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Chapter-12 Principles of Surgical Therapy

BOOK TITLE: Surgical Oncology: Fundamentals, Evidence-based Approaches and New Technology

Author
1. Breaux Jason A
2. Ahrendt Steven A
ISBN
9789350250518
DOI
10.5005/jp/books/11193_11
Edition
1/e
Publishing Year
2011
Pages
19
Author Affiliations
1. University of Pittsburgh, USA
2. University of Pittsburgh, USA
Chapter keywords

Abstract

The effectiveness of surgical extirpation in the treatment of cancer has been recognized since ancient times. The most well preserved early writings on the subject are by the Roman physician Galen who observed that some breast cancers could be cured by complete surgical removal of the tumor. Later, the Scottish surgeon John Hunter (1728-1793) described methods of patient selection and techniques of cancer surgery including wide excision for margins and lymphadenectomy for superficial cancers. The introduction of anesthesia and aseptic technique in the late 19th century paved the way for a rapid growth in surgical oncology, as more extensive resections to remove tumor became feasible. The concept of radical operations to completely remove tumors en bloc with a margin of normal tissue, along with the lymphatic drainage, was developed during this period straddling the turn of the 20th century. The classic example is the Johns Hopkins surgeon William S Halsted and his development of the radical mastectomy. More recently advancements in the understanding of tumor biology, the diagnosis of tumors at an earlier stage and the development of effective adjuvant therapies have resulted in a general trend toward less radical operations for cancer. Cancer, even at early stages, is being thought of and approached as a systemic disease warranting a systemic approach for effective treatment. Surgical therapy today is one component, albeit oftentimes the most important, in the multidisciplinary approach to treatment of solid tumors. A prime example of this trend is the evolution of the surgical treatment of breast cancer. There has been a progression from radical to modified-radical to segmental mastectomy and from extensive axillary node dissection to sentinel lymph node biopsy. Despite the trend toward less radical surgery for cancer, the role of surgical therapy remains paramount in the treatment of most localized solid tumors. The importance of sound surgical therapy remains vital as widespread screening for common malignancies produces trends toward diagnosis at early stages, when surgery is most effective and can be curative as a primary modality. Today, very few solid tumors can be cured with non-surgical therapies and adequate resection is the most essential part of most treatment algorithms. The importance of surgical treatment, therefore, has not diminished but rather changed with improved understanding of tumor biology and with the development of effective adjuvant therapies. Likewise, the indications for surgery in cancer have expanded to meet the needs of increasingly complex treatment algorithms to not only include removal of the tumor, but also play a crucial role in the diagnosis, staging, prevention and palliation of cancer. The most recent advancement has been the incorporation of minimally invasive surgical techniques widely applied in surgery for benign disease, to surgical oncology. While this process is still very much in evolution, it stands to reason that this represents the future of both oncologic surgery and surgical therapy in general.

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