In My Opinion

RRC Requirements: Keeping Up with the Times

Nicholas J. Cassisi
Dean
University of Florida, Gainsville
Gainsville, Florida, USA

When was the last time you did a partial laryngopharyngectomy (PLP) or a subtotal supraglottic laryngectomy (SSL) or a three-quarters laryngectomy? For that matter, how many hemilaryngectomies have you done in the past year? I’m sure that most of us continue to do total laryngectomies but in my practice even those numbers have decreased. More and more often today, tumors of the larynx and hypopharynx are being treated with radiation therapy and/or chemotherapy, thus fostering the concept of organ preservation.

Unfortunately the Otolaryngology Residency Review Committees have not kept up with these changing times. Programs are still judged to some degree on "numbers" of these kinds of cases. The standards that were in effect in the past are no longer viable. In my opinion, it is far more valuable for the residents to have experience in the diagnosis, disposition and management of patients with laryngeal cancer. This requires exposure and knowledge about radiation therapy and chemotherapy. The most productive way to achieve these goals is through a multidisciplinary head and neck tumor conference, with surgeons, radiation oncologists and medical oncologists participating in the care and disposition of these patients. This will ensure that the patient receives the best treatment options for their cancer.

Once this is achieved, program directors must place pressure on the RRC to adapt to today’s standards of care. That’s my opinion.