Minimally Invasive Oncological Surgery

Significance of tumor surgery in treating cancer

Surgical resection of a malignant tumor is among the most frequently employed methods of cancer treatment. As it is the oldest therapeutic modality of malignant diseases, surgery has been widely researched and is well established in various fields of medicine.

Optimally, the goal of surgery is the complete removal of the tumor leaving the patient cured and cancer-free, which is referred to as a curative approach. Nevertheless, surgery may also fulfill a palliative purpose, which is to reduce the patient's symptoms. Additionally, surgery can also be used in combination with chemotherapy or radiation therapy to maximize the chance success.

An increasing number of cancer surgeries can be performed by minimally invasive surgery (MIS).

Today, advancements in medical devices ranging from high-resolution endoscopes to precise robotic operators have made minimally invasive procedures viable in numerous surgical fields. This so-called keyhole surgery requires skin incisions of only a few centimeters and is already routinely used in many procedures, while in the past often entire body cavities had to be opened for the same purpose. Nowadays, even tumors affecting larger organs such as liver or stomach can be operated on minimally invasively.

The advantages of MIS are numerous. For instance, the cosmetic results are much more favorable as the small scars left behind are often barely visible, especially in comparison to the large incisions that were previously required which stretched over the entire chest or abdominal cavity. Moreover, patients after MIS usually experience less pain, make a speedier recovery and can therefore be discharged from the hospital sooner.

Routine activities and even physical exercise can be resumed earlier, while complications like scar hernias or adhesions within the surgical site are also more rare. All in all, MIS is more gentle and less stressful for cancer patients, which is a significant benefit especially for those who still have to undergo further treatments and procedures. The body’s own tumor defense system is less compromised, and patients recovering from surgery can proceed with further therapy more quickly.

MIS generally involves a series of small skin incisions that allow a camera and all the necessary surgical instruments to be introduced into the body. In specific cases, one single small incision is sufficient for the entire operation. The surgeon can then control camera and movement of instruments from the outside and follow what's happening inside of the body via a monitor.

The organs and tissues affected are cautiously exposed, any pathologic tissue is resected and adjacent structures such as lymph nodes are inspected and consequently resected, too, if necessary. Before the operation, the procedure is precisely planned on the basis of pre-operative tests. Once removed, the tissue is secured via another small incision to the outside for further examination.

To be feasible for minimally invasive surgery, the tumor often has to be at a specific localization with little or no spread. In this regard, early stage cancers are often considered easier to operate on than very large, advanced or even metastatic cancers.

Robotic-assisted operations are even more innovative. In this case, the surgeons control the robots' arms that are connected to surgical instruments reaching into the patient's body. Of particular advantage is the extremely high resolution and magnification as well as precise motion of the robot in areas inside the body that are otherwise difficult to reach.

Scope of minimally invasive cancer surgery

Nowadays, MIS is applied in the treatment of cancers of the stomach and esophagus as well as colon and rectum. Malignant liver tumors and cancer of the abdominal membrane can also be treated by MIS in certain cases. Furthermore, the minimally invasive surgical treatment of tumors of the spleen, adrenal glands and pancreas is possible.

There are genetic diseases which increase the likelihood of tumor development and which are inherited. Among these are Lynch syndrome, hereditary non-polyposis colorectal carcinoma (HNPCC) or familial adenomatous polyposis (FAP) for instance. MIS can be beneficial for patients suffering from these conditions as well. Moreover, MIS is indicated for chronic inflammatory bowel diseases, such as ulcerative colitis or Crohn's disease, especially as some of those mentioned go along with an increased risk of cancer.

Cancers of the uterus, ovaries, prostate or lungs may also frequently be operated on minimally invasively.

Altogether, tumors as well as organs or tissue segments can be removed safely within the scope of minimally invasive cancer surgery and in addition potential complications or essential reconstructions can be managed in this manner.

Which doctors are experts in cancer surgery?

Oncologists deal with a wide range of cancers and associated conservative management as well as treatment planning, however it's mostly general surgeons that are responsible for tumor surgery. Depending on the organs affected by cancer, for example surgical gynecologists, urologists or endocrinologists may also have a part in cancer surgery. In this context, specialization in oncological surgery or even minimally invasive cancer surgery is a possibility and it’s becoming a growing focus in medicine.