Principles of surgical treatment in oncology

Inoperability[edit | edit source]

Surgical:
- due to extent, location (grows, clings to large vessels, located in the trunk, generalized…);
- for internal reasons - old age, comorbidities, GA cannot be administered.
Oncological:
- type is inappropriate to operate due to histological type ( malignant lymphoma , erysipeloid variant ca breast );
- tumor size is associated with a high probability of micrometastases;
- generalized tumor process.

It is rarely used.
in some congenital abnormalities and disorders (eg prophylactic colectomy in polyposis, orchidopexy in cryptorchidism, bilateral ablation in BRCA positive…).

only in localized forms or in situ tumors;
the prerequisite is perfect removal of the tumor, or lymphadenectomy;
however, we often have to add other modalities, as many solid tumors have to be considered as systemic diseases;
Some less invasive procedures have been used lately - for example, using the sentinel node method (we put a dye or radiopharmaceutical in the tumor area, the nodes stain within a few minutes, are removed and examined; if they are negative, radical lymphadenectomy does not have to be done…)

an important part of comprehensive treatment;
by removing the tumor, we reduce the mass of tumor cells in the body and improve the effect of other modalities (chemotherapy);
therefore, there is no point in removing the tumor unless it improves the effect of the treatment;
another indication is if there is a risk of local complications (obstruction of the GIT, bile ducts, spinal cord compression);
in the GIT we solve this with various anastomoses, lumen-retaining endoprostheses, stents…;
for superficially accessible tumors, we perform so-called remediation operations - removal of exulcerations (smells, bleeds, become infected).

palliative performance, only in certain circumstances (the size of the resection does not affect organ function, acceptable performance morbidity…);
most often in liver meta;
unresectable meta up to 3 cm can be treated by injection installation of 98% ethanol, or use cryodestruction;
other organs - lungs, brain, bones (excochleation and cement filling - fracture prevention);
pain surgery - myelotomy, chordotomy….