Surgical Principles

The majority of the cancer patients will encounter surgery of either curative or palliative intent during the course of their care. Surgery is integral for establishing a malignant diagnosis, for staging the extent of disease, and ultimately for definitive treatment. In patients receiving multimodal therapy of curative intent, understanding the anticipated extent of the surgical procedure is critical for assessing the benefits, the risks, and the optimal delivery of radiation aimed at enhancing local control. Meanwhile, attention should be paid to the impact of radiation on perioperative morbidity as well as of the vice versa so that the therapeutic ratio can be maximized for the individual patient. Patients with sarcoma, pancreas, breast, rectal, bladder, head and neck, or gynecological cancers will often undergo multimodality treatment that includes radiation, systemic therapy, and surgery. The role and types of surgical management in these many of these disease sites are reviewed within this chapter along with an overview of perioperative management.