Surgical management of cancer distant metastasis

Surgical management of cancer distant metastasis

as mentioned before surgical management of cancer included three groups 
 surgical management of primary tumour
surgical management of Regional lymph nodes basin
  Surgical management of Distant metastasis which will be discussed here

The treatment of a patient with distant metastases depends on the number and sites of metastases, the cancer type, the rate of tumor growth, the previous treatments delivered and the responses to these treatments, and the patient's age, physical condition. under desires.

Although once a tumor has metastasized it is usually not curable with surgical therapy, such therapy has resulted in cure in selected cases with isolated metastases to the liver, lung, or brain.

Patient selection is the key to success of surgical therapy for dis­tant metastases. The cancer type is a major determinant in surgical decision making. A liver metastasis from a colon cancer is much more likely to be an isolated. and thus resectable, lesion than a liver metastasis from a breast carcinoma. The growth rate of the tumor also plays an important role and can be determined in part by the disease-free interval and the time between treatment of the primary tumor and detection of the distant recurrence. Patients with longer disease-free intervals have a higher survival rate after surgical metas­tasectomy than those with a short disease-free interval. Similarly, patients who have synchronous metastases (metastases diagnosed at the initial cancer diagnosis) do worse after metastasectomy than patients who develop metachronous metastases (metastasis diag­nosed after a disease-free interval). The natural history of metastatic disease is so poor in some tumors (e.g., pancreatic cancer) that there is no role at this time for surgical metastasectomy. In cancers with more favorable outlooks, observation for several weeks or months, potentially with initial treatment with systemic therapy, can allow the surgeon to monitor for metastases at other sites.

In curative surgery for distant metastases, as with surgery for

primary tumors, the goal is to resect the metastases with negative margins. In patients with hepatic metastases that are unresectable because their location near intrahepatic blood vessels precludes a margin-negative resection. or because of multifocality or inadequate hepatic function, tumor ablation with cryotherapy or radiofrequency ablation is an alternative.Curative resections or ablative pro­cedures should be attempted only if the lesions are accessible and the procedure can be performed safely

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