The gastrointestinal system includes organs such as esophagus, stomach, small intestine, colon, rectum, anal canal, liver, bile ducts, pancreas, and spleen. Gastrointestinal cancers are common cancers in our country and the incidence varies from region to region. The incidence of cancers like gallbladder cancer is quite high in North India as compared to other countries. However, the incidence of cancers such as colon, pancreatic, esophageal and stomach cancers is lower compared to other parts of the world. The real burden of these cancers is still considerable, due to the huge population combined with an unfair distribution of medical resources in our country. Surgery plays a critical role in the treatment of these cancers. This article explains the role and principles of surgery for these cancers and who is best approached for their surgical treatment.
How is treatment for these cancers determined?
Before treating these cancers, the patient should be thoroughly evaluated to determine the diagnosis and clinical stage. This requires a detailed history and clinical examination and appropriate investigations, which vary mainly depending on the involved organ and tumor type.
Preferably, all cases are discussed in a multidisciplinary tumor committee, which mainly consists of a gastrointestinal and HPB cancer surgeon, radiotherapist-oncologist, medical oncologist, radiologist and pathologist.
Treatment largely depends on the
- Type of cancer
- Stage of the disease
- The patient’s condition
- Associated medical problems
- Patient preference
What is the role of surgery for these cancers?
Surgery is the only treatment option that can potentially cure and therefore plays a vital role in the treatment of these cancers. However, not all patients are candidates for surgery. Surgery is the main treatment modality for early and locally advanced cancers and for some metastatic cancers such as colorectal, neuroendocrine cancers. However, the majority of patients with inoperable or metastatic cancers and those unsuitable for surgery are treated with other modalities such as chemotherapy, radiotherapy and/or targeted/immunotherapy.
Is surgery alone sufficient to treat these cancers?
Surgery is the main treatment modality in early and locally advanced cancers. Surgery alone is sufficient to cure early stage cancer. However, most of these cancers are advanced at presentation. There is robust scientific evidence supporting the combination of surgery with other forms of therapy, such as chemotherapy, radiotherapy or their combination, to improve outcomes in locally advanced stages. Depending on the type of cancer, these therapies can be given before surgery (neoadjuvant) or after surgery (adjuvant). For example, most locally advanced esophageal, gastric, and rectal cancers are treated with neoadjuvant therapy followed by surgery and adjuvant chemotherapy after surgery is completed. recommended for locally advanced colon cancer.
What are the principles of surgery for these cancers?
Surgery for these cancers is based on the tumor type, disease stage, spread pattern, and size of the tumor. Surgery for most locally advanced cancers involves removal of the tumor containing organ(s) with adequate margins, surrounding lymph nodes, and adjacent involved organ(s). The degree of removal of margins and lymph nodes depends on the organ involved and the type of cancer. Properly selected early stage cancers can be treated with less invasive modalities such as endoscopic or transrectal resections. The best chance of cure is possible with complete removal, defined as R0 resection.
How safe is surgery for these cancers?
Surgery for these cancers is an invasive treatment modality and carries the risk of mortality and complications. Advances in anesthesia, intensive care, interventional radiology and the advent of minimally invasive techniques such as laparoscopic and robotic surgery have all contributed to a substantial improvement in surgical safety. It is also important to emphasize that proper surgical training and expertise in treating these cancers significantly improves outcomes.
Who to approach for surgical treatment of these cancers?
Today, oncology is evolving towards organ-based specialization and practice. This has been shown to improve short- and long-term results. It is therefore important to consult a surgeon with specialized training and expertise in treating these complex cancers.
Dr. Abishek Mitra | Senior Consultant – Gastroenterology – Surgery, Gastrointestinal Oncology, Liver Transplant & HPB Surgery, Oncology, Surgical Oncology | Dshilaharam Narayana Super Specialty Hospital, New Delhi