Oncological surgery is a procedure indicated for the removal of the tumor and what we call the safety margin, which is an area without disease around it. This prevents cancer cells from remaining in the patient’s body.
It is considered the safest type of treatment that exists for cancer and, alongside chemotherapy and radiotherapy, it’s one of the most commonly used procedures against the disease. It is worth noting that a multidisciplinary approach, in which several therapeutic modalities are associated, usually generates better results.
In its early stage, cancer can be controlled or even cured through surgery. The surgical procedure will always be performed under anesthesia, in a hospital environment and with material and staff properly prepared for the intervention.
The main factors that must be observed in the decision-making process for cancer surgery are the following:
- Healing perspective;
- Type of cancer diagnosed;
- Complete or partial removal of the tumor;
- Assistance in diagnosing the location of the tumor;
- Checking whether the cancer has spread (metastasis) or is affecting the functioning of other organs; and
- Relief from the adverse effects of the disease.
Types of oncological surgery
Depending on the factors mentioned above, the oncologist and the multidisciplinary team will choose the most suitable option for surgery according to each case. The following are the options available:
Primary or curative (removal of the tumor) – in some types of cancer, the only treatment is its total removal through surgery. This procedure can also be done alongside other approaches, such as chemotherapy and radiotherapy;
Diagnosis – In most types of cancer, a biopsy is the main way to achieve an accurate diagnosis. During the procedure, the surgeon makes an incision in the skin and removes some of the suspicious tissue or the entire tumor. This sample is then sent to a pathologist, who will assess whether there are cancer cells, their type and origin;
Staging – Staging surgery is used to identify the size of the tumor and whether the cancer has spread to other organs or parts of the body.
Debulking (cytoreductive surgery) – sometimes it is not possible to completely remove the tumor because it is invasive. This means that the cancer has invaded other cell layers in the organ and can spread to other parts of the body (metastasis). In these cases, surgery is done to remove as much of the tumor as possible and treatment is supplemented with chemotherapy and/or radiation therapy either before (neoadjuvant) or after the operation (adjuvant). Complementary treatments aim to reduce the size of the tumor as much as possible;
Palliative – is adopted as a way to alleviate the adverse effects caused by the tumor, such as pain, the pressure it may be exerting on an organ, bowel blockage and bleeding, among others. This approach usually improves the quality of life of individuals with advanced or metastatic cancer;
Reconstructive – after the main surgery to remove the tumor, a new procedure can be indicated with the aim of improving the body’s function. On some occasions, reconstructive surgery may be done right after the tumor is removed, during the same procedure. An example is breast reconstruction after mastectomy (breast removal surgery);
Preventive – surgery can also be an alternative to reduce the risk of developing cancer. One example includes removing precancerous polyps in the colon as a way to prevent colon cancer. Or, in women with mutations in the BRCA1 and BRCA2 genes, the doctor may suggest the removal of the breasts (mastectomy) or ovaries (oophorectomy) as a way to reduce the risk of developing these types of cancer.
Minimally invasive surgical procedures
In addition to traditional surgery, popularly called open surgery (in which larger incisions are made in the skin), there are those called minimally invasive surgeries. This type of approach offers a faster recovery time and fewer adverse effects, such as pain, as well as a smaller cut.
The following are the main types of minimally invasive surgery:
Videolaparoscopy – holes are made in the skin, including the navel, through which a thin tube that carries a camera at one of its ends is inserted. Images can be viewed with perfect clarity on a video monitor. In the other small cuts surgical instruments are places, which are manipulated externally by the surgeon. This surgery can be performed for diagnostic or curative purposes, and is increasingly being used for oncological treatments;
Laser – a narrow beam of high-intensity light is used to destroy cancer cells;
Cryosurgery – consists of using chemical agents, such as liquid nitrogen, at a temperature of -195.8°C, to freeze and kill cancer cells. Also known as cryotherapy, it is a therapeutic process based on the treatment of cold injuries. An example of its use is in low-risk early-stage prostate cancer in men whose surgery or radiation therapy is not indicated. Another is to eliminate basal cell carcinoma (a type of skin cancer);
Mohs micrographic surgery – can be considered the most accurate and effective technique for the treatment of the most frequent types of skin cancer. It allows for the identification and removal of the entire tumor while preserving healthy skin around the lesion. The procedure consists of removing the skin cancer, layer by layer, and examining each one of them under a microscope in real time, until a disease-free margin is obtained, that is, until the complete removal of the tumor. Finally, the reconstruction of the wound, resulting from the removal of the tumor, is performed;
Endoscopic – A video camera and a spotlight attached to a cannula (thin, flexible tube) are inserted into the body through the mouth, rectum or vagina to examine internal organs, shown on a high-resolution video monitor. During this procedure, the doctor may remove samples of suspicious tissue, with the aid of instruments also inserted through the cannula, to be later evaluated by a pathologist;
Robotics – started to be carried out in 1999 with the help of a robot called Da Vinci®. It consists of mechanical arms, a screen with amplified 3D image and a console. This type of approach allows clinicians to perform complex procedures with more precision, flexibility and control than conventional surgery.
It is performed through small incisions in the skin, through which the surgical instruments and the camera are inserted. The doctor operates them through a control similar to the joystick of a video game, guided by the image with excellent resolution transmitted in real time on the screen.
Some of the benefits of robotic surgery include shorter hospital stay, faster patient recovery, less bleeding during the procedure, reduced risk of infections, and minimal scarring. The main types of cancer that can benefit from it are bladder, colorectal, gynecological, kidney, lung, prostate, oropharynx, thyroid and digestive system.