Synopsis
Distinguish curative, cytoreductive, diagnostic and symptom-relieving cancer operations, establish resectability and fitness through multidisciplinary assessment, and prevent perioperative decisions from undermining oncological outcomes.
- Curative surgery aims for complete oncological removal with an appropriate margin and regional staging where relevant; tumour rupture and unplanned piecemeal excision can destroy that opportunity.
- Resectability describes whether anatomy permits adequate removal, while operability describes whether the person can tolerate the procedure; they are related but not interchangeable.
- Neoadjuvant treatment may downstage disease or test biology before surgery; adjuvant treatment addresses residual microscopic risk after resection.
- Palliative surgery treats obstruction, bleeding, perforation, pain or other local harm when complete cure is not realistic and benefit exceeds recovery burden.
- Prehabilitation, nutrition, smoking cessation, anaemia management and medication planning can reduce complications without becoming an indefinite barrier to treatment.
- Consent must include intent, alternatives, stoma or organ-loss possibilities, functional consequences, recurrence risk and the chance that exploration will not permit resection.
- Pathology must report tumour type, stage elements, response, margins and nodes using the current RCPath dataset, because operative success is not judged by appearance alone.
- Postoperative deterioration may reflect bleeding, leak, sepsis, thrombosis, cardiopulmonary failure or adrenal and metabolic complications and requires early escalation.
Key red flags
Tachycardia, hypotension, rising lactate, respiratory decline, severe pain or reduced urine output can signal leak, bleeding, sepsis or thrombosis.
Investigation priorities
Define local planes, nodes and distant disease before committing to operation.
Management branches
Potentially operable cancer is discussed before definitive local treatment.
- Confirm tissue, stage, biological subtype and resectability in the specialist MDT, including whether neoadjuvant treatment improves the route.
- Assess fitness, frailty, nutrition and patient goals, then compare operation with radiotherapy, systemic and supportive alternatives.
- Consent for intent, margin, organ loss, stoma, functional effects, complications and the possibility of unresectable findings.
Surgery is selected as the preferred local treatment.
- Use the tumour-specific en-bloc technique, planned access and nodal strategy, avoiding rupture and unplanned piecemeal removal.
- Provide protocol-led thrombosis, antibiotic, analgesic, glycaemic and enhanced-recovery care with clear responsibility for devices and drains.
- Escalate early physiological deterioration and investigate bleeding, leak, sepsis, thrombosis or cardiopulmonary failure rather than attributing it to normal recovery.
Key medicines
Enoxaparin for perioperative thromboprophylaxisA common higher-risk surgical prophylaxis dose is 40 mg subcutaneously once daily. Use the authorised local start time; for eligible abdominal surgery NICE specifies at least 7 days, and after major abdominal cancer surgery consider extending to 28 days, with renal, weight and bleeding adjustments.Coordinate dosing with surgery and neuraxial procedures; review active bleeding, platelet count, renal function, low or high body weight and previous heparin-induced thrombocytopenia. This is prophylaxis, not the treatment dose for established thrombosis.