General principles of surgical oncology Kwok-Leung Cheung

No conflicts of interest in the past two years to disclose. Disclosure No conflicts of interest in the past two years to disclose.

Outline Surgery in context Principles of surgery Challenges in geriatric oncology

Outline Surgery in context Principles of surgery Challenges in geriatric oncology

Therapeutic options for solid malignancies* Surgery Radiotherapy Systemic therapies – chemotherapy, endocrine therapy, targeted therapy, immunotherapy *cf Haematological malignancies

Therapeutic options for solid malignancies* Tumour – operability, biology and sensitivity to therapy Patient – fitness, tolerability, choice Logistics Combinations and alternatives *cf Haematological malignancies

Outline Surgery in context Principles of surgery Challenges in geriatric oncology

Surgery in Oncology Mostly therapeutic cf diagnostic ‘Removal’ of tumour – curative versus palliative Obtaining information (operative and pathological staging) Reconstructive surgery cf organ transplant Prophylactic surgery

Breast Surgery as a Model

Breast Surgery as a Model

Breast Surgery as a Model

Breast Surgery as a Model

Breast Surgery as a Model

Breast Surgery as a Model

Breast Surgery as a Model

Breast Surgery as a Model

Outline Surgery in context Principles of surgery Challenges in geriatric oncology

Evidence Base Mainly retrospective cohorts RCTs and GA-related studies emerging Not much on health economics Alternatives to radical surgery

better ones when to operate, and the best when not to operate.’ ‘Good surgeons know how to operate, better ones when to operate, and the best when not to operate.’

Alternatives to Radical Surgery No surgery or no treatment Non-operative treatment Minimally invasive surgery

Minimally Invasive Surgery

Minimally Invasive Surgery

Minimally Invasive Surgery

Selection

Factors contributing to postoperative complications Age Co-morbidities Preoperative cognitive function Intensity of surgery

Optimisation

Outline Surgery in context Principles of surgery Challenges in geriatric oncology

Basics of Surgery in Geriatric Oncology Part of a multi-modality approach Achieving cure, palliation, staging, functional preservation and prevention Ongoing challenges in obtaining a strong evidence base, selection and optimisation of patients as appropriate

by surgery: it will be something we will inject.’ ‘’We shall never overcome cancer by surgery: it will be something we will inject.’