Minimally Invasive Surgical Oncology: State-of- the-Art Cancer Management PDF
Preview Minimally Invasive Surgical Oncology: State-of- the-Art Cancer Management
Minimally Invasive Surgical Oncology Ronald Matteotti Stanley W. Ashley ● (Editors) Minimally Invasive Surgical Oncology State-of-the-Art Cancer Management Editors Ronald Matteotti, MD, FMH Stanley W. Ashley, MD, FACS Surgical Oncologist/Minimally Brigham and Women’s Invasive Surgeon Hospital/Harvard Med 263 Osborn Street Chief, General Surgery Philadelphia, PA 19128 Department of Surgery USA Francis St. 75 [email protected] Boston, MA 02115 USA [email protected] ISBN 978-3-540-45018-4 e-ISBN 978-3-540-45021-4 DOI 10.1007/978-3-540-45021-4 Springer Heidelberg Dordrecht London New York Library of Congress Control Number: 2011922048 © Springer-Verlag Berlin Heidelberg 2011 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. 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Cover design: eStudioCalamar, Figueres/Berlin Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) To our patients suffering from cancer: May new scientific discoveries, improved treatments and technologies contribute to a better quality of life. To my grandmother Margarethe Matteotti, my father Werner and Mary the greatest supporters in my life. We would like to express a special thank you to Stephanie Benko and Gabriele Schroeder from Springer Verlag who greatly supported this project along the way. Ronald Matteotti Foreword I The view of a pioneer in open approaches to Surgical Oncology It must seem surprising that an ‘open surgery’ surgical dinosaur should be invited to write a foreword for this text on minimally invasive surgical oncology. I accepted with some trepidation, expecting to be faced with the unpleasant task of writing a critical foreword of a technical text. But the title misled me, this is not a technical treatise but a disease focused management text in which the technical issues of mini- mally invasive approaches are emphasized. Above all, the text is comprehensive; from history to surgical education, research, robotics, to immunological response. Organ specific summaries are all covered in great depth. The authorship is a ‘who’s who’s’ of minimally invasive surgery and perhaps more importantly, a ‘who will be a who’, as the next generation develops these technical refinements. For me trying so long to focus on cancer management as a disease-based entity rather than a discipline-based entity it is most encouraging to see a text emphasizing technique but not neglecting important issues of underlying biology, evaluation and a synthesized approach to management. Having started my surgical career prior to the use of CT or MRI, I reflect how seamlessly we incorpo- rated these techniques into patient management. I am encouraged that this will be similarly encompassed by the current generation of surgical oncologists. The trend is clear. They are courageous enough to address natural orifice surgery in oncology. Except for the increasing use of cesarean section as opposed to trans- vaginal delivery surgical procedures are progressively moving from large incisions to small incisions to natural orifice surgery. While debate will no doubt continue as to the relative importance of minimally invasive approaches over the more open approaches, it is clear to me that where applicable the avoidance of a large abdominal incision with its accompanying significant risk of subsequent incisional hernia, should be replaced with a minimally invasive approach. Whether the relevant merits of mini- mally invasive surgery change other issues of outcome should not be a debate. Minimally invasive surgery is a technique; it does not change the disease and one would hope would not change the discipline with which surgeons approach the appro- priate operation regardless of the technique employed. This then makes it an onco- logic text that allows support for a minimally invasive approach where appropriate. It is not surprising that the minimally invasive approach has not been extensively embraced in technically challenging procedures particularly those that require not only resection but subsequent reconstruction. In situations where the techniques by which tumors are removed, for example pancreaticoduodenectomy, is less of an issue than the consequences of the reconstruction; it is no surprise that minimally invasive vii viii Foreword I approaches have not been embraced. Indeed, the choice of the minimally invasive approach in pancreatic surgery chooses the cases that are most amendable to success regardless of technical approach. We would all like to approach the “easy” case regardless of technique. Where minimally invasive approaches have most appeal is in the more challenging case, in the more challenging patient where the ability to per- form by a minimally invasive approach has very significant benefits to the patient. An obvious example of this is in hysterectomy and bilateral salpingo oophorectomy in the morbidly obese where morbidity of the resection is often associated with the extensive abdominal incision when approached conventionally. Some MIS approaches still appear to me to be techniques looking for an indication. When asked how mini- mally invasive surgery has altered my approach to thyroid and parathyroid surgery, I do confess my incision is smaller and the patient goes home earlier. But I still use less pre- and intra-operative testing than most (at least when I control the plethora of tests often ordered) and my morbidity and success rate seems unchanged. We should welcome a text, which focuses on the technical aspects of minimally invasive surgery, but remains comprehensive and inclusive of disease management approaches which ultimately are the only way to improve overall outcome. I am cautiously optimistic that by the time I need my first procedure for malig- nancy minimally invasive techniques will be at such a level that I can contemplate the same outcome as I might from the open approach but with less pain, morbidity, and no need for an incisional hernia repair! I shall not need a hysterectomy; I will be pleased to have a distal pancreatectomy. But if you need to convert, convert early [1]. As for my thyroidectomy, a robot assisted thyroidectomy by the bilateral axillo-breast approach (BABA) is not for me [2]. A small neck incision cannot possibly make me look worse than I do now, and I do not want to risk lymphedema. In the meantime, given my secondary interest in sarcoma, it is hard to envision minimally invasive surgery dealing with a 15-kg retroperitoneal soft tissue sarcoma. So my timing is right; it will take a little longer to solve that problem with a minimal- ist approach. I congratulate the editors and their authors. Prof. Murray F. Brennan, M.D. Memorial Sloan-Kettering Cancer Center, 1225 York Avenue, New York, NY 10065, USA References 1. Jayaraman, S., Gonen, M., Brennan, M.F., D’Angelica, M.I., DeMatteo, R.P., Fong, Y., et al.: Laparoscopic distal pancreatectomy: evolution of a technique at a single institution. J. Am. Coll. Surg. 211(4), 503–509 (2010) 2. Lee, K.E., Koo do, H., Kim, S.J., Lee, J., Park, K.S., Oh, S.K., et al.: Outcomes of 109 patients with papillary thyroid carcinoma who underwent robotic total thyroidectomy with central node dissection via the bilateral axillo-breast approach. Surgery. 148(6), 1207–1213 (2010) Foreword II The view of a pioneer in Minimally Invasive Surgery There can be little doubt that the introduction of laparoscopic surgery in the mid 1980s has had a far reaching effect on surgical practice. In many ways, this development has to be categorized as disruptive as defined by Christensen in his book the Innovator’s Dilemma, because it has radically changed the way in which we, as clinical surgeons, manage and treat our patients. From the early years of cholecystectomy and appendec- tomy, the scope of laparoscopic surgery has expanded to the safe execution of major operations for life threatening disorders across all surgical specialties, imparting sig- nificant benefits primarily to the immediate outcome of patients and to surgical health- care in general. The technology has continued to progress as has the surgical approaches exemplified by natural orifice and single incision laparoscopic surgery, in the quest for reduction of the traumatic insult to our patients. In some respects this progress has exceeded the expectations of the early pioneers with the advent of HDTV imaging systems and robotic surgery. To a very large extent, traditional open surgery now serves as a fall-back approach used whenever the minimally access approach proves difficult for whatever reason. This is as it should be, as surgical operations must never be considered as feats (the macho phenomenon) but simply as the appropriate means to cure or palliate patients for whom our profession exists to serve. The concerns that the laparoscopic approach by virtue of the positive capnoperi- toneum somehow compromises the clinical outcome including cure rates of patients with cancer by enhancing the risks of wound recurrence and distant spread have been disproved by seminal studies including RCTs, such that we have now level I evidence on the equivalent cure rates between the open and the laparoscopic approach for cancer surgery, certainly for colon cancer. Paradoxically, the major expansion of the laparoscopic approach witnessed in the last 10–15 years has been in surgery for solid cancers. It is timely therefore that all these significant advances are brought together for the benefit of practicing surgeons. In this respect the two Editors, Ronald Matteoti and Stanley Ashley, are to be complimented for recruiting leading contributors for Minimally Invasive Surgical Oncology which, in my view, achieves its objective in providing a state-of-the art account. It provides a wealth of information on all the topics which should be of considerable interest to both estab- lished surgical oncologists and residents. Appropriately in my opinion, the first 10 chapters deal with general issues and technological advances relevant to oncologi- cal practice and are followed by specific chapters on the laparoscopic treatment ix
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