Difficult Decisions in Head and Neck Oncologic Surgery

Zhen Gooi, MD, specializes in the care of patients with benign and malignant head and neck tumors. Within the field of head and neck surgery, his clinical interests are reconstruction of the head and neck, transoral robotic surgery and de-escalation of treatment for patients with HPV-related head and neck squamous cell carcinoma.Dr. Agrawal's work has achieved international recognition in the field of head and neck surgical oncology, and head and neck cancer genetics. Under his leadership, a team of researchers completed a landmark study that examined the genome of head and neck squamous cell carcinoma.  His group then followed up by publishing the genomic landscapes of the remaining major head and neck cancers, including esophageal squamous cell carcinoma, esophageal adenocarcinoma, medullary thyroid cancer, adenoid cystic carcinoma, and mucoepidermoid carcinoma.  Dr. Agrawal then applied these findings to identify tumor DNA as a biomarkers that improve cancer diagnostics in the saliva and plasma of patients with head and neck squamous cell carcinoma.  His research is focused on the application of cancer genetics to design diagnostic approaches to reduce morbidity and mortality from head and neck cancer. In addition to his clinical and research contributions, Dr. Agrawal is an accomplished educator -- teaching medical students, residents, and fellows about the management of patients with head and neck cancer. Prior to joining the University of Chicago, Dr. Agrawal was an associate professor at John Hopkins University.

• 1. Evidenced based-medicine.- 2. Decision analytic techniques.- 3. Decision making from a physician perspective.- 4. Decision making from a patient perspective.- 5. Elective versus therapeutic neck dissection for clinically node negative oral cavity cancer.- 6. Management of moderate dysplasia of the oral cavity.- 7. Ideal resection margins in oral cavity cancer.- 8. Should margin sampling be obtained from the specimen or from the resection bed?.- 9. Should level IIb undergo routine dissection in clinical node negative oral cavity cancer.- 10. Sentinel node biopsy or elective neck dissection for clinical node negative oral cavity cancer.- 11. Surgical or non-surgical treatment for advanced oral cavity cancer.- 12. Management of early T-stage oropharyngeal cancer.- 13. Surgical management versus chemoradiation for unknown primary tumor.- 14. Should treatment deintensification be routine for HPV associated oropharyngeal cancer.- 15. Early oral feeding following primary total laryngectomy.- 16. Up-front surgery or organ preservation for advanced laryngeal cancer.- 17. What is the best treatment paradigm for advanced larynx cancer with oligometastatic disease?.- 18. Surgery or radiation therapy for early stage glottic cancer.- 19. Should thyroid cancer with distant metastatic disease be treated with curative or palliative intent.- 20. What is the optimal management of papillary thyroid microcarcinoma?.- 21. Should routine central neck dissection be performed for thyroid carcinoma?.- 22. When should one operate on anaplastic thyroid cancer?.- 23. Should pre-operative embolization be utilized routinely for carotid body tumors prior to surgical resection?.- 24. Vagal paraganglioma and schwannoma-  surgical or non surgical management?.- 25. Parotid malignancy with facial paresis- should the facial nerve be sacrificed?.- 26. Adjuvant management of advanced high grade parotid malignancy.- 27. Is parotidectomy indicated in cutaneous exteral auditory canal cutaneous skin cancer?.- 28. What is the ideal resection margin in head and neck Merkel cell carcinoma.- 29. Basosquamous cutaneous cancer- should routine neck dissection be offered?.- 30. Is routine anti-coagulation warranted following free flap reconstruction?.- 31. Does two venous anastamosis lead to better outcomes in free flap reconstruction.- 32. Reconstruction for early tongue cancer.- 33. Should reconstruction be staged with cutaneous melanoma of the head and neck?.- 34. Prophylactic versus reactive gastrostomy tube placement for advanced head and neck cancer.- 35. Is routine physical therapy warranted following neck dissection.- 36. What is the best time interval for obtaining surveillance imaging following non-surgical treatment of head and neck cancer?.- 37. What is the best imaging modality to predict extracapsular nodal extension?.- 38. Is there a role for triple endoscopy in the staging of head and neck cancer?.- 39. Is there a role for induction chemotherapy in advanced head and neck cancer.- 40. Is routine carotid imaging warranted following radiation treatment of head and neck cancer.