Ten years ago, cancer surgery required large incisions and significant organ removal. Today, cancer surgery is becoming more accurate, with a focus on removing only the required tissue. This shift in viewpoint,
from “more is better” to “less is more,” has led to increased healing, improved long-term survival, and better quality of life.
Previously, cancer surgery aimed to achieve maximal clearance by removing the entire tumor. Although these surgical procedures were effective in removing tumors, they were associated with severe trauma, extended hospitalization, and limitations in a person’s ability to engage in everyday activities. Advances in cancer biology, imaging technology, and surgical innovations have enabled surgical oncologists to better understand how malignancies spread and identify which patients may benefit from more aggressive surgery, thereby changing their approach.
Dr. Amit Parasnis, HOD & Consultant, Surgical Oncology & Surgery, Manipal Hospital, Baner, Pune, shares all you need to know:
Laparoscopic and robotic-assisted surgery, both minimally invasive procedures, have transformed cancer treatment across various fields, including gastrointestinal, gynecological, urological, and thoracic surgery. During these procedures, the surgeon makes very small incisions, uses a high-definition camera to view inside the patient’s abdomen, and operates with advanced surgical instruments that enable extremely precise movements. This allows for the same accuracy in tumor removal as open surgery, but with significantly less blood loss, fewer complications, and a faster recovery period.
Organ conservation surgery is another emerging concept in the treatment of certain cancers, including breast, rectal, laryngeal, and kidney cancers. In selected patients, it is possible to minimise the amount of tissue removed.
One example is breast conservation surgery combined with radiotherapy, which has been shown to provide survival rates comparable to complete mastectomy in patients with early-stage cancer. In rectal cancer, chemotherapy and radiation administered prior to surgery can shrink the tumor, resulting in less extensive surgery. In rare cases, this may even help patients avoid the need for a permanent stoma.
The integration of systemic treatments and surgery is the primary driving force behind these advances. Before surgery, patients may receive systemic therapies such as targeted therapy, immunotherapy, and advanced chemotherapy, which work together to shrink the tumor.
This approach, known as neoadjuvant treatment, helps convert complex surgical procedures into safer and less extensive surgeries with improved success rates.
Precision imaging and intra-operative imaging technologies are also improving, allowing surgeons to map tumors in real time, identify lymph nodes during removal, and ensure clear margins without removing unnecessary tissue. These technological advances reduce the risk of post-surgical complications and help preserve the function of the affected organs.
Post-surgical care has also evolved significantly. It now includes Enhanced Recovery Protocols that focus on early mobilization of patients, better pain management, shorter hospital stays, and faster return to normal daily activities.
A Word of Caution
Organ-conserving and less radical surgery is possible in cases of early-stage cancers and in patients who are willing to undergo neoadjuvant and adjuvant therapies.
Late presentation of cancer, as well as economic or logistical constraints, can limit the use of conservative surgery. In such cases, radical surgery involving organ removal may be a better option for improving survival, provided the patient understands and accepts the resulting functional and cosmetic limitations.
