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.
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.
Surgery is selected as the preferred local treatment.
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.