Recent advances in surgical oncology

1. Recent advances in Surgical Oncology

2. Introduction
• Oncosurgeries have undergone a sea of change in recent times.
• Advances have resulted from simple, painstaking clinical observations on
one hand and highly sophisticated scientific methods on the other.
• These advances have changed the way surgeries are done, and are shaping
the future of Surgery

3. Preoperative Planning
• Better Imaging techniques
– 128 slice CT
– 3T MRI
– PET CECT
• Surgeons understanding of planes of surgery on imaging: No radiologist can tell
you sometimes actually what you want to know before surgery
• Most Forgotten part: Clinical examination
• Whom should be operated and whom should not be.

4. Perioperative Preparation
• Fitness assessment for surgery
• ERAS protocol

5. What has been changed in Surgical Oncology

6. • MIS:
– Laparoscopic
– Robotics
• Magnification Loup for Open Surgery:
– Allows Magnification,
– More favourable working distance and
– Depth of field.
• Intra-operative frozen section
• CRS with HIPEC
• Sentinel LN biopsy: Breast, Penis and now in Uterus and H& N malignancy.
• More focus on Organ/ Limb preservation with equivalent oncological outcomes.
• Curative intent in selected Oligometastic cancers.

7. Thoracic Oncology
• Open thoracotomy and Sternotomy to Minimal Invasive Surgery.
• Multiportal VATS to Uniportal VATS for Lung Surgery.
• Lung Surgery: Pneumonectomy to Lobectomy and Now Segmentectomy.
• MIS Thymectomy.

9. GI Oncology
• Rectum
– Mesorectal resection
– Organ Preservation in selected cases
• Colon
– Complete mesocolonic excision with central vessels ligation ( D2
Lymphadenectomy)
• Stomach:
– D2 Lymphadencectomy:New Standard of treatment.
• CRS with HIPEC: has role in limited peritoneal disease in case of Colon, Rectum and
Stomach cancer

10. Hepato Billiary Malignancies
• Pancreas
– Borderline resectable Pancreatic cancer: Can be candidate for curative
resection after Neoadjuvant CTRT.
• Liver :
– Lobectomy to Segmentectomy and central hepatectomy in selected cases
– TACE, TARE, RFA, MWA
• Gall Bladder:
– Emerging role of Neoadjuvant treatment in locally advance but borderline
CABG.

11. Breast
• Mastectomy to Breast conservation with good cosmesis.
• Oncoplasty Type I and Type II.
• Augmentation with Regional flap, Implants
• Complete breast reconstruction with free flap
• Sentinel Lymph node Biopsy, Axillary Sampling

13. Head and Neck Onco
• Organ Preservation in Ca Larynx and PFS if Larynx is Functional and not T4.
• Role of Sentinel LN biopsy is evolving, Not a standard presently.
• Evolving Role of Neoadjuvant Chemo f/b surgery in selected locally advance oral
cavity cancer.
• Thyroid:
– Hemithyroidectomy in localized single lesion less then 4 cm without regional
LNs.
– Nerve monitoring during surgery

15. Gyne Onco
• Evolving role of Sentinel LN biopsy in ca endometrium.
• CRS with retroperitoneal TAH + BSO with HIPEC.
• MIS

17. Soft Tissue and Bone Sarcoma
Amputation to Limb preservation
Customized Implant.

18. Uro Oncology
• MIS
– Perticularly for Radical prostatectomy.
• Radical Nephrectomy to Partial Nephrectomy even for more then 4 cm tumour.
• Ileal Conduit to Neobladder.

19. Take Home message
• Over the last 2 decades surgical oncology principals have achieved new heights and
are very safe.
• Organ preservation in oncology is evolving.