本文是2020年在美国耳鼻喉科学会(American Academy of Otorhinolaryngology-Head and Neck Surgery, AAO-HNS)举办的第29届尤金·N·迈尔斯医学博士国际研讨会关于头颈癌的讲座的记录。19世纪末，经过治疗的患者生存率为10%。随着手术技术的改进，当前约有三分之二的患者可以存活超过5年。团队合作和手术重建的进展为切除性手术带来了进步；相关辅助治疗在过去30年中进一步改善了预后。然而，前瞻性试验缺乏；大部分积累的知识基于回顾性的研究和部分现实世界的数据分析。当前对预后因素的认识在有效的治疗决策过程中起着核心作用。尽管头颈癌中大多数肿瘤和患者相关的预后因素受不了医疗干预的改变，一些环境因素（包括治疗、决策和质量）可以被改变。理想情况下，治疗策略的决策应该在专门的多学科团队会议上进行。然而，证据表明，外科医生和医院的手术量和专业化在头颈癌治疗后的患者生存中起着重要作用，无论是初次治疗还是挽救性治疗。颈淋巴结清扫术中手术质量保证的指标（手术切缘和淋巴结取样）对头颈癌患者的生存有显著影响，且可受到外科医生的专业知识的影响。用于改善外科手术质量的策略包括持续的绩效测量、反馈和最佳实践措施的传播。 本文是由Thieme出版的开放获取文章，根据创作共用许可的Creative Commons Attribution-NonDerivative-NonCommercial License，允许复制和再生产，只要给予原作适当的署名。内容不得用于商业目的，或进行改编、混搭、转变或基于之上构建。(https://creativecommons.org/licenses/by-nc-nd/4.0/)。

This paper is a transcript of the 29 th Eugene N. Myers, MD International Lecture on Head and Neck Cancer presented at the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) in 2020. By the end of the 19 th century, the survival rate in treated patients was 10%. With the improvements in surgical techniques, currently, about two thirds of patients survive for > 5 years. Teamwork and progress in surgical reconstruction have led to advancements in ablative surgery; the associated adjuvant treatments have further improved the prognosis in the last 30 years. However, prospective trials are lacking; most of the accumulated knowledge is based on retrospective series and some real-world data analyses. Current knowledge on prognostic factors plays a central role in an efficient treatment decision-making process. Although the influence of most tumor- and patient-related prognostic factors in head and neck cancer cannot be changed by medical interventions, some environmental factors-including treatment, decision-making, and quality-can be modified. Ideally, treatment strategy decisions should be taken in dedicated multidisciplinary team meetings. However, evidence suggests that surgeons and hospital volume and specialization play major roles in patient survival after initial or salvage head and neck cancer treatment. The metrics of surgical quality assurance (surgical margins and nodal yield) in neck dissection have a significant impact on survival in head and neck cancer patients and can be influenced by the surgeon's expertise. Strategies proposed to improve surgical quality include continuous performance measurement, feedback, and dissemination of best practice measures.Fundação Otorrinolaringologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).