What Is Tumor Resection Surgery

Introduction

Tumour resection surgery is the process of removing as much tumour as possible. The purpose of this surgery is to remove all the tumour and not leave any cancerous cells behind while maintaining the healthy tissue. Tumour resection surgery can be an effective treatment for numerous cancers; however, it is not always a cure for the cancer. In these cases, the surgery would need to be followed up with other cancer treatments such as chemotherapy and radiotherapy before remission is achieved. 

Understanding tumours

Abnormal and damaged cells can multiply uncontrollably as a result of DNA damage or DNA errors, which leads to the formation of tumours. Tumours can either be benign or malignant. Benign tumours are not cancerous meaning they do not spread to other parts of the body. Whereas a malignant tumour occurs when a cancerous tumour spreads to other tissues or organs.¹ The spread of a primary tumour leads to the formation of a secondary tumour in another location of the body. These tumours are also known as metastatic tumours. Metastasis refers to the dissemination of a primary tumour to secondary sites. For example, a primary tumour in the lungs can become metastatic and spread to the bones. 

According to the World Health Organisation (WHO), tumours are most commonly found in:

• Breast
• Lung
• Prostate
• Rectum
• Colon
• Skin

Tumour resection surgery is a common cancer treatment for primary tumours that have not extensively metastasized throughout the body. However, if the tumour has spread, oncologists will evaluate the size and the location of the other secondary tumours before considering resection surgery as an option. 

Suitability of tumour resection surgery 

Cancer surgery can be carried out for a range of different cancers; however, the suitability of the treatment depends on the location and size of the tumour. Both malignant and benign tumours can be removed using this surgery. Despite not being cancerous, benign tumours may cause adverse effects or develop into cancerous tumours. An oncologist will assess the benefits of removing a benign tumour. 

The removal of solid tumours via surgery has been shown to provide the best outcome and improve prognosis for early-stage cancer. It is metastatic tumours that lead to death, therefore it is crucial that the cancer is treated before it metastasises.²  

Tumour resection procedure 

The type of tumour resection surgery is dependent on the location, type, and size of the tumour. The types of surgery include: 

• Total removal

The surgeon removes the entire tumour along with some health tissue adjacent to the tumour known as the margin. The goal of this surgery is to have a ‘negative surgical margin’ where no cancer cells are present in the surrounding tissue. 

• Partial removal

The tumour is only partially removed. This is done when the tumour is located in certain areas such as the spinal cord or the brain. The goal of this surgery is to reduce the size of the tumour and to reduce symptoms.  

• En Bloc resection

The removal of the tumoural mass in its entirety as it is surrounded by a layer of healthy tissue. This type of surgery is common in the removal of spinal tumours.³

Tumour resection surgery can also be carried out in a minimally invasive method known as laparoscopic resection surgery. The surgeon removes tumours using small incisions in the body and uses a laparoscope to see inside the body. This method offers many advantages over conventional tumour resection surgery such as smaller incisions, less scarring, and a shorter recovery time.  

Risks and complications

Just like other types of surgery, tumour resection surgery may lead to a range of side effects. 

Side effects include:

• Organ damage 
• Loss of blood 
• Infection 
• Blood clots 
• Reaction to anaesthesia

Many of these side effects are experienced as a result of any surgery and are not exclusive to tumour resection surgery. Please discuss your concerns with your oncologist prior to undergoing surgery. 

Other side effects of tumour resection surgery vary depending on the location of the tumour. For example, removing a tumour from the brain can lead to neurological deficits and deterioration. However, this was shown to be dependent on the location of the tumour in the brain. It is of note that brain tumours can also cause neurological deterioration, therefore treating them is imperative before any adverse effects are experienced.⁴ 

In some cases, the surgery may not remove all cancerous cells. This is known as minimal residual disease and can occur when there is inadequate removal of the tumour or when cancerous cells spread into the blood during surgery. This poses a risk of cancer recurrence. Tests can be conducted to see if there are remaining cancer cells. If the individual tests positive, further cancer treatments such as chemotherapy or radiotherapy can be carried out to prevent tumour formation and cancer recurrence. 

Recovery and rehabilitation 

Immediate postoperative care includes:

•  Monitoring in the recovery room

Medical staff will carry out a range of tests to assess your condition. 

• Pain management

Painkillers are prescribed to alleviate symptoms and side effects of the surgery.

• Wound care

Wounds are treated to prevent infection. Medical staff will instruct you on how to care for the wound after they are discharged from hospital.

• Physical therapy

This may be required to regain mobility and strength (this depends on the location of the surgery).

Your oncologist will follow up with you to monitor your recovery and assess the requirement for further treatment. Please report any symptoms or side effects to your oncologist during these appointments. 

Success and prognosis

There are a range of factors that influence the success of a tumour resection surgery. These factors include: 

•  Surgical margin (or tumour removal)

Removal of the entire tumour along with some healthy tissue (margin) will reduce the chance of some cancer cells remaining or the tumour returning.⁵ 

• Tumour location

Some tumours are located in hard-to-reach areas. 

• Type of tumour

Malignant tumours have a greater chance of recurrence.

• Intraoperative bleeding

Intraoperative bleeding refers to blood loss that occurs during the surgical procedure. This should be controlled and blood transfusions are required if the blood loss is excessive.⁵ 

• Preoperative treatment

Chemotherapy may be used to reduce the size of the tumour, as this enables easier removal of the tumour.

The quality of life after tumour resection surgery is dependent on the success of the surgery. If a negative surgical margin is achieved, then the tumour may not return and the patient is in remission. However, if cancer cells do remain and the tumour returns, other treatments such as chemotherapy will need to be administered. 

Alternatives to tumour resection

In cases where tumour resection surgery is not a suitable treatment, other treatments would need to be discussed. Other cancer treatments include: 

• Chemotherapy

Drugs are used to kill cancer cells. Several cycles of chemotherapy are often needed. 

• Radiotherapy

High doses of radiation are used to kill cancer cells. 

• Immunotherapy

There are several classes of immunotherapy drugs, such as monoclonal antibodies, checkpoint inhibitors, and vaccines. They all function in different ways to equip the body’s immune system to target and kill cancer cells.

These treatments can be used in combination with surgery, either before to reduce the size of the tumour or after to remove any remaining cancer cells. 

FAQs

Can a tumour resection surgery be performed on tumours located in critical areas of the body, such as near major blood vessels or the spinal cord? 

It may be possible for surgery to be performed in critical areas. The oncology team will evaluate the risks and if they can be mitigated. The patient will be informed of all the potential risks so that they can give informed consent. 

Can tumour resection surgery be carried out for elderly patients? 

Oncologists will consider the overall health and the frailty of the patient. They may alter the procedure to minimise risks and more post-operative care will be given.

Summary 

Tumour resection surgery is the removal of a benign or malignant tumour before it metastasizes. This treatment can be carried out alongside other cancer treatments such as chemotherapy or radiotherapy in order to achieve remission. Tumour resection surgery may not be suitable for all cancer cases. Please discuss your treatment options with your oncologist. 

Just like other surgeries, tumour resection surgery comes with various side effects, depending on the type of tumour resection surgery and the location of the tumour. Consult with your oncologist, they will help you make an informed decision.