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Presidential Address |

Tradition, Teamwork, and Tailored Treatment Surgical Oncology in the Genomic Era

Gregory T. Wolf, MD
Arch Otolaryngol Head Neck Surg. 2009;135(4):337-341. doi:10.1001/archoto.2009.12.
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The next decade will be one of the most exciting, challenging, and, perhaps, unsettling eras in head and neck surgical oncology. We can expect surgical dogma and traditional oncologic principles to be challenged in every aspect. These challenges will be raised by experienced colleagues who have observed the evolution of our understanding of tumor behavior and the limitations of conventional surgery, radiotherapy, and chemotherapy. New questions will be raised because of increasing knowledge of the basic biological characteristics of carcinogenesis, cellular proliferation, and immune homeostasis. How should we prepare ourselves and the next generation of surgical oncologists for these challenges? I believe that we are at a critical crossroads in head and neck oncology between a well-worn highway of surgical technique and a newer roadway of tumor biology and molecular medicine. The obvious main roadway will lead to superb technical advancements in areas such as free tissue transfer, robotics, minimal-access surgery, and application of new laser and optical technologies. Advances on this road will expand our capabilities to repair, restore, and preserve function. The other path that is currently being paved and is less traveled by surgeons is that of bio-oncology, tissue engineering, molecular risk profiling, tailored and personalized treatment, metabolic and molecular intervention, biochemical surveillance, and cancer prevention. Are these separate paths or do they diverge and then cross at future points? How can surgeons in training follow more than one road? What are the special requirements necessary to sustain surgical oncology during the development of these future paths? Importantly, as practicing surgeons, how do we best execute our responsibility to our patients during such rapidly evolving times?

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