D. Gregory Farwell, MD, recently arrived at Penn Medicine to assume the leadership of the Department of Otorhinolaryngology - Head and Neck Surgery (Penn ENT) from the University of California, Davis.
A practicing surgeon, Dr. Farwell has a particular focus on patients with tumors of the head and neck, and the complex reconstructive surgeries required to help them achieve optimal quality of life after surgery.
An advocate for innovation in surgery, his practice includes minimally-invasive surgery for thyroid and parathyroid disorders, trans-oral robotic surgery for oropharyngeal tumors, and more recently, non-invasive fluorescent technologies to assist in margin detection during robotic surgery.
The following interview was conducted in September 2021:
Dr. Farwell, as a surgeon and academic who's practiced primarily on the West Coast, what brought you to the Penn ENT program in Philadelphia?
In the first place, the reputation of Penn Medicine's Department of Otorhinolaryngology - Head and Neck Surgery spans the globe.
Everyone in the field is aware that transoral robotic surgery had its origin at Penn.
The research originating at Penn and its influence on national guidelines for sleep medicine, sinus surgery, cancer biology, and the essence of hearing cannot be underestimated. Each of our subspecialties are top notch — and the impact on science, innovation and discovery emerging from the Department is world class.
When you combine these things with an institution like Penn that's attracting incredibly bright people, you have a very special thing. I couldn't be happier to be here.
You've published recently on several topics of interest to Penn ENT, including TransOral Robotic Surgery (or TORS) and fluorescent-guided intraoperative imaging, both of which had their origin here.
As the Department Chair and a surgeon, what do you see as the future direction for these innovations at Penn?
It's certainly a relevant question, because TORS originated here at Penn, and Penn has been instrumental in fluorescent image-guided surgery. Both TORS and fluorescent image-guided surgery are elements of precision surgery in head and neck surgery. And when you think about my role as a surgeon that treats tumors that affect the way we look, the way we hear and swallow, the way we speak, and our social interactions, it's clear that this type of precision surgery is the future.
I've spent my career in head and neck surgery, and I am passionate about doing everything we can to advance precision surgery and help our patients. Whether it's ultimately a combination of different technologies or different modalities, I think we can expect great things to arise in the years ahead at Penn for these therapies.
Head and neck surgery tends to get a good share of attention in ENT, but what's happening at Penn ENT in the other areas of the specialty?
Our ENT team is at the cutting edge across the entire specialty in both research and treatment.
Our rhinologists are truly world-class. They're doing unbelievable research in understanding what's driving the inflammation that leads to the nose and sinus problems here in Philadelphia and elsewhere. Their influence on the field is remarkable and is the reason they are consistently viewed as one of the truly exceptional rhinology groups in the country.
Our otologists and neurotologists are restoring hearing and treating tumors from an unbelievably sensitive part of the body, and developing a new center for adult genetic hearing loss which will provide clues into why some of us are predisposed to hearing loss.
And our laryngologists provide cutting edge therapy for those with voice and swallowing problems. Excitedly, we are growing this division to include additional research into better ways to prevent and treat these challenging conditions.
As a specific example of the Department's impact on the field:
Sleep problems are epidemic in the United States. The sleep surgery group here at Penn has no equivalent in the country for the sophistication of the ways they're looking for the causes of sleep disturbance and the ways they're trying to find patient-specific solutions.
For people with sleep apnea and other disorders, it's very important to know the origin of the problem — and we know that this isn't happening for most patients. The default solution is to get a C-PAP and mask, a treatment many patients can't tolerate, which leaves them at a disadvantage for what to do next.
And this is the difference at Penn ENT's Sleep Surgery Program.
The group here is three or four standard deviations above the average. They offer very specific analyses of each patient to understand the source of their sleep problems. So for some patients, the solution is going to be the mask. For some may be a new technology called Inspire. For others it's going to be skeletal surgery to ensure that the breathing passages are as open as possible.
Distraction Osteogenesis Maxillary Expansion (DOME) expands the upper jaw to improve airflow when the oral vault is too narrow.
Transpalatal advancement pharyngoplasty is an advanced option for treating soft palate collapse.
Our sleep surgeons work closely with the clinicians at the Penn Sleep Medicine Center, as well, and their collaboration makes for better outcomes, better understanding, better research and better patient care.
Airway cells demonstrating the cilia motility-associated proteins endothelial nitric oxide synthase (eNOS) [pink] and tubulin [green].
You mentioned the collaboration between our sleep surgeons and the Penn Sleep Medicine specialists. Are we seeing more of this sort of interaction and collaboration in ENT?
That's been happening at Penn ENT for some time.
For example, our rhinologists are currently performing research that has its origin in microbiology and immunology. The object of this research began as an effort to better understand what causes the inflammation that leads to sinus polyps and infections. It turns out, though, that this investment in research has discovered a category of proteins called bitter taste receptors that may have a very important role in cancer surveillance, prevention, and treatment.
This is just one of many examples of how important it is to have that cross pollination across disciplines and ideas.
Dr. Farwell, what are your aspirations for Penn Medicine's Department of Otorhinolaryngology - Head and Neck Surgery moving forward?
Penn ENT is an impactful place and one that's very unique, but at an institution like Penn, we can do even more.
So we're recruiting now for additional specialists in laryngology and neurotology, for example. We're going to be growing our research division and bringing in additional expertise in auditory science to help us better understand and treat hearing problems.
We will be hiring researchers in viral carcinogenesis to investigate why some viruses cause cancer and we are doing several clinical trials looking at improvements in the way we can treat these cancers and decreasing those side effects. So in the big picture it's going to be taking what's an unbelievable group and look for those opportunities where we can just keep raising the bar for our patients and for the department and for Penn.
Finally, Dr. Farwell, what's the one thing you would want Penn ENT's long-term and vital referring physicians in the community to know?
When I think about referring physicians, I'm reminded of one of the things a former colleague of mine would say — that we're here to complete, not to compete.
I think this really speaks to the way we would like to be viewed by our colleagues and partners, as working with referring physicians. We want to partner with them to provide care for their patients. I am excited about improving the integration of our Penn academic and community ENT team and ensuring that by working together, we can ensure that the care their referred patients receive is exactly the world-class care we would all want for our loved ones.
And I want personally to thank our referring partners. Their trust, by sending patients to Penn, provides a benefit that comes full circle by providing resources for future research, for example. This leads to new discoveries and new standards of care, and these advances feed back into the field as we train the next generation of ENTs, who become their partners in the future.
The trust of our community partners is a huge part of the success we have, ultimately, in every aspect of what we do.