This issue brings together a series of articles that at first glance span different corners of head and neck surgery, from factors that predict perineural invasion in hypopharyngeal squamous cell cancer, described by Li et al., to pragmatic questions about service delivery and patient care pathways.Reference Doran, Whiriskey, Sheehy, Johnston and Byrne1 When taken together, these articles highlight that progress in medicine arises from not just isolated findings but the interaction and alignment of biology, technology and everyday clinical decision making.
A complementary perspective emerges from the review of the epidemiological and clinical landscape of nasopharyngeal carcinoma over two decades reported by Khalil et al. Whilst nasopharyngeal carcinoma shares with hypopharyngeal cancer a potential for submucosal and perineural extension, its epidemiology, viral associations and therapeutic managements paint a contrasting picture. Advances in radiotherapy precision, plasma Epstein–Barr virus DNA monitoring and immunotherapy are reshaping outcomes, but only when matched by systems capable of early detection, co-ordinated care and equitable access for all populations.Reference Cai, Wang, Ma, Yang and Xu2–Reference Simo, Robinson, Lei, Sibtain and Hickey5
The theme of when research data research meets reality threads through many articles in this issue and the medical literature in general. Large data sets and sophisticated analyses are only as powerful as their alignment with day-to-day clinical practice, as seen in the article examining outcomes in advanced laryngeal cancer. Real-world results remain influenced by other external factors, such as referral delays and patient co-morbidities.Reference Homer and Winter6–Reference Zhu, Gong and Liu8
This issue also focuses on the surgeons of tomorrow. Surveys of UK ENT trainees show that the human work environment is a key driver of progress. This includes confronting the uncomfortable reality that bullying, harassment and undermining behaviours still occur within surgical training, with consequences that extend beyond individual distress.Reference Walsh, Gulati, Shah, Snee, Rapoport and Scriven9, Reference Smith, Tallentire, Pope, Laidlaw and Morrison10 The evaluation of ENT trainee well-being in the UK makes it clear that psychological safety, respectful supervision and a culture that values compassion are not optional extras but a pre-requisite for high-quality care and high-quality training. A profession that prioritises dignity and well-being will not only train better surgeons, it will serve patients better too.
SENIOR EDITORS
ANN-LOUISE MCDERMOTT
JONATHAN FISHMAN
STEPHEN JONES
