Principles of oncologic surgery

Question 1

What are the aims of oncologic surgery

Answer 1

• Diagnostic - biopsy
• Therapeutic

Question 2

What are comorbidities of oncologic surgery?

Answer 2

• Tumour-related e.g. vomiting
• Unrelated e.g. cardiac, hepatic, renal disease
• Correct physiological abnormalities as much as possible before surgery

Question 3

What should be done with anaesthesia and analgesia regarding tumour surgery?

Answer 3

• No local anaesthetics into tumours - Distorts tissue + complicates histopathology, can increase metastasis
• Appropriate preoperative analgesia is essential - tumour + surgery = painful

Question 4

With nutrition what should be considered?

Answer 4

• Appetite can be affected by pre-op pain = consider placing feeding tube

Question 5

Why would you consider prophylactic antibacterials?

Answer 5

• Tumours, adjunctive treatment + comorbidities can cause immunosuppression
• Oncologic surgeries can be long

Question 6

What should be done to prepare for surgery?

Answer 6

• Clip a wide area - reconstruction may be required
• Avoid vigorous scrubbing - cell exfoliation = increase risk of metastasis

Question 7

What are different types of tumour excision?

Answer 7

• Radical excision - Removal of the entire anatomical compartment containing the tumour
• Wide excision - Resection of the tumour and a margin of surrounding normal-appearing tissue
• Marginal excision - Removal of all visible tumour dissecting around the tumour margin
• Debulking - Incomplete resection with residual gross disease

Question 8

What is the best chance of achieving surgical cure for a tumour?

Answer 8

• First surgery - try take as much as possible away

Question 9

What are factors for surgical approach?

Answer 9

• Tumour type and behaviour
• Tumour grade
• Tumour size
• Anatomic location
• Owner’s preferences
• Intent of surgery - curative / palliative
• Function
• Ethics
• Cosmesis

Question 10

Why would you perform lymphadenectomy?

Answer 10

• Diagnostic - for staging
• Therapeutic - to reduce disease burden or further metastasis
• benefit uncertain for most tumours

Question 11

How do halsted’s principles help with oncological surgery?

Answer 11

• Gentle tissue handling
  -rough handling = cell exfoliation = tumour rupture contaminates wound bed
• Meticulous haemostasis
  -early ligation = reduced metastasis
  -don’t cut into tumour with ligatures
  -excessive cautery = complicates margin
• Minimal tension
  -don’t compromise resection for reconstruction
• Accurate tissue apposition
  -longer-lasting sutures
  -avoid multifilament - can harbour tumour cells

Question 12

What should be done when assessing surgical margins?

Answer 12

• Submit a useful sample - tack tissues - reduce distortion / shrinkage
• Use enough formalin
• Give enough information - signalment, history, staging, differentials

Question 13

What should be done to manage incomplete margins?
(if all the tumour isn’t cut out)

Answer 13

• No treatment - Low recurrence rate or low impact of recurrence
• Staging resection of the scar - Determines if tumour really still present
• Wide or radical excision of the scar - Aims for a surgical cure
• Adjunctive treatment