tissue. Some researchers are exploring surgeries that
don’t require an incision at all, with entry to the body
through the mouth or rectum.
Yet new techniques have important limitations. For
example, laparoscopic surgery may not be an option
for large tumors. In addition, patients who have had
surgeries in the past may have scar tissue that can make
laparoscopic or laser surgery difficult, if not impossible.
Clinical trials using robotic surgery have not shown
increased patient survival over open surgery.
The goal of new techniques is to safely minimize
pain, speed up recovery times and reduce the risk
of post-operative side effects associated with more
invasive procedures, McMasters says. “There are a
lot of people trying to push the envelope to figure out
how to best use the technology, and where it has the
most impact,” he says. At the same time, “we have
to show that we’re adding value when we do these
approaches, and not just cost.”
McMasters would like to see more clinical-trial
evidence that demonstrates an improvement using
newer methods over conventional surgery or other
treatments: “There are plenty of times, in my esti-
mation, that the best way by far to take care of the
cancer is a good old-fashioned, open operation.”
Patients should look for a surgeon with experience doing the type of procedure recommended
to treat their cancer. “There’s very good data that
high-volume surgeons in high-volume settings tend
to have the best outcomes in surgery,” Drebin says.
He recommends seeking out surgeons who work
at cancer centers and specialize in treating specific
From a patient’s perspective, feeling confident in
your choice of surgeon and understanding your treatment plan can go a long way in bolstering morale, says
Becky Sail, a 29-year-old corporate communications
manager in Boston. In 2010, when she was 22, Sail
was diagnosed with an aggressive angiomyxoma—an
abdominal sarcoma so rare that only about 250 cases
have been documented worldwide.
At the time of her diagnosis, the pelvic mass was
the size of a softball. Although this type of growth
almost never spreads to other organs, the tumor
recurs in the same place after it has been removed
surgically. Sail initially underwent exploratory
surgery at a hospital in Albany, New York, where her
parents lived. When her surgeon saw that the growth
was not, as first suspected, a large cyst, he suggested
Sail go to a cancer center, where specialists could
Sail ended up going to the Dana-Farber Cancer
Institute in Boston, where she was planning to move
• Research your surgeon’s experience. Most cancer surgery in the
U.S. is performed by general surgeons. Look for a surgeon with
experience in the type of procedure you’ll undergo. You could choose
a general surgeon, or, for complex or rare procedures, you might
consider a surgical oncologist.
• Find out who will be involved in your care. “Most patients these days
are being treated by multidisciplinary teams,” says surgical oncologist
Jeffrey Drebin, chair of the department of surgery at Memorial
Sloan Kettering Cancer Center in New York City. Teams may include
oncologists, oncology nurses, radiologists, and even researchers who
specialize in certain diseases or treatments, like immunotherapies.
• Seek a second opinion. Not all surgeons will recommend the same
procedure. Patients and surgeons alike suggest finding a surgeon who
will work out a treatment plan that you trust.
• Set realistic expectations and assemble your care team. A patient’s
recovery from surgery can take time, and being physically incapacitated
can lead to feelings of vulnerability. Prepare for recovery by asking for
help from family and friends. Also, discuss upcoming changes with your
children in advance.
• Ask about clinical trials. A clinical trial may be investigating the
effectiveness of surgery combined with new types of treatment.
Clinical trial participation may offer an opportunity for a better
outcome than standard care alone, says Kelly McMasters, a surgical
oncologist at the University of Louisville in Kentucky and president of the
Society of Surgical Oncology. —S.O.
LEARN ABOUT YOUR SURGERY