Surgical Oncology

Surgery may be used to obtain tissue for an accurate diagnosis or to determine the extent of cancer. Procedures may include surgical biopsy, endoscopic or minimally invasive assessment, sentinel lymph-node biopsy, lymph-node sampling, or staging laparoscopy. The tissue removed is examined by a pathologist to confirm the diagnosis and identify features that may help guide treatment. Not every patient requires a surgical biopsy or staging operation; less-invasive image-guided techniques may be suitable in some cases.

Open cancer surgery is performed through an incision that gives the surgeon direct access to the tumour and surrounding structures. It may be recommended for large or complex tumours, cancers involving multiple organs or major blood vessels, or situations in which minimally invasive surgery would not allow safe and complete treatment. Open surgery remains an important and effective approach in cancer care. The choice between open and minimally invasive surgery is based on oncological safety, technical feasibility, and the patient’s individual circumstances.

Minimally invasive cancer surgery uses small incisions and specialised instruments to perform an operation. Depending on the area being treated, this may include laparoscopic or thoracoscopic surgery. For appropriately selected patients, potential benefits may include smaller incisions, less postoperative pain, reduced blood loss, a shorter hospital stay, and faster recovery. These outcomes are not guaranteed, and minimally invasive surgery is not suitable for every cancer or every patient.

Robotic-assisted cancer surgery is a form of minimally invasive surgery in which the surgeon controls specialised instruments from a console. The system can provide magnified three-dimensional views and a wide range of instrument movement, which may assist in operating within confined or anatomically complex areas. Robotic-assisted cancer surgery is recommended only when it is considered safe, appropriate, and likely to support the intended surgical outcome.

Organ-preserving surgery aims to remove the cancer while retaining as much healthy tissue and organ function as is safely possible. Depending on the diagnosis, this may involve preserving speech, swallowing, continence, mobility, fertility, appearance, or the function of an affected organ. Suitability depends on factors such as tumour size, location, stage, response to treatment, and the ability to achieve adequate cancer clearance. Organ-preserving surgery may need to be combined with chemotherapy, radiation therapy, or another treatment.

Cytoreductive surgery, also called debulking surgery, aims to remove all visible cancer or reduce the amount of disease as much as safely possible. It may be considered for selected cancers that have spread within a body cavity or involve several nearby structures. The operation can be extensive and may involve more than one organ. Careful assessment is required to determine whether the potential benefits justify the risks and whether additional treatment will be needed.

Hyperthermic intraperitoneal chemotherapy, or HIPEC, is a specialised treatment used for selected cancers involving the lining of the abdominal cavity, known as the peritoneum. It usually follows cytoreductive surgery to remove visible disease. Heated chemotherapy is then circulated within the abdominal cavity for a specified period during the operation. HIPEC is not appropriate for every cancer involving the peritoneum. Suitability depends on the cancer type, extent of disease, whether adequate cytoreduction appears achievable, previous treatment, organ function, and overall health. The potential benefits and significant risks of this complex procedure require evaluation by an experienced multidisciplinary team.

Pressurised intraperitoneal aerosol chemotherapy, or PIPAC, is a minimally invasive procedure in which chemotherapy is delivered into the abdominal cavity as a pressurised aerosol. It may be considered for carefully selected patients with cancer involving the peritoneum, including some patients whose disease cannot be completely removed surgically. The role of PIPAC continues to be evaluated, and it is not a standard treatment for every patient with peritoneal disease. Availability and eligibility may depend on the diagnosis, previous treatment, treatment goals, and the supporting clinical evidence. Patients should discuss potential benefits, uncertainties, alternatives, and risks with a specialist multidisciplinary team.

Oncoplastic and reconstructive surgery combines cancer removal with techniques intended to restore form, cover a surgical defect, or preserve function. Reconstruction may use nearby tissue, tissue from another part of the body, implants, or a combination of approaches. Depending on the procedure and treatment plan, reconstruction may be performed during cancer surgery or at a later stage. Planning involves balancing cancer clearance, healing, appearance, function, and the possible need for radiation therapy or other treatment.

In selected patients, surgery may be considered for cancer that has returned or spread to another part of the body. Procedures may include removal of a limited number of metastatic deposits, treatment of an isolated recurrence, or surgery to relieve symptoms caused by obstruction, bleeding, pain, infection, or pressure on nearby structures. The purpose of surgery may be curative in carefully selected situations, but it may also be intended to control disease or improve comfort and function. Decisions are made after considering the extent of cancer, available non-surgical treatments, expected benefits, operative risks, and the patient’s priorities.