Removing the taboo on the surgical violation (Cut-Through) of Cancer

Abstract

IMPORTANCE The surgical dictum of en bloc resection without violating cancer tissue has been challenged by novel treatments in head and neck cancer. OBSERVATIONS An analysis of treatment outcomes involving piecemeal removal of sinonasal, laryngeal, oropharyngeal, and hypopharyngeal cancer shows that it did not compromise tumor control. The rationale for the evolution toward use of this technique is outlined. CONCLUSIONS AND RELEVANCE While complete resection with clear margins remains a key end point in surgical oncology, we believe it is time to acknowledge that this time-honored dictum of avoiding tumor violation is no longer valid in selected situations.