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The main aims of the oncologic surgeon should be an early tumor diagnosis, complete surgical resection, and a careful post-treatment follow-up to ensure a prompt diagnosis of recurrence. Radiologic and endoscopic methods have been traditionally used for these purposes, but their accuracy might sometimes be suboptimal. Technological improvements could help the clinician during the diagnostic and therapeutic management of tumors. Narrow band imaging (NBI) belongs to optical image techniques, and uses light characteristics to enhance tissue vascularization. Because neoangiogenesis is a fundamental step during carcinogenesis, NBI could be useful in the diagnostic and therapeutic workup of tumors. Since its introduction in 2001, NBI use has rapidly spread in different oncologic specialties with clear advantages. There is an active interest in this topic as demonstrated by the thriving literature. It is unavoidable for clinicians to gain in-depth knowledge about the application of NBI to their specific field, losing the overall view on the topic. However, by looking at other fields of application, clinicians could find ideas to improve NBI use in their own specialty. The aim of this review is to summarize the existing literature on NBI use in oncology, with the aim of providing the state of the art: we present an overview on NBI fields of application, results, and possible future improvements in the different specialties.

Background and objectives Cemented hip arthroplasty is considered the standard of care for treating both osteoporotic femoral neck fractures and pathologic disease of the proximal femur due to the ability to achieve strong fixation in poor quality bone. There is minimal literature evaluating uncemented arthroplasty for pathologic disease of the proximal femur. This objective of this study is to compare outcomes of patients undergoing cemented and uncemented arthroplasty of the proximal femur for an oncologic indication. Methods Patients who underwent hip arthroplasty procedures in one health system for an oncologic indication were identified. Demographics, cancer history, operative history, and complications were collected retrospectively. Harris Hip Scores (HHS) and Musculoskeletal Tumor Society Scores (MSTS) were prospectively collected via telephone. Results 41 patients met criteria for review. 18 underwent cemented and 23 underwent uncemented arthroplasty. There were no significant differences in age, demographics, complications, 30-day mortality, intraoperative blood loss, transfusion requirements, average HHS, or average MSTS. Conclusion No significant differences were found for patients undergoing hip arthroplasty for an oncologic indication regardless of whether or not the femoral component was cemented. Our results suggest that cemented and uncemented techniques are both safe and effective methods to be used at the oncologic surgeon's discretion.

Deep lobe parotidectomy (DLP) is a critical procedure to master for any head and neck oncologic surgeon. This procedure is indicated for any deep lobe malignancy, a superficial lobe malignancy with extension into the deep lobe, refractory inflammatory conditions, and the presence of metastatic disease within a superficial or periparotid lymph node. This article describes the relevant anatomy and steps required to perform a deep lobe parotidectomy with and without facial nerve sacrifice. In addition, the history of the procedure, patient work up, indications, and possible complications are discussed.

The nevoid basal cell carcinoma syndrome (NBCCS) is a genetic disorder that affects the PTCH gene, which is highly associated with tumor suppression. It presents a case of NBCCS diagnosed in a 49-year-old Caucasian male. His medical history has shown a great number of surgical procedures for the removal of lesions that are common to the syndrome. One of the lesions was removed from the mandible and sent for biopsy. The patient was diagnosed by means of a jaw biopsy conducted by a buccomaxillofacial surgeon, and histopathologic sections showed a diagnosis of odontogenic keratocyst (OKC) and squamous cell carcinoma (SCC). Also, in the same section, some calcified materials were found that refer to psammoma bodies. The patient is still under care with an oncologic surgeon for future surgeries given the nature of the disorder. This case illustrates the importance of a multidisciplinary team in the diagnosis and treatment of patients with NBCCS.

Summary Surgery for malignant tumors of the maxillofacial region has benefited significantly from advances in imaging technology and instrumentation and in maturation of craniofacial and orthognathic reconstructive surgical techniques during the past two decades. These developments allow the maxillofacial oncologic surgeon to precisely visualize the anatomic involvement of the malignant process in order to better determine exactly which surgical ablative procedure is of greatest benefit to the patient. Reconstructive surgical options are available that are not solely dependent on local tissues or delayed staged tissue transfers, enabling the surgeon to obtain satisfactory resection margins at the ablative surgical site and at the same time offering the patient the possibility of immediate restoration of anatomic form and an expeditious return of function depending on the specific malignant tumor treated. This review deals with some of the most common approaches to surgically treating malignancies of the maxilla and mandible, in addition to providing a brief review of malignant tumor-specific behavior and surgical recommendations as they relate to those malignancies of the jaws that have traditionally been treated through surgery. It is hoped that those colleagues dealing in maxillofacial surgical oncology will continue to report their findings so that these unfortunate patients can continue to benefit from evolving advances in this exciting field.

Summary The head and neck oncologic surgeon must continue to keep abreast of advances in surgical oncology, as well as radiation oncology, medical oncology, and basic sciences. It is encouraging to see for the first time a reduction in the mortality rate from oral cavity cancer. These advances must be expanded to further reduce mortality and morbidity rates and to raise the quality of life for our patients with head and neck squamous cell carcinoma.

Introduction Society of Urologic Oncology (SUO)-accredited fellowship programs have undergone substantial expansion. This study developed a mathematical model to estimate future changes in urologic oncologic surgeon (UOS) manpower and analyzed the effect of those changes on per-UOS case volumes. Materials and methods SUO fellowship program directors were queried as to the number of positions available on an annual basis. Current US UOS manpower was estimated from the SUO membership list. Future manpower was estimated on an annual basis by linear senescence of existing manpower combined with linear growth of newly trained surgeons. Case-volume estimates for the 4 surgical disease sites (prostate, kidney/renal pelvis, bladder, and testes) were obtained from the literature. The future number of major cases was determined from current volumes based upon the US population growth rates and the historic average annual change in disease incidence. Two models were used to predict future per-UOS major case volumes. Model 1 assumed the current distribution of cases between nononcologic surgeons and UOS would continue. Model 2 assumed a progressive redistribution of cases over time such that in 2043 100% of major urologic cancer cases would be performed by UOSs. Results Over the 30-year period to “manpower steady-state” SUO-accredited UOSs practicing in the United States have the potential to increase from approximately 600 currently to 1,650 in 2043. During this interval, case volumes are predicted to change 0.97-, 2.4-, 1.1-, and 1.5-fold for prostatectomy, nephrectomy, cystectomy, and retroperitoneal lymph node dissection, respectively. The ratio of future to current total annual case volumes is predicted to be 0.47 and 0.9 for models 1 and 2, respectively. The number of annual US practicing graduates necessary to achieve a future to current case-volume ratio greater than 1 is 25 and 49 in models 1 and 2, respectively. Conclusions The current number of SUO fellowship trainees has the potential to decrease future per-UOS case volumes relative to current levels. Redistribution of existing case volume or a decrease in the annual number of trainees or both would be required to insure sufficient surgical volumes for skill maintenance and optimal patient outcomes.

Based on 25 years' personal observation of the history of head and neck oncologic surgery and the changes in multidisciplinary approach and teaching, a guide of preparation and self-evaluation for surgeons in this field is outlined.