Many head and neck cancer patients will benefit from surgery. Patients at high risk of locoregional recurrence will also benefit from adjuvant postoperative radiation treatment.

Surgery can be used as the primary treatment of a number of head and neck cancers with curative intent. It can be used to salvage residual or recurrent disease or in the palliative management of some patients.

Timeframe for starting treatment

Surgery should be scheduled within four weeks of the MDM.

The time from definitive surgery to starting adjuvant treatment (plus concomitant systemic therapy when indicated) should be not more than six weeks.

Training and experience required of the surgeon

Fellow of the Royal Australian College of Surgeons or equivalent, with adequate training and experience that enables institutional credentialing and agreed scope of practice in head and neck cancers (ACSQHC 2015).

It is also necessary for the surgeon to have ongoing and regular attendance at and a commitment to MDMs and continuing professional development in head and neck oncology. All cancer surgeons should actively participate in regular audits of their surgical results and their oncological outcomes with functional outcome measures.

Documented evidence of the surgeon’s training and experience, including their specific (sub-specialty) experience with head and neck cancer and procedures to be undertaken, should be available.

Surgeons who undertake a high volume of resections have better clinical outcomes for complex cancer surgery and improved survival for their patients (David et al. 2017; Eskander et al. 2014; Liu et al. 2019).

Health service characteristics

To provide safe and high-quality care for patients having surgery, health services should have these features:

• critical care support
• 24-hour medical staff availability
• 24-hour operating room access and intensive care unit
• appropriate nursing and theatre resources to manage complex head and neck surgery
• diagnostic imaging including access to instrumental swallowing assessments
• pathology
• nuclear medicine imaging
• nurses, dietitians, dentists and speech pathologists with training and current experience in managing patients with head and neck cancer
• a clearly defined path to emergency care and advice after hours
• a clearly defined path and assured access to inpatient care
• ability to perform or refer to ancillary study.