Numerous variables impact on the indications and outcomes of surgical approaches in cancer control.
Tumour related factors
The nature and extent of surgery relies on accurate histology, staging, and grading of the tumour.2 Factors indicating whether a solid tumour is amenable to surgery include its:2
- growth rate
- metastatic potential.
Slow-growing tumours with a long cell cycle, low growth fraction and low metastatic potential are the most amenable to definitive surgical treatment.
Factors related to the person affected by cancer
Individual factors which influence decisions about surgery in the management of cancer include:2
- the staging and grading of cancers at presentation
- an individuals' health status
- disease trajectory
- treatment history.
As with any treatment, the potential benefits of surgical intervention in people with cancer must be considered against the risks. The most common causes of death after surgery are bronchopneumonia, congestive heart failure, myocardial infarction, pulmonary embolism and respiratory failure.1 Risk factors to consider include smoking, obesity, and cardiac and pulmonary comorbidities. Neo-adjuvant, concomitant, and adjuvant therapies may also complicate post-operative recovery, resulting in impaired secondary wound healing, infection or electrolyte imbalance.2
It has been demonstrated that short and long term outcomes after surgical treatment of cancer do not differ according to the person's age.14 However, older people with cancer may not be offered standard surgery and may be more likely to undergo palliative procedures or have no surgery at all due to a presumed fear of increased post-operative morbidity and mortality.15, 16
Health service related factors
Improved surgical outcomes have, in part, been attributed to the subspecialisation of the team looking after the person affected by cancer before, during and after surgery.9 Volume is one proxy indicator for improved outcomes17 For example, one study of Australians with colorectal cancer reported that those seen by high volume surgeons were less likely to be given a permanent stoma or have macroscopic residual tumour and were more likely to receive a colonic pouch, be seen by a stoma therapist and undergo a laparoscopic procedure.18 It has been acknowledged that, ‘ensuring that all patients have access to treatment by the appropriate team in the appropriate setting remains a challenge for the clinicians, the colleges and state and federal institutions’.9
Review the surgical record of a person affected by cancer and identify factors which were taken into account in determining the decision to undergo surgery.
Access a current text and Effect of smoking on early complications after elective orthopaedic surgery19 and Temporary abstinence from smoking prior to surgery reduces harm to smokers20 (free resource, but you must register and login to access it), and:
- Outline the increased risks posed to a surgical candidate who smokes
- Describe the benefits of temporary cessation of smoking before surgery.
- Summarise current trends in mortality associated with surgery in older adults
- Sutline factors associated with higher surgical risk in older adults.
Access the article Treatment patterns for cancer in Western Australia: does being Indigenous make a difference?23 and relevant statistical data at the AIHW website and:
- Describe any disparities in the surgical management of cancer in Indigenous and non-Indigenous populations in Australia
- Summarise the possible reasons for the disparities
- Discuss recommendations to reduce disparities.
Access Quality of care in surgical oncology24, and summarise the reported impact of the following health service outcome measures on quality in surgical oncology:
- Volume-outcomes relationship
- Multidisciplinary teams
- Surgical technique.