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​Surgical oncology

About surgical oncology

Surgical oncology is a cancer care field that focuses on using surgery to diagnose, stage and treat cancer. Surgical oncologists may also perform palliative surgeries to help control pain, increase a patient’s comfort level and manage cancer-related symptoms and side effects.

Whether a patient is a candidate for surgery depends on factors such as the type, size, location, grade and stage of the tumor, as well as issues related to the patient’s health, including age, physical fitness and other medical conditions.

Many patients may have cancer surgery combined with other treatments, such as chemotherapy, radiation therapy and/or hormone therapy. Nonsurgical treatments may be administered before surgery (neoadjuvant therapy) or after surgery (adjuvant therapy) to help prevent cancer growth, metastasis or recurrence.

Depending on the type of cancer, the size of the tumor and its location, surgery may be performed using minimally invasive techniques, such as laparoscopy or robotic surgery. Other conditions may require open surgeries, which are more invasive and have larger incisions. A surgical oncologist may work with other doctors and clinicians to help reduce pain and other side effects and speed recovery from surgery.

Advanced Surgical Recovery Program (ASURE)

The Advanced Surgical Recovery Program (ASURE) is designed to help patients recover from surgery more quickly and with fewer complications. ASURE is intended to improve surgical outcomes and enhance the patient experience before, during and after surgery, while also reducing patients’ overall hospital stay.

The program is delivered by a multidisciplinary team of surgeons, anesthesiologists, nutritionists, mind-body therapists, nurses and other clinicians working collaboratively to implement evidenced-informed protocols, all under one roof. ASURE combines post-surgical rehabilitation with pre-habilitation, by preparing patients before surgery.

Typically, ASURE protocols involve nutrition, pain management with non-narcotic pain relievers and physical activity within 24 hours after surgery.

Compared with traditional care, the ASURE program is designed to improve patients’ quality of life immediately after surgery and in the long term. The use of enhanced recovery methods like those used in ASURE has been shown to reduce fatigue, post-surgery complications and the amount of narcotics used in post-surgical care, while helping patients resume their everyday activities more quickly.

Surgical oncology procedures

Appendectomy

Surgery to remove an appendix is known as an appendectomy. It is usually an emergency procedure performed when the appendix, a small organ attached to the large intestine, becomes irritated and inflamed. The condition is called appendicitis. The appendix swells when it becomes blocked by infection, cancer, a foreign material or stool.

When an appendectomy is performed and an appendix tumor is discovered, and lab tests confirm it is appendix (or appendiceal) cancer, additional surgery to remove more tissue may be necessary. In addition to appendix surgery, patients may receive chemotherapy, and in rare cases, radiation therapy.

Bowel resection

Bowel resection is a surgical procedure used to treat and prevent cancer and other diseases of the colon by removing part of the large intestine. It is also known as a colectomy, colon resection or colon removal. Surgery is a common treatment for colorectal cancer. Bowel resection involves the surgical removal of colorectal tumors, as well as surrounding tissue and several nearby lymph nodes. A bowel resection that involves removing the entire colon is called a total colectomy. A subtotal colectomy removes most of the colon. When a portion, or segment, of the colon is removed, it is known as a segmental colectomy.

ERBEJET® 2

ERBEJET2 uses a high-pressure water jet to selectively target and dissect water-soluble tissue and provide precise margins along the line of dissection. This technique is designed to help spare critical structures, like blood vessels, nerves and ducts and may help reduce the potential for blood loss. ERBEJET2 may be used in both open and laparoscopic surgical procedures, typically with shorter operating times.

Flexible robotic surgery (Flex® Robotic System)

The Flex® Robotic System is a surgical system with a flexible robotic endoscope. The minimally invasive technology allows surgeons to access hard-to-reach areas of the mouth, throat, rectum and colon. In the throat, the system's flexible scope is designed to allow surgeons to view and reach areas of the throat that aren’t typically or easily accessible with standard instruments. A traditional endoscope moves in straight lines and is limited to lines of sight. In the rectum and colon, the scope allows surgeons to view and reach areas that were previously only accessible by surgery. 

Learn more about flexible robotic surgery for head and neck cancer

Hyperthermic intraperitoneal chemotherapy (HIPEC)

HIPEC is a highly concentrated, heated chemotherapy treatment that is delivered directly to the abdomen during surgery. Unlike systemic chemotherapy delivery, which circulates throughout the body, HIPEC delivers chemotherapy directly to cancer cells in the abdomen.

Before patients receive HIPEC treatment, doctors perform cytoreductive surgery to remove visible tumors in the abdomen. Cytoreductive surgery is accomplished using various surgical techniques. Once as many tumors as possible have been removed, the heated, sterilized chemotherapy solution is delivered to the abdomen to penetrate and destroy remaining cancer cells.

Learn more about HIPEC in our regional therapies section

Surgical options for lymphedema

Lymphedema is a condition in which excess lymphatic fluid collects and causes swelling, usually in the arms or legs. The condition is a result of damaged lymph nodes following cancer treatment. Two surgical options to treat lymphedema include:

Pneumonectomy

A pneumonectomy is a surgery performed to remove an entire lung. It may be performed to to treat non-small cell lung cancer and conditions such as chronic obstructive pulmonary disease (COPD) and tuberculosis. The types of pneumonectomy procedures include:

Pneumonectomy procedures may be invasive and complex. Patients receive general anesthesia so that they sleep through the procedure. Patients also have an endotracheal tube placed in their mouths, which allows a ventilator to breathe for them during the surgery.

Robotic surgery (da Vinci® Surgical System)

The da Vinci® Surgical System offers a minimally invasive alternative to both open surgery and laparoscopy. Because it requires only a few tiny incisions and offers greater vision, precision and control for the surgeon, patients can often recover sooner, move on to additional treatments if needed, and get back to daily life quicker. Potential benefits of the da Vinci system for patients include less pain, lower risk of infection, less blood loss and less scarring.

Learn more about the da Vinci Surgical System

Thoracotomy

A thoracotomy is a surgical procedure performed to open the chest cavity. It uses an incision made into the chest that allows surgeons to access the throat, lungs, heart and diaphragm. A thoracotomy may be part of a patient’s surgical treatment if he or she has been diagnosed lung cancer or other cancers, or other diseases of the heart and lungs.

Learn more about thoracic surgery

Thyroidectomy

In this procedure, most or all of the thyroid gland is surgically removed (total, near-total or subtotal thyroidectomy). Many patients with thyroid cancer have a thyroidectomy.

The three types of thyroidectomy procedures are:

Tracheoesophageal puncture

A tracheoesophageal puncture, or TEP, may be an option for patients who undergo a laryngectomy (removal of the larynx/voice box) either because they have laryngeal cancer (cancer of the voice box) or because they have a non-functioning larynx, from radiation or trauma. To perform a tracheoesophageal puncture, a head and neck surgeon places a small, one-way valve between the trachea and the esophagus, either during the laryngectomy or during a secondary surgery that may be performed any time after the laryngectomy. The valve allows for air to travel from the wind pipe (trachea) into the esophagus, but it blocks food, saliva and liquids from the airway. As air enters the esophagus, it produces a vibratory signal that the patient may use for voicing.

After undergoing a tracheoesophageal puncture, our patients work with a trained speech therapist to learn how to speak using the vibratory signal produced by the valve.

Learn more about head and neck cancer surgery

Video-assisted thoracic surgery (VATS)

Video-assisted thoracoscopic surgery (VATS) is a minimally invasive surgical technique used to diagnose and treat symptoms in the chest, including lung cancer. During the VATS procedure, one or more small incisions, or “ports,” are made in the chest. Then, a thorascope (a type of endoscope with a small video camera) and surgical tools are inserted through the incision(s). The thorascope transmits an image of the chest cavity onto a video monitor to help guide the procedure. VATS may be used to biopsy lung tissue and to perform complex procedures, such as lung resections (lobectomy).

This innovative procedure may result in less post-operative pain, fewer complications, and a shorter hospital stay than traditional surgical approaches, like thoracotomies, which require a single large incision in the chest.