by Ismail Gögenur, Professor, DMSc
Through decades we have realized that surgery is the main stay of treatment in patients with solid cancers. This has been the reality since the introduction of surgery for cancer in the late 18th century. From the beginning of these days and until now in 2019 we still live with the fact that depending on the site of cancer 1 out of 3 of our patients have a cancer recurrence. Most of these cancer recurrences are at distant sites outside the surgical resection area. Thus, it is completely clear that we as surgeons cannot solve the whole problem for all our patients by surgery alone. Waiting for the recurrence is our only approach putting the patient in a completely different situation where the possibility to cure is severely reduced and the treatment either surgical or oncological is with much higher costs for the patients and the society. An understanding of the metastatic process is crucial to tailor preoperative and postoperative interventions for the patients who have the highest risk of recurrence.
As our patient group is getting increasingly older and with an increasing number of comorbidities we can not only focus on the biology of the cancer but also need to have a focus on the phenotypic reality of the patients. Thus, we need to be experts in predicting the short-term outcomes after surgery in order to make the patient survive surgery with minimal morbidity in order to receive adjuvant oncological care. A huge window of opportunity is to approach the patient by different methods of prehabilitation in order to prepare the patient both immunologically and through optimized diet, exercise also prepares the patient for the “marathon” ahead of them. It is encouraging to see that there are more and more clinical trials demonstrating that preoperative interventions may indeed reduce complications after surgery for patients with cancer. At the Center for Surgical Science we will within the next six months publish several papers showing that basic interventions such as non-steroidal anti-inflammatory drugs in the immediate postoperative period may reduce the risk of recurrence after colorectal cancer surgery. There is indeed a need for continuous attention on selecting patients for evidence-based interventions in the perioperative period in order to improve functional and oncological outcomes.