Chapter 12: A Brief History of the Section of Head and Neck Surgery
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Here Dr. Goepfert sketches the history of the Section of Head and Neck Surgery, officially started in 1952 with Dr. William McComb. He discusses Dr. McComb’s commitment to the principle of radical surgery, noting that during this period there were only limited possibilities for reconstructive surgery. He also talks about Dr. McComb’s collaboration with Gilbert Fletcher to combine surgical intervention with cobalt-60 radiotherapy, also discussing radiation therapy applied via implants. He notes that Drs. McComb and Fletcher published an excellent book in ‘65/65, Cancer of the Head and Neck. Dr. McComb was succeeded by Dr. Richard Jesse, who advocated for surgery combined with radiation and chemo therapy. He worked to define specific treatments for disease sites, using a single treatment when possible to avoid complications. He also implemented blood saving techniques during surgery and started intra-arterial infusions of chemotherapy. He was also a strong proponent of multidisciplinary care during a time of antagonism between surgeons who believed in radical surgery and those advocating radiation therapy. Dr. Goepfert explains that Dr. Jesse should also be remembered for creating the creating the chaplaincy at MD Anderson, an initiative that was fundamental to creating the Lutheran Pavilion. Dr. Goepfert compares the leadership styles of Drs. Jesse and McComb. (Continues, Segment 13)
Identifier
GeopfertH_02_20120828_C12
Publication Date
8-28-2012
City
Houston, Texas
Interview Session
Helmuth Goepfert, MD, Oral History Interview, August 28, 2012
Topics Covered
The University of Texas MD Anderson Cancer Center - MD Anderson Past; MD Anderson History; Building/Transforming the Institution; Multi-disciplinary Approaches; Portraits; Controversies
Transcript
Tacey Ann Rosolowski, PhD:
Yeah. Let’s shift gears. Before we talk about your role as head of the Department of Head and Neck Surgery, I did want to get a little bit of a sense of the history and the two gentlemen that preceded you.
Helmuth Goepfert, MD:
The program in the head and neck section basically officially started when Dr. McComb, back in 1952 or thereabouts—I think it was ’52—was hired by Dr. Clark. Now, mind you, from what you know already from the history of MD Anderson, you know how limited it was in those days. They operated in one place; patients were hospitalized somewhere else. So, I’m not going to go into that. But Dr. Clark [R. Lee Clark, MD], before that—as he was a general surgeon—he would operate thyroids. That was his favorite disease to treat, and he published extensively in that. There are some landmark articles that still exist, that still are quoted from Dr. Lee Clark. Of course, McComb came, and McComb was a product of Memorial Hospital in New York.
Tacey Ann Rosolowski, PhD:
Do you know why Dr. Clark selected him?
Helmuth Goepfert, MD:
That’s a good question. McComb basically was one of the favorite students of Dr. Hayes Martin, who was the chairman of Head and Neck Surgery at Memorial, a very unique person that sort of has endured through generations his name. Now nobody knows him anymore, but he was really an icon. He set forth some principles of head and neck surgery that McComb espoused and brought with him.
Tacey Ann Rosolowski, PhD:
What were those principles?
Helmuth Goepfert, MD:
Radical surgery in the sense that you could not enter a larynx if you were not going to do a total laryngectomy. So, any cancer that was not amenable to radiation therapy, the only option surgically was a total laryngectomy, which in those days is what existed. They were very much, for example, against modified or less than radical neck dissections. The neck dissection itself evolved over the years as part of the treatment of head and neck cancer.
Tacey Ann Rosolowski, PhD:
I guess I’m not sure what you mean by neck dissection. Could you define it?
Helmuth Goepfert, MD:
Yeah, neck dissection is the surgical procedure utilized to remove cancer in the lymph nodes of the neck and adjacent structures that may be involved.
Tacey Ann Rosolowski, PhD:
Kind of like when they would remove the— (speaking at same time)
Helmuth Goepfert, MD:
The axilla—the lymph nodes in the axilla that they remove from the axilla itself all the way up to the level of the clavicle. Here the radical operation was basically to remove lymph nodes all the way from here down to the clavicle.
Tacey Ann Rosolowski, PhD:
So the level of the ear down to the clavicle.
Helmuth Goepfert, MD:
Yeah, and, yes, there was no departure from that principle.
Tacey Ann Rosolowski, PhD:
That’s pretty devastating for the patient.
Helmuth Goepfert, MD:
But, yes, primarily because you lose the function of one of the important nerves, which is the spinal accessory nerve. The spinal accessory nerve, which goes through the latter part of the neck and what’s called the posterior triangle—and radical neck dissection is just eliminated. That function sort of drops the shoulder. They have shoulder drop. They cannot comb their hair anymore. You cannot raise your arm, and it becomes a very painful shoulder and a very painful neck. So, he had that principle. He was a strong proponent of radical surgery, yes, but radical surgery in those days was limited by the fact that you did not have any good surgical reconstruction. So, the surgical reconstruction in those days was relatively limited, I would say. There were a few techniques that were utilized, but most of patients that had a very radical operation and required reconstruction stayed a long time in the hospital. Hospitalization for these things took over and over and over again, and sometimes it was six months before a patient would finish the reconstruction. Of course, this often was head and neck cancer, and in six months they already had a recurrent disease or metastasis and tired of it, so they have spent the last six months of their life in the hospital. So that was the scenario. The next scenario was that Dr. McComb was radical in surgery and basically did not use techniques to spare blood loss.
Tacey Ann Rosolowski, PhD:
Why was that?
Helmuth Goepfert, MD:
Because it was not—they used scissors, they used knives, they used hemostats, but they didn’t use any of the electrosurgical knives that we are used to and that allow you to coagulate at the same time that you cut. You sort of followed certain principles that diminished the blood loss. That basically evolved under Dick Jesse, under Ballantyne and so forth. Today it’s the way that we operate, but in those days, a patient would have head and neck surgery and they’d immediately hang a unit of blood when they started. Three or four units of blood, okay, that was what I needed. He was radical in his surgery. In those days radiation therapy was still in the old mode of orthovoltage therapy. The cobalt unit was developed here by Dr. Fletcher. You know that history from other sources. Eventually the two sort of came together and started looking at the possibilities of, number one, better defining the treatment parameters for disease that could be treated by radiation—be this by external radiation therapy or be this by implants. In those days it was the radium needle implant. It was not the after loading technique or anything like that. It was the radium needle implant. They started the first attempts to combine treatment—surgery and postoperative radiation therapy. Dr. McComb himself was not a great publisher, but he and Dr. Fletcher in radiation oncology—or radiation therapy—produced what then was probably the best book in head and neck cancer—Cancer of the Head and Neck by McComb and Fletcher. That was published in 1964 or ’65. I was here when they first published it. I have one that is still signed by the then Vice President for Education. So, this joint interaction between two specialties started then in a primitive way. When Dr. Jesse came, and Jesse had been trained first as a general surgeon in Nebraska, he came to this department as a fellow first, and then Dr. White was the Chairman of surgery. He hired him as a surgeon. He was the second surgeon hired in this department in Head and Neck Surgery after Dr. Ballantyne. Dr. Jesse certainly set the foundations for several principles. Number one was the interaction between surgery and radiation therapy and the combined management of head and neck cancer. Number two, the specific definition of what disease sites would be better treated by one or by the other—the principle that for any disease, if it could be treated by just one modality, it would be better than joining two modalities.
Tacey Ann Rosolowski, PhD:
Why was that?
Helmuth Goepfert, MD:
Because two modalities add to morbidity, and if they’re not going to add on to the outcome, it’s not really necessary. Dick Jesse, too, implemented some—he was a very fast surgeon—started to implement some blood-saving techniques. He was using the electrosurgical units and so forth. Chemotherapy, Dick Jesse began the program of intra-arterial infusion, as I explained to you yesterday. Some of these papers were published in the late ‘60s, early ‘70s.
Tacey Ann Rosolowski, PhD:
Were their collaborations with developmental therapeutics? You mentioned J Freireich yesterday.
Helmuth Goepfert, MD:
No. Not yet. That came later. Definitely Dick Jesse sort of was a strong proponent of multidisciplinary care and respect for what the other specialty could do. This was a time in which there was still a great deal of antagonism out in the rest of the world, if you want to say so, in the area of radiation—between radiation therapy and surgery. There’s a famous quote by Dr. Jesse in the early ‘60s or mid ‘60s at one of the international conferences. He had been on a panel of early laryngeal cancer, and there still were proponents of doing total laryngectomy for this. This was predominantly among the otolaryngologists. He got up at the lectern and started his talk by stating that if there are still people that do a total laryngectomy for early laryngeal cancer, they should be—no—to treat early laryngeal cancer by total laryngectomy is malpractice. He stated that in this meeting. It caused a tremendous upheaval, but he was right. He was right. So, Dick Jesse is further to be remembered at this institution because he basically created the chaplaincy. Dick Jesse was fundamental in getting the funds for the so-called Lutheran Pavilion, and he was the one that sort of—the first chapel was built under his leadership. Dick Jesse was an educator, a surgical educator, and his death was very untimely because in the early ‘70s he caught hepatitis B from a patient. In his case, it evolved into liver cirrhosis, and he died of liver cirrhosis and esophageal variceal bleed. Dick Jesse trained most of the ones that were around then and most of the ones that we formed the department. After he left this was Dr. [Lauren A.] Byers, Dr. [Oscar M.] Guillamondegui, Dr. Gard, and Dr. [Robert “Bob” M.] Byers. No, he already had left. [Dr.] John Bardwil had left already before that. But, as I say, this is the history of these two masters’ that sort of—by 1971 there was a landmark publication between Dr. Fletcher and Dr. Jesse on the interaction of surgery and radiation therapy and the management of head and neck cancer.
Tacey Ann Rosolowski, PhD:
When you look back at these two men, how would you compare their styles of leading the department?
Helmuth Goepfert, MD:
Dr. McComb was a man of not many words, but what he said was the way it had to be done. So, it was a little bit in the school of Hayes Martin that he—now, mind you, I only knew McComb when I was a fellow, because when I came back as an advanced fellow, back in 1971, he was stepping down already, and he was not that visible anymore. But more of a communicator was Dr. Jesse. That certainly is true. He was much more of a communicator, and he was much more of an interdisciplinary person. He sort of participated actively with Dr. [Joe B.] Drane and some of the people in oncological dentistry to do sort of a program for the dentists in Texas thinking that by doing that and teaching the dentist how to recognize oral cavity cancer they could improve the care of cancer. Come to find out that the people that could get oral cancer in those days, which was smokers and drinkers, never go to the dentist. (laughs) So that was the end of it. But, as I say, if the dog doesn’t like the dog food, he aren’t going to eat it. So, these were the basic issues with Dr. Jesse and Dr. McComb.
Recommended Citation
Goepfert, Helmuth MD and Rosolowski, Tacey A. PhD, "Chapter 12: A Brief History of the Section of Head and Neck Surgery" (2012). Interview Chapters. 1011.
https://openworks.mdanderson.org/mchv_interviewchapters/1011
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