Curative surgery

The long-term outcome after cancer surgery depends on tumour type and the stage of presentation. Survival rates for some cancers have improved due to earlier presentation following public awareness and screening programmes e.g. breast and cervical cancer. Improving techniques mean larger resections can be carried out with low risk, often with excellent functional results e.g. limb-preserving surgery for osteosarcoma. In the CNS, vital structures continue to inhibit the extent of resection.

For some cancers results are good—5-year survival rate in breast cancer is over 75% and for large bowel cancer it approaches 70%. Unfortunately, the cure rate for pancreatic and gastric cancer remains low with 5-year survival rates significantly less than 10% for patients treated in Europe.

Long-term tumour control can only be expected if all the cancer is removed at the operation. Such operations for rectal cancer result in very low recurrence rates in patients with localized disease. Conservation surgery for breast cancer has to be diligently performed to ensure complete removal of tumour. This requires close collaboration between the surgeon and pathologist.

With the development of high-quality radiological imaging and more accurate staging, more localized, low-morbidity operations can be performed e.g. perianal excision of early rectal cancer. Minimal access surgery is associated with less trauma for the patient, a shorter hospital stay, and a quicker return to normal function, but its role in cancer surgery is still unproven.

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