University of Pennsylvania Health System
3400 Spruce Street
Philadelphia, PA 19104
|Number of Fellowships: 2|
Duration (in years) : 1 year
Gregory S. Weinstein, M.D.
Ara Chalian, M.D.
Bert W. O’Malley, Jr., M.D.
Jason G. Newman, M.D.
Christopher Rassekh, M.D.
Steven Cannady, MD
Rabie Shanti, M.D.
Overview: A recent trend in many centers has been to define the role of the head and neck surgeon as a doctor, who diagnoses head and neck squamous cell carcinoma in preparation of non-surgical treatment, such as chemotherapy and radiation, reserving the surgical role for treatment failures. The philosophy of management at the University of Pennsylvania (PENN) is based on a different approach. The Center for Head and Neck Cancer meets weekly and all patients are presented prior to treatment. Our approach is to recommend the best treatment for each patient, either surgical or non-surgical. The overall approach is to focus on cancer control while optimizing functional outcome. At times, surgery is superior in the oropharynx and larynx for both cancer control and better functional outcome. This is accomplished with the judicious use of a variety of surgical approaches, such as endoscopic laser approaches, transoral robotic surgery utilizing the da Vinci Surgical System, transcervical resection, open or endoscopic partial laryngectomy, and free flap reconstructions.
While we fully agree that in many instances non-surgical treatment is the superior treatment option, this is not always the case. In fact, here at PENN we have carried out major chemoradiation trials, and fully support the role of non-surgical management of carcinomas of the head and neck when appropriate. We are uniquely positioned to integrate non-surgical management into our regimens given that, in the Department of Otorhinolaryngology-Head and Neck Surgery at PENN, we employ a full-time clinical medical oncologist.
Nonetheless, a head and neck surgeon should never have to be in a position to offer non-surgical treatment to patients because they do not feel comfortable performing the full spectrum of surgical techniques that are available for their patients. The goal and educational emphasis of our fellowship is to provide a learning environment that allows our fellows to mature into surgeons that view themselves as the advocate for the surgical approaches when surgery is the superior modality for a given patient and cancer.
Strengths: The clinical strengths of the program include learning a full complement of organ preservation surgery (i.e., supracricoid partial laryngectomy, endoscopic laser laryngeal surgery for cancer), Transoral Robotic Surgery (TORS) utilizing the da Vinci Surgical System, thyroid and parathyroid surgery, parotid surgery,microvascular free flap surgery, and endoscopic and open cranial base surgery. With the outstanding addition of Steve Cannady MD , a Mark Wax MD trained free flap surgeon, together with Ara Chalian DM, our fellows will learn how to perform free flaps efficiently and successfully on a very large number of cases. The graduating fellow will be armed with the technical and perioperative management skills necessary to treat these complex problems, as well as the skills to manage all aspects of “general” head and neck surgical oncology. The University of Pennsylvania Center for Head and Neck Cancer is the first services in the world to offer Transoral Robotic Surgery (TORS) for the diagnosis and treatment of benign and malignant lesions of the upper aerodigestive tract. Robotic surgery has been found to be an important advance in the management of patients with head and neck cancers, and our fellows will be fully trained robotic surgeons. The TORS training program includes hands on cadaver training in our TORS training laboratory which is located in our department Temporal Bone Lab. We also offer post-graduate TORS training and have regularly scheduled TORS trainings that allow fellows to observe numerous TORS cadaver training sessions as well. It is our opinion that this will create an immediate clinical and research medium for an academic Head and Neck Surgeon. The goal of the program has been to help the recent fellowship graduates to transition into being independent practitioners in head and neck oncology.
Fellows’ Duties/Responsibilities: The Head and Neck Fellowship at the University of Pennsylvania is a clinically oriented 12-month experience, designed to provide advanced training in all aspects of the care of the head and neck cancer patient. During this time, the fellow will be mentored by the full-time head and neck faculty, as well as by a team comprised of medical oncologists, radiation oncologist, pathologists, and radiologists. They will work at, and cover both the Hospital of the University of Pennsylvania and Pennsylvania Hospital. The fellow works closely in the operating room with the supervising attending surgeons, and will actively participate in the training of residents. The fellow is involved in both ablative and reconstructive aspects of patient care. Comprehensive management of the patient is emphasized, and the fellow will be involved in the initial consults, preoperative visits, tumor board discussions, and postoperative care of the patients. This continuity of care allows for a better understanding of the full process of cancer management. Fellows are involved in clinic one-half day per week. They attend meetings of the PENN Center for Head and Neck Cancer, with presentation of approximately 800 new head and neck cases per year. This multidisciplinary treatment conference familiarizes the fellow with both surgical and non-surgical approaches in the management of head and neck cancer. As a junior member of the faculty, the fellow will also have an independent half-day clinic, and will diagnose, treat, and care for patients in this setting.
Research Opportunities: Research and teaching opportunities are also available and encouraged. The staff is available and interested in fostering clinical research.
The program has a very strong track record in academic job placement nationally. For those prospective applicants with an interest in our program the list of prior fellows and their contact information is available from our Staff Assistant, Viba Nguyen (Viba.firstname.lastname@example.org )