Minimally invasive procedure for those battling throat cancer

Nearly 40,000 people every year face a brutal battle with head and neck cancer. When caught early, there's a good chance of survival, but treatment is rigorous. Sometimes it means taking away basic abilities like swallowing, eating and talking. However, with the help of a robot one man can enjoy dinners with his family again.

He's a firefighter, a cook, and a cancer survivor, but Tom Scaccia's most important title: Grandpa.

"You see those two babies, those are my granddaughters. I'm not in the ground, so every morning I get up I see them, that's the important part," said Scaccia.

Tom had a tumor in tongue that spread to his throat. Chemo and 33 radiation treatments destroyed the tumor and most of his throat.

“That was the hard part,” explained Tom, “not being able to eat. I fed myself through a tube in my stomach."

Doctors decided to reconstruct his throat using skin, tissue and blood vessels from his forearm. A massive operation.

Professor and vice-chair otorhinolaryngology-head and neck surgery

"You'd have to split the lip in the middle you'd have to split the jaw, open it up like a book just to get there,” said Dr. Richard Smith, the Professor and Vice-Chair Otorhinolaryngology-Head and Neck Surgery

Instead, doctors Richard Smith and Evan Garfein used a robot to rebuild Tom's throat. The robot's arms went through tom's mouth. With surgeons at the controls, they removed the dead tissue. Through a small incision in the neck they inserted the healthy skin and tissue from Tom's forearm.

Dr. Evan Garfeinm, from the Montefiore Mecial Center, explained, "the tissue there is very thin and pliable which is good for the base of the tongue it doesn't interfere with swallowing or speaking."

This means a three-inch incision instead of splitting the jaw. One day in the hospital instead of three- weeks and one-month recovery instead of three.

A couple of months after surgery, Tom is back in the driver's seat, not exactly fighting fires yet, but another very important job at the fire house … cooking.

Tom is cancer-free, but Dr. Smith says head and neck cancer patients have a 20% risk of developing a second cancer. He says that's why finding minimally invasive techniques are so important, in case a patient has to have multiple procedures. Doctors say for some patients the minimally invasive technique could replace chemo and radiation all together.


BACKGROUND: According to The National Cancer Institute, head and neck cancer arises in the head or neck region (in the nasal cavity, sinuses, lips, mouth, salivary glands, throat, or larynx). Head and neck cancers account for approximately 3 to 5 percent of all cancers in the United States. These cancers are more common in men and in people over age 50. It is estimated that about 39,000 men and women in this country will develop head and neck cancer. Tobacco and alcohol use are the most important risk factors for head and neck cancers, particularly those of the oral cavity. The treatment plan for an individual patient depends on a number of factors, including the exact location of the tumor, the stage of the cancer, and the person's age and general health.

NEW TREATMENT: Head and neck cancer surgery often results in large tissue defects associated with devastating functional deficits and disfiguring deformities. Doctors can now reconstruct the throat using skin, tissue and blood vessels from the forearm. Free tissue transfer is a surgical reconstructive procedure using microsurgery. A region of "donor" tissue is selected that can be isolated on a feeding artery and vein; this tissue is usually a composite of several tissue types. The composite tissue is transferred (moved as a free flap of tissue) to the region on the patient requiring reconstruction.

ROBOTIC TECHNOLOGY: Called the DaVinci surgery for throat cancer, it's a safe, effective and minimally invasive procedure using the most advanced technology available. Small incisions are used to introduce miniaturized wristed instruments and a high-definition 3D camera. The surgeon views a magnified, high-resolution 3D image of the surgical site. As the surgeon manipulates the controls, it responds to the surgeon's input in real time, translating his or her hand, wrist and finger movements into precise movements of miniaturized instruments at the patient-side cart. It means a three-inch incision instead of splitting the jaw and one day in the hospital instead of three weeks. The best part; a one-month recovery instead of three months.


Anne McDarby
Public Relations
Montefiore Medical Center
(718) 920-8274

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