Fellowship in Advanced Head & Neck Surgical Oncology and Microvascular Reconstruction

Host:

Washington University School of Medicine

Program:

Head & Neck Oncology/Transoral Laser Microsurgery/Microvascular Reconstruction

Mailing address:

Jose Zevallos, MD, MPH
Department of Otolaryngology
660 S. Euclid Ave.
Campus Box 8115
St. Louis, MO 63110

Program address:

517 S. Euclid Ave
St. Louis, MO 63110
Phone (314) 362-0365
Fax (314) 362-7522

Program email:

jpzevallos@wustl.edu

Program Director:

Jose Zevallos, MD, MPH

Program Duration:

This is a one year program, July 1 - June 30.


Prerequisite Training/Selection Criteria

The applicants, to be eligible to start full duties on July 1, must have:

  • A medical degree from an accredited institution

  • Graduation from a US ACGME-accredited otolaryngology residency program

  • A physician’s license from the Missouri State Board of Healing Arts, BNDD, and DEA.

  • Three letters of reference — at least two from faculty members of the training program of origin, one of whom is the program chair — provided to the preceptors of the fellowship

  • Attain hospital privileges at Barnes-Jewish Hospital and the John Cochran VA Medical Center.

  • Participation in the AHNS centralized application process and match

  • Preference is given to those applicants who have performed exceptionally in their residency program and excelled in the six core competencies. We place an emphasis on l) a high level of technical proficiency, 2) a keen interest in academic otolaryngology as a future career and 3) a strong track record in teaching and working well with other trainees and faculty. Salary is commensurate with PGY level.

Overview

The Fellowship in Advanced Head & Neck Surgical Oncology and Microvascular Reconstruction within the Department of Otolaryngology at Washington University is a longstanding feature of the educational curriculum offered within this academic medical center.  Since 1984, 33 fellows have continuously occupied this position.  Prior to this, the Department offered a Head and Neck surgery fellowship, which concentrated mainly upon resectional techniques, under the direction of Dr. Joseph Ogura.  Our intention is to carry on this strong legacy of surgical innovation within the multidisciplinary context of modern head and neck cancer care.  The large majority of fellows have graduated from this program to faculty positions in other academic institutions, where they practice and teach the techniques they have learned. The fellowship takes place primarily at Barnes-Jewish Hospital.  Rotations at the John Cochran V.A. Hospital are also possible, and provide the fellow with graduated autonomy in both head and neck cancer ablation and complex reconstruction.

Goals and Objectives for Training

  • Diagnosis and office management/work up of patients with neoplastic (benign and malignant) diseases of the head and neck.

  • Surgery for head and neck cancer and other benign tumors of the head and neck, transoral surgery, skull base surgery, and reconstruction for defects of the head and neck with a special emphasis on microvascular free tissue transfer techniques.

  • Post-operative management and rehabilitation of patients with head and neck oncologic conditions and reconstructions.

  • Participation in Multidisciplinary Head and Neck Cancer Clinic.

  • Participation in management of a multidisciplinary Head and Neck Oncology Tumor Board within an NCI Comprehensive Cancer Center.

  • Multidisciplinary  treatment planning  and coordination  with radiation oncology, medical oncology, other surgical-medical services (i.e. thoracic surgery, neurosurgery, ophthalmology,  dermatology,  etc.), pathology,  radiology,  speech pathology,  and prosthodontics  for patients with  head and neck neoplastic  diseases. This includes neoplastic diseases of the upper aerodigestive tract, skull base, thyroid gland, parathyroid glands, salivary glands and skin.

  • Participation in presentation of a head and neck reconstructive core curriculum lecture program for residents and medical students.
     

Strengths

The broad educational purpose of this fellowship program is directed to graduating fellows who develop and have superior proficiency in head and neck surgical oncology.  An important strength of this program is exposure to the full depth and breadth of transoral techniques for upper aerodigestive tract malignancies, including both transoral laser microsurgery (TLM) and transoral robotic surgery (TORS).  Additionally, our fellows graduate with an expert level of confidence with complex head and neck reconstruction and independent skills in microvascular free tissue transfer. Competence in choice and execution of flaps from all relevant donor sites for reconstruction of a full range of recipient sites is attained (free tissue transfer, regional flaps, and local flaps). Another important feature of the fellowship is a broad experience in open and endoscopic skull base resection and reconstruction with two dedicated skull base surgeons within our group.
 

Teaching Staff

Dr. Jose P. Zevallos MD, MPH, FACS -  Dr. Zevallos serves as Division Chief of Head and Neck Surgery and at Washington University and director of the fellowship.  He is a head and neck surgeon-scientist with extensive experience in head and neck surgical oncology and reconstructive techniques.  He completed his residency training at Baylor College of Medicine and head and neck surgery fellowship with Dr. Mark Urken at Mt. Sinai Beth Israel Medical Center in New York City.  In addition to his clinical practice, Dr. Zevallos is a federally funded translational head and neck cancer researcher who has published extensively on the epidemiology of head and neck cancer.  His supervisory responsibilities include recruitment, and selection of the fellow and design of the schedule. Daily observation and mentoring of the fellow’s skill set and competency is incorporated. As the year progresses, Dr. Zevallos ensures that appropriate progress is being made in skill acquisition, advising the fellow on what aspects may need strengthening. Dr. Zevallos also tracks the numbers of procedures performed with or by the fellow to ensure he/she gains adequate experience as the year proceeds.

Ryan S. Jackson, MD – Dr. Jackson is an Assistant Professor of Otolaryngology in the Division of Head and Neck Surgery at Washington University.  He has an undergraduate degree in nuclear medicine and completed his specialty training in Otolaryngology at the University of South Florida.  He was recruited to the Otolaryngology faculty at Washington University after completing an Advanced Head and Neck Oncology and Reconstructive Surgery fellowship at Mayo Clinic in Rochester, MN.  He has clinical expertise in Head and Neck Oncology and robotic surgery and has been involved in clinical research projects on patients who have had transoral robotic surgery for oropharyngeal carcinoma.   His clinical interests include transoral robotic surgery, minimally invasive surgery for oropharyngeal cancer, HPV positive oropharyngeal cancer, microvascular free tissue transfer reconstruction of major ablative head and neck defects, thyroid neoplasms, benign and malignant salivary gland neoplasms, benign and malignant head and neck tumors, osteoradionecrosis of the mandible.

Randy C. Paniello, MD, PhD, MPH - Dr. Paniello is an NIH-funded surgeon-scientist that practices both head and neck surgery and laryngology.  He completed his otolaryngology residency at Washington University and his microvascular fellowship with Dr. Richard Hayden.  In addition to the full range of traditional head & neck surgical procedures, he has expertise in open partial laryngectomies and performs them frequently. The head & neck fellows are also invited to participate in his complex laryngology cases, including tracheal resections with end-to-end anastomosis and laryngeal reinnervation procedures.

Patrick Pipkorn, MD - Dr. Pipkorn went to medical school and residency in Sweden. As part of his otolaryngology program, he spent a full year with Dr. Johannes Fagan focusing on head and neck cancer at the University of Cape Town, South Africa.  After completion of two years of head and neck fellowships, the first one at University of California-Davis, Sacramento and the second one at Washington University in St Louis, he transitioned to faculty at our department. During his first year, he pursued further training in a master’s degree focusing on clinical investigation under the leadership of Dr. Jay Piccirillo.  Dr. Pipkorn’s research interests are within clinical outcomes. During the fellowship you will be working closely with Dr. Pipkorn who performs all aspects of head and neck oncologic surgery, including endoscopic and open skull base surgery, transoral laser surgery as well as microvascular reconstruction. Having had an extensive exposure to multiple training programs and different countries and cultures, he brings a unique perspective to our program.

Jason T. Rich, MD, FACS - Dr. Jason Rich is a head and neck surgeon who performs both oncologic ablation as well as reconstructive surgeries for cancers of the head and neck. He received his medical degree at The Ohio State University and completed his residency training Otolaryngology at Washington University in St. Louis, Missouri. He then completed a head and neck surgery fellowship at the University of Toronto. Since then he has been faculty at Washington University in St. Louis. Dr. Rich performs all aspects of head and neck oncologic surgeries including transoral laser microsurgery. He performs a wide variety of reconstructive techniques that span from local flaps to microvascular free tissue transfer with a focus on tailoring reconstruction to each patient’s specific needs and circumstances. He also has an interest in airway reconstruction. His research interests include geriatric head and neck risk stratification and improving long-term surveillance and care for head and neck survivors.

Debra Gonzalez, MD - Dr. Debra Gonzalez joined the department in July 2015 where she serves full time as Chief of Otolaryngology at the John Cochran Veterans’ Administration Medical Center and part time as Assistant Professor of Otolaryngology at Washington University.  She received her M.D. from Cornell University Medical College in New York.  She then completed a Laser Research Fellowship in Otolaryngology at Vanderbilt University Medical Center and fulfilled an Otolaryngology residency at the University of Vermont Medical Center.  After residency, she completed a head and neck oncology and microvascular reconstructive surgery fellowship at the University of Iowa Hospital and Clinics, and joined the faculty at the University of Tennessee.   Dr. Gonzalez was recruited to Washington University School of Medicine from Southern Illinois University School of Medicine where she was Assistant Professor after completing a laryngology fellowship at that institution.  Dr Gonzalez’ scope of practice includes the full range of head and neck cancer ablative and reconstructive surgery in the oral cavity, pharynx and larynx including transoral laser resection and microvascular free flap reconstruction.  She also enjoys thyroid and parathyroid surgery, endoscopic sinus surgery, microlaryngeal surgery and sleep surgery.  We are fortunate to have her lead Otolaryngology at the St. Louis V.A. Medical Center.

Christine Klatt-Cromwell, MD - Dr. Klatt-Cromwell, MD serves as a rhinologist and skull base surgeon.  She completed residency at the University of North Carolina in Chapel Hill, and then completed the Advanced Rhinology, Oncology and Open/Endoscopic Skull Base Surgery Fellowship at the University of North Carolina in Chapel Hill under Dr. Adam Zanation.  Her clinical work encompasses skull base tumors, sinonasal tumors, and minimally invasive head and neck tumor surgery.  She also works extensively in rhinology doing functional rhinologic surgery, CSF leaks, and skin cancer surgery.

Wade L. Thorstad, MD, Associate Professor of Radiation Oncology

Hiram A. Gay, MD, Associate Professor of Radiation Oncology

Mackenzie Daly, MD, Assistant Professor of Radiation Oncology

Douglas R.  Adkins, MD, Professor of Medicine, Division of Medical Oncology

Peter Oppelt, MD, Assistant Professor of Medicine, Division of Medical Oncology

Samir El-Mofty, DMD, MS, PhD, Professor of Pathology & Immunology

Rebecca Chernock, MD, Associate Professor of Pathology & Immunology
 

Duties and Responsibilities of Fellows

Clinical responsibilities are divided amongst 6 head and neck surgeons and 2 endoscopic skull base surgeons. These clinical responsibilities are divided between the clinic, the operating room, and postoperative care. In a typical week, the fellow’s time is divided by approximately 1.5 days per week in the clinic, 3 days in the operating room and 0.5 days for research. The fellow evaluates and manages patients with advanced head and neck oncologic conditions, including those undergoing transoral surgeries (transoral laser microsurgery or transoral robotic), open partial laryngectomies, surgery for paragangliomas, surgery for skull base malignancies (endoscopic and open), and complex reconstructive surgeries requiring free tissue transfer. All clinical care is done in close collaboration with the otolaryngology residents and under the supervision of the faculty. The fellow has an Instructor position with the medical school and is expected to function at this level. As such, for other head and neck case (including laryngectomies, thyroidectomies, parotidectomies, neck dissections, and sentinel lymph node biopsies, etc.) the fellow supervises the work of the residents and takes more of a teaching physician role, particularly in the operating room.
 

Research Opportunities

The fellow is required to formally allocate approximately 10% of his/her time to research.  This involves designing a research project, acquisition and analysis of data.  A large tissue repository is available for molecular/translational research projects within an established laboratory.  For clinical research, data is acquired from epidemiologic databases or patient charts. There are significant options available for research projects, with an impressive infrastructure within the department and institution for support. One written abstract/manuscript is expected to be submitted for either a peer-reviewed scientific program or for publication in a peer-reviewed journal.   Projects undertaken by fellows have included detailed measurements of flap dimensions for precise planning of head and neck reconstructions, analysis of how preoperative variables correlate with postoperative outcomes, and defining quality metrics for patients undergoing surgery for head and neck malignancies.  Data analysis and outcomes of transoral laser microsurgery cases has produced several publications and data is collected on a regular basis for future studies.
 

Supervision, Teaching and Call

The fellows work in a teaching and supervisory role to the otolaryngology residents.   He/she provides oversight and support to the residents in pre-operative, operative, and post-operative care of the head and neck patient, including regular ward rounds with the residents.  During resident-level operative procedures, the fellow acts in a teaching surgeon role to the residents and helps them develop their technical skills. The fellow is also available to provide assistance and supervision to residents for inpatient consultations.

The fellows are required to take department otolaryngology call 1 weekday per month, and 1 weekend approximately every 4 months. This is equitable with the call responsibilities with the other faculty members in the department. The fellows also take call for the patients that they directly take part in surgical or non-surgical management of their neoplastic disease.
 

Evaluation

Fellows are evaluated informally on an ongoing basis with regular feedback. Residents are formally evaluated at 6 months and at the completion of the fellowship.