Surgical Principles

Most patients with cancer will encounter surgery of either curative or palliative intent during their care. Surgery can play a role in establishing a malignant diagnosis, staging the extent of disease, providing definitive treatment, or palliating cancer-related symptoms. For many patients with solid tumors, surgery is a component of a coordinated multimodality treatment regimen that often includes radiation and systemic therapy. Thus, understanding the anticipated extent and outcomes of surgical treatment offered in this setting 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 and vice versa so that the therapeutic ratio can be maximized for the individual patient. The principles of surgical management of breast, pancreatic, sarcoma, and rectal cancer are reviewed within this chapter, along with an overview of perioperative management.