mayo's Mohs surgery team. Multidisciplinary collaboration allows for unique perspectives on the care and management of patients with complex skin cancers and on treatments or cures that minimally impact facial aesthetics and function.

Mayo Clinic is on the forefront of investigating the role of immunotherapy given before surgery for squamous cell carcinoma of the skin. This emerging treatment has great promise in reducing the morbidity and cosmetic defects seen from surgery. The division is participating in an NRG Oncology trial comparing immunotherapy given before surgery to surgery alone in the treatment of squamous cell carcinoma of the skin.

Throat (oropharynx) cancer

Researchers in the Division of Head and Neck Cancer and Reconstructive Surgery have a strong interest in throat cancer — also known as oropharyngeal squamous cell carcinoma — related to human papillomavirus (HPV). Research is focused on individualizing treatment for each patient based on both traditional risk factors and novel biomarkers, with the goal of maximizing cure and minimizing toxicity. This research includes multiple ongoing clinical trials involving:

• Novel applications of immunotherapy and chemoimmunotherapy.
• Proton radiation therapy.
• Therapeutic cancer vaccines.
• Transoral robotic surgery.

Division researchers have shown that in patients with low or intermediate risk disease, these approaches can de-escalate or decrease the total amount of treatment a patient needs to achieve a cure. This results in improved quality of life for patients, which might mean less dry mouth and sticky saliva or improved swallowing function. In addition, this approach allows us to help identify patients at high risk of recurrence who would not benefit from de-escalation of therapy and might even benefit from escalating it.

In addition, the division has a strong research interest in identifying cancer early and preventing it before it reaches a more advanced stage. Ongoing studies focus on investigating novel point-of-care testing that healthcare professionals could offer to patients during clinic consultations.

The division is using data from these trials and the results of oropharynx biomarker research to study new individualized treatment approaches, with the goal of curing HPV-related throat cancer with as few side effects as possible. An additional research goal is to offer patients a simplified and accurate follow-up schedule.

Learning from patient experiences: Transoral robotic surgery

With one of the largest oropharynx cancer practices in the world, the Mayo Clinic Department of Otolaryngology — Head and Neck Surgery maintains an ever-growing database of patient outcomes for patients treated with the full spectrum of treatment options. This vital resource allows researchers to answer meaningful retrospective questions that would be impossible to answer with prospective studies, thereby informing patient care. The database also provides the critical pilot data to launch higher impact prospective trials and establishes a foundation of questions that are best answered by basic science.

Working with industry partners, the Division of Head and Neck Cancer and Reconstructive Surgery participated in the U.S. Food and Drug Administration approval process for the da Vinci single-port robotic platform. The team was then able to complete one of the first postapproval studies investigating outcomes associated with this device.

Thyroid cancer

Thyroid cancer research in the Department of Otolaryngology — Head and Neck Surgery is focused on understanding the full breadth of the disease, from its early stages to advanced cancer. Research is driven by physician-scientists with profound understanding of the intricacies of thyroid cancer, head and neck anatomy and physiology, airway management, voice, and swallowing function, which require careful study and experience.

The department's integrative and collaborative research approach is uniquely facilitated by the faculty's embedded understanding of thyroid and laryngopharyngeal anatomy and physiology. Further, the Mayo Clinic's shared-management patient care strategy is at the foundation of the department's team-based approach to treating and studying this complex disease.

This team approach extends to less aggressive and more common thyroid cancers and benign thyroid abnormalities. The division's thyroid cancer specialists manage and study cancers that extend toward the larynx, pharynx and esophagus to find the best ways to maximize preservation of function while minimizing recurrence and side effects or toxicity of treatment. In the course of care, researchers have investigated surgical techniques that have resulted in multiple publications.

This collaborative approach is exemplified by the department's coordinated management of anaplastic thyroid cancer. Researchers have found that treating selected patients with surgery followed by intensity-modulated radiation therapy and — more recently — proton beam radiation therapy, as well as chemotherapy, provides significant improvement in survival. In some cases, patients have been cured.

The division's multidisciplinary research team includes collaborators with expertise in specialties including but not limited to:

• Biomedical engineering.
• Immunology.
• Individualized medicine.
• In-house 3D anatomical modeling.
• Laboratory medicine and pathology.
• Neurosurgery.
• Radiology.
• Regenerative medicine.
• Surgical robotics.

The division conducts prospective clinical trials, basic science and translational research, and retrospective data analysis. Its research is primarily funded by generous benefactors and grants.