Surgeon is the most important prognosis factor in cancer treatment. How to select the best surgeon? What best surgeon should know for cancer treatment? Patients sometimes over look this most important cancer prognosis factor in their treatment. Leading Swiss abdominal cancer surgeon explains surgical treatment options for colorectal cancer and liver tumors.
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Colorectal cancer best surgery options. 2. Dr. Anton Titov, MD. Surgeon is a very important prognostic factor for colon cancer. You write in one of your reviews: “The surgeon is one of the most important prognostic factors for patients with colon cancer.” “An accurate intraoperative lymph-node staging may result in upstaging 15 to 30% of patients.” Moving a patient from stage 2 to stage 3 colorectal cancer means that patient will require adjuvant chemotherapy. You also write that certain colon cancer resection techniques can actually worsen the prognosis for colon cancer survival. Certain colon cancer surgery methods can decrease 5-year survival expectancy in colon cancer patients for up to 40%. Why the surgeon is the most important prognostic factor for patients with colon cancer? How quality of the surgeon and the type of surgery affects long-term survival of patients with colorectal cancer? Dr. Christoph Maurer, MD. Yes, so, let’s start with the example of rectal cancer. 20 years ago we surgeons have learned that the mesorectum is absolutely crucial to be removed during rectal cancer surgery. Mesorectum is the fatty tissue surrounding the rectum. Because within this mesorectum we have the lymph nodes. And we have to respect the anatomical planes of tissue. We have to respect the mesorectal fascia. And we have to dissect along this holy plane of rectal cancer surgery. And the same is true for colon cancer. We have to respect the anatomical planes of mesocolon during colon caner removal. We have to leave intact both sides of the mesocolon. We have to avoid opening the mesocolon during surgical operation. Because otherwise we risk to open also the lymphatic vessels and the lymph nodes. This will result in colon or rectal cancer tumor spillage. And we have to do absolutely central dissection of the blood vessels. Because along the whole human body all the lymph nodes and the lymph vessels are following the arteries. So, if you want to be radical with regard to lymphatic spread of colorectal cancer, we have to do a central dissection of the arteries. That means, for right-sided colon cancer, we have to dissect the ileocolic artery. We have to dissect it completely centrally at the level of the superior mesenteric artery. And the third thing is about quality of cancer surgery. We have to do en bloc resections. We have to avoid opening of the tumor. Dr. Anton Titov, MD. And previously we talked to prominent Swedish rectal cancer surgeon, Dr. Torbjorn Holm. We discussed the importance of knowledge of the best current cancer surgery techniques. So that rectal cancer patients have the best survival rates. So, it’s very similar, in that sense, for the colon cancer surgery techniques too. Dr. Christoph Maurer, MD. Exactly, exactly. A good cancer surgeon even in stage 3 colon cancer has almost the same long-term survival as in stage 2 colon cancer patients. Stage 3 colon cancer means cancer has involvement of the lymph nodes. Stage 2 colon cancer means there is no lymph node involvement. Good surgeon improves stage 3 colorectal cancer survival. Because the surgeon is able to remove all local and regional lymphatic cancer spread. This surgical principle of complete lymph node removal is more important than any additional chemotherapy for colon cancer. Dr. Christoph Maurer, MD. So it’s worthwhile to adopt this structured concept to perform locoregional colorectal cancer resection radically.