Surgical Interventions in Cancer
Summary of Key Points
• The cancer surgeon is a key member of a multidisciplinary cancer care team.
• The surgeon is frequently the “entry point” for patients who are suspected of having cancer or are newly diagnosed with cancer.
• The surgeon must be prepared to communicate the results of initial biopsy pathology and staging to the patient, interpret these results in a meaningful way, and prepare the patient for the next steps in care.
• To be an effective member of the “team,” the surgeon must have knowledge of the biology and natural history of the cancer to be treated.
• The surgeon must be technically experienced in diagnostic procedures and operative interventions used in cancer management.
• The cancer surgeon must be experienced in the preoperative and postoperative care of surgical patients with complex cases.
• The surgical oncologist must have an appropriate knowledge base in medical and radiation oncology.
• Patients treated in a multimodality setting and in high-volume centers have improved outcomes.
• Training of the surgical oncologist must encompass the following:
Etiology and genetic predispositions of cancer
Environmental risk factors and natural history of specific tumors
Understanding of how to provide cost-effective treatment
Skills to develop, conduct, and manage clinical trials
Guidance in the management of advanced disease, including appropriate nutritional support
Guidance in offering compassionate support
Guidance in determining and evaluating outcomes
Skills in managing complications of treatment and of disease progression
• The surgical oncologist should be a participant in clinical trials, providing guidance in design and monitoring of quality control aspects of the surgical intervention component, as well as providing overall leadership and guidance in the study design and implementation.
• The surgical oncologist should be an educational resource in the health care environment and the community.
• The surgical oncologist plays an important role in prevention and screening.
1. Which of the following statements is not a measurable benefit for patients undergoing minimally invasive surgery?
2. Which is the most important factor for the surgeon to consider when obtaining tissue for cancer diagnosis?
A Knowledge of the suspected tumor type
B The proper placement of the biopsy incision
3. In many cases, patients with isolated metastases from solid tumors are candidates for surgical resection. The surgeon should consider which factors when presented with such patients?
1. Answer: C. The intracorporeal suturing of intestinal anastomoses has always been a challenge for conventional laparoscopy, especially in advanced cancer surgeries. Robotic-assisted laparoscopic surgery has been helpful in overcoming this disadvantage.
2. Answer: B. The proper placement of a biopsy incision, and for that matter, the trajectory of a core needle tract, is critical. Misplacement can compromise subsequent surgery because the goal is to include excision of the surgical biopsy tract to avoid as much as possible leaving implanted cancer cells.
3. Answer: F. Many patients with isolated or limited metastatic disease located in the liver, brain, and lung can experience significant palliation and sometimes can experience a cure through surgical resection of metastases. Two more prominent examples are colon and rectum cancer and soft tissue sarcoma.
