Figure 1

Synopsis

The art of surgical oncology is the integration of surgery with other treatment modalities to try to cure, give durable local control, or palliate clinical signs. We regularly face many significant challenges in surgical oncology, which require some advanced problem solving and continued learning from our clinical cases. Some of these include determining resectability, patient selection, treatment of complications induced by surgery or other modalities, and dealing with multifocal or metastatic disease.

From the perspective of resectability, each surgeon evaluates this through a different lens, given their individual experience and training. The determination of resectability can be further complicated in cases with large tumors, as decisions may be tempered by recent experiences or perception of the client’s capability or desire to proceed with resection. Determining options, risks, and morbidity associated with surgery are foundational skills to the specialty. Sometimes the patients may not be ideal candidates for procedures, such as a Sertoli cell tumor case with pancytopenias requiring cryptorchid testicle removal. Problem-solving may be required to optimize patient pre-operative or post-operative care to maximize the chance of success for these patients.

Surgeons performing complex oncologic procedures will often be managing complications that result from these procedures. In most cases, the surgeon will plan to optimize the management of the patient and education of the client to minimize complications. Also, infrequent complications occur following treatment with other modalities like radiation therapy. When these complications arise, they can be one of the most challenging aspects of our job. There are reasons why the complications have occurred, e.g., tension, infection, vascular compromise, that need to be considered in problem-solving to resolve the complication and enable healing or the return to function. Surgery is often utilized for local control of solid tumors, but the role of surgery in the treatment of regional and distant metastases is less well defined. Problem-solving with different treatment strategies and surgical approaches may be needed to try to diagnose and treat metastatic disease in addition to local disease.