Description: management of salivary gland tumors

Background: Salivary gland tumors are one of the most common conditions encountered in head and neck surgery. Surgery is still the backbone of treatment, but there are new developments and controversial points regarding surgical treatment. Today, in treatment, in addition to oncological results and tumor control, quality of life and cosmetic results should also be taken into consideration.

Outcome Objectives: 1. Review of surgical dogmas and their validity 2. To better outline the modern surgical approach by sharing experiences and clinical results

1 – Description: Transoral Robotic Surgery (TORS) represents a transformative advancement in the surgical management of T1–T3 hypopharyngeal cancers and glottic cancers involving the anterior commissure—tumors traditionally considered to have poor prognoses and located at complex anatomical locations. This robotic-assisted technique features a high-magnified 3-D endoscope and endo-wristed instruments with motion scaling and tremor reduction capabilities. These technological advantages enable surgeons to perform precise, minimally invasive resections while preserving critical structures and organ function. In cases of recurrent laryngeal cancer requiring total laryngectomy, TORS may be applied to minimize trauma to cervical skin and mucosal surfaces of the upper digestive tract, thereby reducing postoperative complications. This session will present over a decade of clinical experience using TORS in combination with neck dissection, emphasizing its role in accurate pathological staging, long-term oncologic control, and functional outcomes. The potential for adjuvant therapy de-intensification based on surgical findings will also be discussed. Special focus will be given to patient selection, surgical strategy, the role of neoadjuvant therapy, and innovative procedures such as TORS supra-cricoid partial laryngectomy with thyroid cartilage preservation and minimally invasive total laryngectomy. Drawing from long-term follow-up data, this presentation will demonstrate how TORS offers not only functional preservation but also potential survival benefits for appropriately selected patients.

2 – Outcome Objectives: -Understand innovative techniques of TORS and criteria for optimal patient selection.

-Learn how TORS enables accurate pathological staging and informs adjuvant therapy planning.

-Recognize key prognostic factors affecting oncologic outcomes, including pathological N stage and extranodal extension (ENE) in hypopharyngeal cancer.

-Appreciate long-term survival rates and functional outcomes following TORS for hypopharyngeal and glottic cancers involving the anterior commissure.

-Explore the potential role of neoadjuvant therapy in enhancing outcomes prior to TORS.

3 – Structure of the Session: The keynote speaker will share over 10 years of experience in transoral robotic surgery (TORS) for hypopharyngeal and laryngeal cancers. He will present innovative surgical techniques through operative videos and discuss long-term outcomes based on his peer-reviewed publications, along with the latest unpublished data available prior to the congress. The session will conclude with a 5-minute Q&A to encourage audience engagement.

4 – Background (Selected Key References):

References

1. Chen-Chi Wang el al. Trans-oral robotic surgery for early T-classification hypopharyngeal cancer. Head Neck. 2016 Jun;38(6):857-62

2. Chen-Chi Wang el al. Transoral Robotic Surgery for Pharyngeal and Laryngeal Cancers-A prospective Medium-Term Study. Journal of Clinical Medicine Mar 2;10(5):967

3. Chen-Chi Wang el al. Transoral Robotic Surgery for Early-T Stage Glottic Cancer Involving the Anterior Commissure—News and Update. Front Oncol. 2022 Jan 31;12:755400. doi: 10.3389/fonc.2022.755400. eCollection 2022

4. Chen-Chi Wang el al. Long-term Outcomes of Trans-Oral Robotic Surgery-Assisted Total Laryngectomy for Recurrent Laryngeal Cancers. Jpn J Clin Oncol. 2020 Jun 10; 50(6): 653-660

5. Chen-Chi Wang el al. Transoral robotic surgery for early glottic carcinoma involving anterior commissure. Head Neck. 2016 Jun;38(6):913-8.

Precision and Perplexity: A 13-Year Journey in Managing Advanced Parotid Cancer – Evidence, Ethics, and Expertise

Format: Keynote Lecture (30 Minutes)

Speaker: Jaiganesh Manickavasagam (Jai Manick), MS(ENT), FRCS(ORL-HNS)

Theme: Serving Tomorrow’s World Today: Therapeutic Innovations

Proposal OutlineIntroduction and Global Context The management of advanced parotid cancer remains one of the most challenging frontiers in Head and Neck surgery. As we look toward 2030, the paradigm is shifting from "radicality at all costs" to "precision oncology." Drawing upon my 13 years of experience as a Consultant Head and Neck Surgeon and Clinical Director for Cancer Services at NHS Tayside, this keynote addresses the management of T3/T4 parotid malignancies.

The Evidence-Based Evolution The session will provide a longitudinal analysis of parotid cancer management, transitioning from traditional surgical approaches to evidence-led, multidisciplinary-driven outcomes. I will discuss the clinical integration of 14 national research projects—where I served as Principal Investigator—and how data from trials like the AQUAx2 (Gene Therapy) and others are beginning to reshape our understanding of salivary gland biology and treatment response.

Surgical "Tricks and Tools" A core segment of this lecture will focus on the "Dundee Experience," utilizing my dual role as Director of the Dundee Institute of Head and Neck Education (DIHNE) and Founder of MCh Head and Neck Surgery. I will share specific surgical pearls gathered over a decade of high-volume practice, including:

- The Facial Nerve Dilemma: Decision-making frameworks for nerve sacrifice vs. preservation in high-grade tumors.
- Advanced Reconstructive Stratagems: Utilizing local and free-flap options to provide both structural integrity and aesthetic restoration.
- Robotic and Digital Adjuncts: The role of precision technology in navigating the deep lobe and skull base interface.

Case Series and The Patient Journey The presentation is anchored by high-definition video case studies of advanced malignancies involving the facial nerve, mastoid, and parapharyngeal space. I will present a unique series of "post-malignancy" reconstructions, mapping the full patient journey from multidisciplinary team (MDT) counseling to functional recovery. These cases illustrate the fine balance between oncological clearance and quality of life.

Conclusion: Tomorrow’s Blueprint I will conclude by addressing the "Complexity Gap"—the space between clinical guidelines and real-world surgical challenges. By synthesizing 13 years of leadership and academic rigor, this keynote provides a blueprint for managing parotid cancer through the lens of surgical innovation, translational science, and compassionate patient care.