Research Assessment #8

Date: ​November 22, 2019

Subject: ​Oncology

MLA Citation:

“Surgical Oncology for Cancer: Procedures & Recovery Programs.” Cancer Treatment Centers

of America, 19 July 2019,

https://www.cancercenter.com/treatment-options/surgery/surgical-oncology.

Assessment:

Over the past few years, the way the medical community has gone about treating cancer

has been revolutionized. Chemotherapy has over time become more effective and is now one of

the most common treatment methods used on cancer patients. Radiation, once thought to be a

harmful substance, has been developed into a life-saving cancer treatment technique. Also,

immunotherapy has been created to help patients be able to recover from the adverse effects of

chemotherapy. Doctors have additionally employed the longtime treatment technique of surgery

to remove sections of the cancerous tumor as well. Although not as new of a treatment method as

the ones aforementioned, surgery still holds out to be a commonly used and effective method to

treat cancer. Even though this treatment method has been present and used for a long time few

people truly understand how exactly Oncologists go about using surgery to treat cancer. The

article entitled “Surgical Oncology” written by the team at the Cancer Treatment Centers of

America delves into all aspects of the age-old treatment of surgery to treat cancer.
 From this article, I acquired a plethora of information about how the subspecialty of

Surgical Oncology works. Up until this point in time, I have been focusing my research on the

medicinal treatment of cancer, so I was unaware of much about the treatment of cancer using

surgery. The first piece of information that I gained from this article is that there is a program

called the Advanced Surgery Recovery Program (ASURE) that has been created with the sole

focus of helping patients to recover from surgical procedures at a faster rate. This program is

carried out by a team of doctors including surgeons, anesthesiologists, nutritionists, mind-body

therapists, nurses, and other clinicians all working to help the patient recover. This is important

for me to understand for if I were to become a Surgical Oncologist in the future I need to be

aware of this program's existence to help my patients go about recovering properly. In the future,

I could refer my patients to this program knowing full well that they will be in safe hands in

terms of how their recovery goes, and that it will be quick for both my patient and the team of

medical professionals that they work with. I can additionally use this information in my Winter

Presentation in January to help educate my audience more about how Surgical Oncologists work

with other medical professionals to help patients recover from a procedure. This newly acquired

information likewise impacted my perspective of Surgical Oncology by showing me how

dependent the overall success of treatment is on professionals who do not typically work in the

field of Oncology, and that if I were to become a Surgical Oncologist in the future I would be

working with medical professionals in all fields of medicine, not just my own. All of this is done

to ensure that my future patients can recover to the best of their ability.

Furthermore, from this article, I also learned about the specific types of techniques

utilized by Surgical Oncologists to treat patients with cancer. The first method that I learned
about was called ERBEJET® 2. This surgical procedure uses a high-pressure water jet during the

surgical cutting of water-soluble tissue that targets only the tissue that needs to be cut to protect

the surrounding critical structures that must remain untouched. This new piece of information

moreover impacted my perspective about the methods of surgery by showing me that in the

future as a Surgical Oncologist there are multiple types of surgery methods that I can use in the

future to complete the task at hand while having as little damage as possible to the surrounding

tissue. The second surgical method that I learned from this article was called Flexible Robotic

Surgery (Flex® Robotic System). This method is used by Surgical Oncologists to help treat

cancers of the head and neck. This information is important because if I were to become a

Surgical Oncologist in the future I need to understand what treatment methods are best suited to

treat certain areas of the body. The final new surgical procedure that I learned from this article is

called a Pneumonectomy. This surgical procedure removes an entire lung to help treat patients

with lung cancers. This information is vital as it brought to light an additional surgical procedure

I may have to employ like the Flexible Robotic Surgery in specific situations only. As a Surgical

Oncologist in the future, I must use the information I gained within this article to help make the

correct decision of which surgical procedure to use in certain situations with cancers inflicting

particular areas of the body. I can also use all of the information that I gained about the different

surgical procedures in my ISM journey during my Winter Presentation to present to my audience

the different surgical methods commonly employed by Surgical Oncologists to help inform my

audience more about all aspects of this specific type of treatment for cancer within the field of

Oncology.
 All in all, this article provided me with an abundance of information about the field of

Oncology from the perspective of a Surgical Oncologist working within the field. The

information from this article changed my perspective of the field of Oncology by showing me a

secondary way that I can go about treating my patients, and what exact procedures I will use in

certain situations to treat my patients. From this article, I learned about a recovery program

offered that Surgical Oncologists use to help their patients recover from procedures. I also from

this article learned about the different treatment methods that Surgical Oncologists employ in

different situations with cancers that affect different areas of the body such as the ERBEJET® 2,

Flexible Robotic Surgery (Flex® Robotic System), and Pneumonectomy. All of the information I

learned within this article is important because it helped me to understand exactly what I must do

in the future if I were to go into Surgical Oncology as opposed to Medical Oncology. I can

furthermore use this information during my ISM journey in my Winter Presentation to help those

that view my presentation understand all that goes into this specific branch of Oncology. In

conclusion, all the information from this article is important for my future if I choose to become

a Surgical Oncologist as it gave me a deeper understanding of the field, and I can use this

information to enhance my Winter Presentation in January to make it more informative.

Article: ​*​All annotations are bold and italicized.*

Surgical oncology

About surgical oncology

Surgical oncology is a cancer care field that focuses on using surgery to ​diagnose​,

stage and treat cancer.​ ​Definition of Surgical Oncology. ​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. ​Factor taken into account

to see if a patient is a candidate for surgery.

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. ​Surgery is often

used in conjunction with other treatments and there are specific terms for when it

is used in conjunction with non-surgical treatment.

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 Advanced Surgical

Recovery Program.

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. ​What an Appendectomy is.

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. ​Difference between a Bowel Resection and

Subtotal 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.​ ​What the

​ ​ 2 is. ​This technique is designed to help spare critical structures, like blood
ERBEJET®

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

​ ​ Robotic System. A
accessible with standard instruments.​ ​Definition of Flex® ​

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.​ ​Definition of the Hyperthermic

Intraperitoneal Chemotherapy.​ 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:

● Vascularized lymph node transfer surgery: This is an intricate microsurgical

procedure used to treat patients with advanced lymphedema affecting the skin
 tissue in the arms or legs. Our plastic surgeons transfer working lymph nodes

from another part of the body, typically the upper groin or lower abdomen, to the

damaged site. We then divide the existing blood vessels that supply the nodes

and connect them at the site where the lymph nodes are needed. We use

reverse lymphatic mapping to reduce the chance of lymphedema occurring in the

areas where lymph nodes were harvested.

● Lymphaticovenular bypass surgery: This surgery is an intricate

super-microsurgical procedure used to treat patients with mild to moderate

lymphedema. Our plastic surgeons perform the surgery by shunting, or moving,

fluid from several dilated lymphatics in the affected limb to adjacent venules (tiny

veins) to reduce pressure. ​Different types of surgical procedures used to

treat lymphedema.

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:

● Standard pneumonectomy: Only the diseased left or right lung is removed.

● Extrapleural pneumonectomy: The diseased left or right lung is removed, in

addition to portions of the diaphragm, pericardium (the membrane covering the

heart) and the pleura (the membrane lining the chest cavity). An extrapleural
 pneumonectomy is typically performed to treat mesothelioma. ​Different types of

Pneumonectomy.

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.

​ urgical System)
Robotic surgery (da Vinci​® S

The ​da Vinci​®​ Surgical System​ offers a minimally invasive alternative to both open

surgery and laparoscopy.​ ​Definition of the da Vinci® ​ urgical System. B

​ S ​ ecause 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 in the chest that allows surgeons to access the throat, lungs, heart and

diaphragm.​ ​What a Thoracotomy is.​ A thoracotomy incision can be made:

 ● Between the ribs on the front or side of the chest (limited anterior or lateral

thoracotomy)

● Down the front of the chest, through the breastbone (sternal splitting

thoracotomy)

● Across the side and around the back of the chest (posterolateral thoracotomy)

A thoracotomy may be part of a patient’s surgical treatment if he or she has been

diagnosed with lung cancer or other cancers, or other diseases of the heart and lungs.

Depending on the type of disease or disorder a patient has been diagnosed with, a

surgeon will perform a thoracotomy followed by another surgical procedure, such as a

lobectomy (removal of one or more lobes of the lungs), esophagectomy (removal of all

or part of the eosphagus) or a wedge resection (removal of part of a lung lobe).

A thoracotomy and the surgical procedure that follows it can take several hours.

Because a thoracotomy is a major, open surgery, patients need to stay in the hospital

for about a week.

When possible, our surgeons perform video-assisted thoracoscopic surgery instead of a

thoracotomy. The minimally invasive procedure allows us to diagnose and treat some of

the same diseases and disorders as with a thoracotomy, but with potentially less

post-operative pain, fewer complications and a shorter hospital stay.

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:

● Conventional thyroidectomy: A small incision is made in the front of the neck to

remove your thyroid gland.

● Endoscopic thyroidectomy: Your surgeon will make a few incisions in the neck

through which surgical instruments and a small camera will pass. This camera

will help guide your surgeon during the procedure.

● Robotic thyroidectomy: Incisions are made in the chest and armpit or high up on

the neck. ​Three types of Thyroidectomies.

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.​ ​What a Tracheoesophageal Puncture. ​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). ​What

a video Video-assisted thoracic surgery (VATS) is.

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.