Surgery can be a simple, safe method to cure patients with solid tumours when the tumour is confined to the anatomic site of origin. Resection of the primary cancer involves definitive surgical treatment, encompassing a sufficient margin of normal tissue with the goal of cure with surgery alone. The magnitude of surgical resection is modified in the treatment of many cancers by the use of adjuvant treatment modalities. Selection of definitive surgical treatment involves careful consideration of the likelihood of local cure balanced against the impact of surgical morbidity on quality of life.1, 2 For example, pelvic nerve preservation is considered to maintain erectile functioning, ejaculation and orgasm.8
During tumour resection, early ligation of blood vessels and lymphatics is carried out to decrease the risk of spread and the tumour should be removed with minimal manipulation. 'En bloc' resection of the primary tumour and its regional extensions to adjacent organs and lymph nodes will reduce the risk of metastatic spread. The surgical procedure also ensures accurate staging of the tumour by determining size, nodal involvement and involvement of adjacent and regional tissues. Such information ensures that the need for and type of adjuvant therapy can be individualised. The extension of the surgical resection to include areas of regional spread can cure some patients, although regional spread is often an indication of undetectable, distant micrometastases and may indicate the need for systemic or locoregional therapy.1, 2
Individuals with a single site of metastatic disease that can be resected without major morbidity are generally considered for resection. This approach is especially appropriate for cancers that respond poorly to systemic therapy.1
Extensive local spread of cancer sometimes precludes the removal of all gross disease by surgery. The partial surgical resection of bulky disease in the treatment of selected cancers, termed 'cytoreductive' surgery, improves the ability of other treatment modalities to control gross residual disease that has not been resected.1, 2 Recent advances have seen shifts in the way advanced and / or metastatic disease is managed. Adjusted sequencing to provide systemic therapy or radiotherapy preoperatively has demonstrated improved outcomes and fewer side-effects.9
Access some evidence based clinical practice guidelines for a cancer with surgical treatment options and:
- Outline the definitive surgical approach/es used for this disease
- Identify the survival outcomes for definitive surgery at different stages of the disease.
Discuss the role of cytoreductive surgery for one cancer type.