ONCOLOGIC SURGERY

Before briefly describing abdominal surgical procedures, it is useful to mention some principles of oncologic surgery. This is undoubtedly the most challenging part for an abdominal surgeon, as it involves both the resection phase (removal of part of the organs affected by the tumor) and the reconstructive phase aimed at restoring anatomical conditions, while protecting the patient from complications that a more or less aggressive surgery may cause. At the same time, the goal is to ensure a good or at least acceptable quality of life in terms of recovery of the patient’s motor functions, digestion, and bowel movement, as well as the function of the organs operated on, limiting long-term sequelae that could sometimes arise.

Oncologic surgery procedures must adhere to certain precise rules that are part of the surgeon’s knowledge base. These include a series of technical steps to ensure radical removal of the tumor, avoiding its rupture and spread, and including the removal of nearby lymph nodes. This ensures the operation’s success in terms of tumor eradication and allows for proper staging, which is essential for classifying the disease stage. This classification provides prognostic elements and may indicate the need for complementary treatments to resolve the oncologic issue.

For this reason, it is crucial to collaborate with other professionals to ensure the best care for the patient and their specific type of cancer. This requires discussing the clinical case with radiologists, oncologists, radiotherapists, pathologists, interventional radiologists, endoscopists, and other professionals, such as dietitians, physiotherapists, and nurses. The surgeon must consult with them during the perioperative period to establish treatment priorities and ensure the best care. This is the purpose of multidisciplinary discussions—regular meetings to analyze individual oncologic cases.

Preoperative treatment (such as chemotherapy or neoadjuvant radiotherapy) may be indicated to reduce the size of the primary tumor, allowing for a safer and more manageable operation with a reduced risk of distant metastases.

More recently, surgery for liver, peritoneal, and lung metastases has become more common, as international studies have shown that, for certain types of cancer (e.g., colorectal, neuroendocrine), treating metastases can significantly improve survival and even lead to recovery.

Advances in anesthesia, resuscitation techniques, and medical treatments for cardiovascular diseases allow for more aggressive surgeries, even in older patients. However, it is important to remember that such procedures should be performed in facilities with Intensive Care Units (ICU) and properly trained professionals.

Oncologic surgery can also be performed using minimally invasive techniques such as laparoscopy and robotic surgery.

Factors such as the tumor location, comorbidities (concurrent diseases), patient characteristics (age, body weight, previous surgeries), and the surgeon’s experience must be considered when deciding on the best approach, whether open, laparoscopic, or robotic.

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