Oncologic Surgery

1. Radicality. This term refers to the wide clearance of the tumor, including an area far broader than the margins of the tumor itself. In order to be able to achieve this during a cancer operation, the surgeon must extend his/her resection to areas away from the palpable and visible edges of the tumor, so as seemingly absolutely healthy tissues are included within the surgical specimen. This is important because there is always a possibility that some cancer cells may have moved away from the main mass of the tumor and be scattered around, not having formed lesions or nodules that can be felt with the tips of the surgeon’s fingers, or seen. For example, in order for a colon cancer operation to be radical and curative, one should remove no less than 5cm of bowel distal to the main tumor and 15cm proximal to it. It cannot be overemphasized that this kind of wide clearance should be sought after in all three dimensions around each tumor.

2. Number of lymph nodes. For a cancer operation to be truly curative, at least 15 lymph nodes should be removed along with the tumor, especially for a cancer of the digestive system. It is proven and stated in the literature again and again that patients who had undergone operations where more than 15 lymph nodes had been removed, had significantly better long-term survival, compared to those with less than 15 lymph nodes removed. Obviously, this kind of extensive “lymph node dissection” requires proven experience in and dedication to oncologic surgery by the surgeon; this far exceeds those of a simple general surgeon.

3. Minimal blood loss. It has been proven and published in many scientific journals several years ago that patients who had minimal blood loss during surgery for a cancerous tumor and required no blood transfusion(s), did a lot better long-term compared to those with significant blood loss during surgery that did require transfusions. So, it is essential that the operative technique should be very meticulous, refined, specialized and respectful of the tissue planes, and all this again requires a truly oncologic surgeon to accomplish.

4. Strategy. As soon as a tumor is diagnosed in a patient, the appropriate management strategy should be designed and implemented for this individual patient. It is essential to assess the stage of the tumor (i.e.: how advanced the tumor is) BEFORE the operation because in several cases it may be far better to first proceed with some other therapy (chemotherapy, or radiation) and not with an operation. This approach, in certain tumors and locations, allows for the eventual operation to be truly radical and curative for the patient.

5. Downstaging. Sometimes a tumor may be so advanced at the time of diagnosis that it is considered unresectable. This is usually the case when the tumor, because of its large size, involves other surrounding organs and major vessels that cannot be taken out altogether. In situations like this, we usually apply therapies and techniques that will shrink the tumor, decrease its size and “free up” the other surrounding organs and major vessels initially involved. This process may render a tumor resectable, even if it was unresectable at diagnosis.

By strictly adhering to these modern principles, we are sure that we are doing the VERY BEST for our patients, so they will not have recurrence of their tumor at the spot that it initially started from, or at another area of their body (metastasis). This combined and coordinated approach will also give patients the highest possible chance to get rid of their tumor once and for all.