广西医科大学附属肿瘤医院联合教学体

Surgical Oncology

Youzhi Lin M.D.

Hepatobiliary Department , Guangxi
Medical University Cancer Hospital

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2023.2.5
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History Perspective

01 Ancient history

02 Milestones

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Ancient History of Surgery for Cancer Treatment in West

◆ 1600 BC First recorded description ◆ 400 BC Hippocrates described the stages ◆ 200 AD Galenid identified cancer
of the surgical treatment of cancer in of cancer and advised against surgery for as a systemic disease (primary and
ancient Egypt terminal disease; he coined the terms metastasis)
“carcinoma” (crab-leg tumor) and
“sarcoma” (fleshy tumor)
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Milestones in Modern Surgical Oncology

◆ The modern era of elective surgery ◆ Ephraim McDowell removed a 22- ◆ Albert Theodore Billroth, Performed:

for visceral tumors began in pound ovarian tumor from a patient, The first gastrectomy (1840)

America in 1809. who survived for 30 years after the The first laryngectomy (1872)

operation. The first esophagectomy (1873)

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Milestones in Modern Surgical Oncology

◆ William Stewart Halsted ◆ What is En bloc resection? ◆ For example: Radical mastectomy
In the 1890s, elucidated the To remove the tumour, the (breast cancer):
principles of en bloc resections organ in which it is contained 1) the breast
for cancer, exemplified by the and the regional lymph node 2) underlying chest muscle
radical mastectomy. drainage (lymphatics and nodes) 3) lymph nodes of the axilla are removed all in one
all in one piece. piece.
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Three Landmark Advances in modern surgery

- strongly proved the development of surgical oncology

1. Application of general anesthesia

In 1846, Dr. Crawford Long. First used general ether anesthesia in the operation
at the Massachusetts General Hospital.

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Three Landmark Advances in modern surgery

- strongly proved the development of surgical oncology

2. Application of the principles of antisepsis

In 1867, Lister introduced the principles of antisepsis.
With this method, the surgical patient death rate drop from 46% to 15%.

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Three Landmark Advances in modern surgery

- strongly proved the development of surgical oncology

3. Discovery of blood type making the blood transfusion safer

1901, Austrian Karl Landsteiner discovered human blood groups : A、B、AB、O.

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Roles of Surgical Oncology

 Cancer prevention
 Histological diagnosis of the cancer
 Classification of tumor stage
 Treatment of the cancer
﹡Cure
﹡Palliation
﹡Reconstruction and rehabilitation

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Cancer prevention
◆ Some underlying conditions or congenital or genetic traits are associated with
an extremely high incidence of subsequent cancer.

◆ We often speak of “Mommy’s mommy,” and I find

myself trying to explain the illness that took her away
from us. They have asked if the same could happen to me.
I have always told them not to worry, but the truth is I
carry a “faulty” gene, BRCA1, which sharply increases
my risk of developing breast cancer and ovarian cancer.

◆ My mother fought cancer for almost a

decade and died at 59. She held out long ◆ My doctors estimated that I had an 87
enough to meet the first of her percent risk of breast cancer and a 50
grandchildren and to hold them in her percent risk of ovarian cancer, although
arms. But my other children will never the risk is different in the case of each
have the chance to know her and woman.
experience how loving and gracious she
was. 尚德 惟精
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Cancer prevention
◆ When these cancers are likely to occur in nonvital organs, it is necessary to
remove the potentially involved organ to prevent subsequent malignance.

Colonoscopy showing
multiple colonic polyps

◆ Familial Adenomatous Polyposis

It is advisable for all patients containing the mutant gene for multiple polyposis to undergo
prophylactic colectomy before age 20 to prevent this cancer.
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Histological Diagnosis

◆ Aspiration biopsy ◆ Excisional Biopsy

◆ Needle (Trucut) Biopsy ◆ Incisional Biopsy

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Aspiration Biopsy
◆ A small needle is inserted into the tumor and a sample of tissue is drawn up into the syringe.
◆ Material from the syringe is put on a slide and examined for the presence of malignant cells.
◆ It is a simple procedure done with minimal discomfort.
◆ Disadvantage : may not always rule out cancer when the result is negative.

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Needle (Trucut) Biopsy

◆ A core of tissue is obtained through a specially designed needle introduced into the suspect tissue.
◆ The core of tissue provided by needle biopsy is sufficient for the diagnosis of most tumor types.

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Excisional biopsy Incisional biopsy

◆ The entire tumor is taken out for diagnosis. ◆ Only part of the tumor is removed for diagnosis.
◆ It is the most common biopsy procedure. ◆ It is usually done when tumor is large.

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Staging of the cancer

Staging is the clinical or pathological assessment of prognosis and plays critical

roles in the treatment decision

Ideal Clinical Staging Pathological Staging

◆ Clinical staging is a preoperative assessment. ◆ Provides exact and confirmed prognostic

◆ It is based on clinical, laboratorial, and information.
radiological information. ◆ Allows decisions to be made regarding
◆ Used to plan treatment method offered to the adjuvant therapy.
patient. ◆ Allows comparison of treatment
outcomes between different centers.

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TNM system
◆ The TNM system is most generally accepted.
◆ Disadvantage: does not recorded all factors
(e.g. grade, contiguous organ involvement) that
is prognostically important.

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Barcelona Clinic Liver Cancer (BCLC) staging classification

Included factors: tumor, liver function, PS and guiding treatment. 尚德 惟精

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Surgery Methods Preoperative Evaluations

 Surgery for Primary Cancer  Age, general condition, evaluation of
 Surgery for Metastases Heart、Liver、Lung、Kidney
 Palliative Surgery functions
 Surgery for Debulking  History of cardiac, pulmonary, hepatic,
 Surgery for Oncologic Emergencies or renal disease, Chronic disease (such
 Reconstructive and Rehabilitative as Hypertension, Diabetes, Chronic
Surgery Bronchitis, T.B, etc.)

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Radical Resection
Remove the tumor completely to attain curative result. Include: tumor, regional LN,
involved organ , No tumor cell were found in the margin by eye or microscope

Adequate Margins of Resection

A complete margin of normal tissue around the primary lesion

Frozen sections used to evaluate tissue margins in instance of doubt

Complete removal of involved regional lymph nodes

Liver resection for primary liver
Resection of involved adjacent organ cancer:
Remove the tumor
En bloc resection of biopsy tracts and tumor sinuses Remove the adjacent normal tissue
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Surgery for Metastatic Disease

Resection of colorectal metastases to the liver
◆ A single site of metastatic disease or significantly improve the survival rate
limited number of metastases to sites such as
the liver, brain, or lung can be cured by
surgical resection.

◆ Solitary metastasis can be resected leading

to long-term cure.

British J Surg 2010,97:1110-1118

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Surgery for Debulking

◆ The benefits of cytoreduction are most dramatic when accompanied by effective chemotherapy or radiation.
◆ the value of cytoreduction has been acknowledged in pediatric solid tumors, lymphoma, and carcinoma of the ovary.

Surgery for palliation

Palliative surgery
◆ is undertaken to relieve symptoms in the absence of cure.
◆ designed to improve quality of life .
Examples :
◆ Relief of intestinal obstruction.
◆ Removal of tumors to control pain or hemorrhage.
◆ Introduction of a feeding jejunostomy to permit adequate nutrition.

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Surgery for Oncologic Emergencies

◆ Hemorrhage, Abscess
The oncologic patient often is neutropenic and thrombocytopenic and has a high risk of hemorrhage or sepsis.
◆ Perforation
Perforations of an abdominal viscus can be caused by direct tumor invasion or by tumor lysis resulting from effective systemic
treatments.

Surgery for Reconstruction and Rehabilitation

◆ Quality of life is an important consideration in the care of the
patient with cancer.
◆ The oncologic surgeon has the responsibility to attend to the
patient's cosmetic as well as curative needs.
◆ For example: Breast reconstruction after mastectomy can offer the
patient a higher degree of comfort and improved quality of life. before after
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Minimally invasive surgery in oncology

Laparoscopic hepatectomy Davinci Robot

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Multi-Disciplinary Treatment
Surgical treatment combined with other modalities to improve prognosis

chemotherapy Intervene therapy

image diagnosis
Pathologic diagnosis
Surgical operation
radiotherapy

immunotherapy

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Questions
• What is sentinel lymph node?
• How to get the cancer histological diagnosis?
• Please describe the roles of surgical oncology?
• What is function of the pathological staging?
• How to choose suitable operation for cancer?
• How to prevent iatrogenic tumor cell spread in operation?

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THANK YOU For Attending

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