Innovations in Otolaryngology: Challenges, Opportunities, Perspectives

Authors:
Prof. Wojciech Golusiński, MD, PhD¹; Piotr Pieńkowski, MD, PhD¹; Ewa Majchrzak, MD, PhD¹; Mateusz Szewczyk, MD, PhD¹; Radosław Janczak, MD¹; Marta Łukomska, MD¹; Piotr Machczyński, MD, PhD¹; Karina Wawrzyniak, MSc¹; Anita Szymańska, MD, PhD¹; Zofia Eichmann, MSc¹; Anna Szeremiota, MSc¹; Elżbieta Nowak, MSc²

¹ Department and Clinic of Head, Neck Surgery and Laryngological Oncology, Poznan University of Medical Sciences, Greater Poland Cancer Centre
² Central Operating Theatre, Greater Poland Cancer Centre

Introduction

Once again, in Poznań, on October 19–21, 2023, the Nationwide Conference “Innovations in Otolaryngology: Challenges – Opportunities – Perspectives” took place. The project we initiated 10 years ago has proven to be a great success. Each year, the number of participants continues to grow. This reflects recognition of the selected topics, the quality of the presentations, and the unquestionable experience of the experts invited to deliver lectures and lead individual sessions.

The innovations discussed during the conference cover the most important areas of otolaryngology and head and neck surgery. They include head and neck oncology, rhinology, otology, oto-surgery, and sleep apnea, which has become a major public health issue.

Innovations in the surgical treatment of head and neck cancers represent remarkable progress in minimally invasive surgery. Today, this is particularly evident in robotic surgery, which is highly anticipated in Poland. Two centres in Poland have begun performing robotic procedures. In the Poznań centre, where robotic head and neck cancer surgery was introduced as the first in Poland, 200 procedures have been performed to date, reflecting extensive team experience in the use of this technology. The centre aspires to the status of a Centre of Excellence.

Medical progress is extraordinary thanks to new medical technologies. However, implementing them into daily clinical practice remains challenging. This is not only due to financial limitations, but primarily due to human factors – the lack of well-educated and experienced staff in innovative otolaryngological practice significantly limits progress. Therefore, it is crucial to organize open, interdisciplinary scientific conferences focused on education and discussion.

Head and Neck Oncology

Head and neck cancers are predominantly squamous cell carcinomas (90% of cases), most commonly located in the oral cavity, pharynx, larynx, hypopharynx, nasal cavity, paranasal sinuses, nasopharynx, and salivary glands.

Each year, approximately 650,000 new cases of head and neck cancer are diagnosed worldwide, accounting for about 6% of all malignancies. Most patients are over 50 years old, and the male-to-female ratio ranges from 2:1 to 5:1.

Risk factors for squamous cell carcinoma of the head and neck include tobacco use and alcohol consumption, especially high-proof alcohol. Epstein-Barr virus (EBV) infection is an important risk factor for nasopharyngeal carcinoma, while human papillomavirus (HPV) infection is a major risk factor for oropharyngeal cancer and may be responsible for up to 70% of cases in this location.

Treatment is based on three pillars: surgery, radiotherapy, and systemic therapy. These methods can be used alone or in combination in advanced disease.

Modern head and neck surgery is based on minimally invasive approaches, including endoscopic techniques in laryngeal and sinonasal surgery, microsurgery, and robotic surgery using the Da Vinci system. Reconstructive surgery using free flaps with microvascular anastomosis plays a crucial role in restoring structure and function after extensive oncological resections. Robotic surgery enables treatment de-escalation in selected patients, reducing treatment-related complications.

Modern radiotherapy focuses on maintaining high treatment efficacy while reducing side effects through advanced techniques such as IMRT, IGRT, VMAT, SBRT, CyberKnife, and proton therapy.

Systemic treatment, previously based mainly on platinum compounds, is rapidly evolving thanks to targeted therapy (cetuximab) and immunotherapy (nivolumab, pembrolizumab). Immunotherapy is currently used in palliative treatment but is expected to play an increasingly important role in curative combined approaches.

Scientific presentations on head and neck oncology were widely discussed during the 5th Nationwide Conference “Innovations in Otolaryngology – Challenges, Opportunities, Perspectives”, held in Poznań on October 19–21, 2023. In the “Head and Neck Oncology” session, Prof. Paweł Golusiński presented the latest data on HPV-related cancers. Dr. Sławomir Okła discussed laser laryngeal surgery, and Prof. Sefik Hosal presented advanced laryngeal cancer treatment. In the “Artificial Intelligence in Medicine” session, Prof. Wojciech Golusiński analysed the role of AI in multidisciplinary tumour boards.

In the EHNS session, Prof. Vincent Gregoire presented radiotherapy options, Prof. Wojciech Golusiński discussed skin cancers of the head and neck, Prof. René Leemans presented salvage surgery in recurrent disease, and Prof. Christian Simon discussed TORS versus radiotherapy in oropharyngeal cancer. Additional sessions covered immunotherapy, nutrition, pain control, and robotic surgery.