Introduction
Organ preservation surgery is an important strategy for the management of cancer and simultaneously avoiding the functional loss of the organ to be operated on. The surgeon, during this surgery, removes only the affected part of the organ and keeps the remaining portion intact. Thus, the majority of the organ function remains intact. The advantages of organ preservation surgery include faster recovery, improved quality of life, and less damage to the healthy tissues. There are several important pieces of information that patients should know before undergoing organ preservation surgery.
Things to know about organ preservation surgery for cancer
- Principles of organ preservation surgery: There are several principles for functional organ preservation surgery. The surgeon should consider these principles and modify them according to the requirement and site of surgery. The principles of organ preservation surgery include local control, comprehensive and accurate assessment of tumor, and use of the best technique for surgery to maximize organ preservation. During local control, the surgeon should continuously and closely monitor the patients as sometimes, the techniques used in organ preservation surgery make it challenging to detect the recurrence. The surgeon should not rely only on the T-staging for performing organ preservation surgery but should also take into account the three-dimensional tumor load and surface spread. The surgeon should also consider the standard resection techniques to obtain the expected outcome, even when there is the removal of the uninvolved (healthy) tissue.
- Techniques for organ preservation surgery: There are several techniques employed in functional organ preservation surgery. The surgeon chooses the appropriate technique that will achieve the best outcome. The use of techniques depends upon several factors, such as the site of cancer, the extent (staging) of cancer, and the risk of cancer recurrence. Some of the techniques for functional organ preservation surgery include lumpectomy (removal of a lump from the breast as a part of organ preservation), Radical tonsillectomy or other oropharyngeal resection, partial laryngectomy or pharyngotomy, transoral laser microdissection, and transoral robotic surgery (TORS) (for preserving laryngeal and pharyngeal functions). The other surgeries include keyhole surgeries and open surgeries. Apart from these invasive surgeries, organ preservation may also be through non-invasive treatment options, including radiation therapy and chemotherapy.
- Limitations of organ preservation surgery: There are some limitations to organ preservation surgery. Organ preservation surgery may not be performed in those cases when cancer spreads throughout the organ. In such cases, the complete organ is removed during surgery. For instance, mastectomy is the procedure for removal of the complete breast tissues and is done when cancer spreads in several parts of the breast. Further, when organ preservation surgery is performed, close and frequent monitoring is required as changes in the organ topography during the functional organ preservation surgery can make the detection of recurrent or residual disease a challenge.
- Quality of life after organ preservation surgery: Organ preservation surgery, especially when there is significant preservation of the organ function, significantly affects the quality of life of the patient. In some cases, it also reduces the cost and discomfort caused due to organ reconstruction surgery, as in the case of breast reconstruction surgery after breast removal. The patients, after the organ removal surgery, may have negative psychological, physical, and functional effects. It also infuses a sense of confidence in patients and makes them socially comfortable. In contrast, patients who have organ removal surgery, such as breast removal or vocal cord removal surgery, may have depression and may go into social isolation.
- Application of organ preservation surgery in cancer: Organ preservation surgery has an important place in the management of cancer. Organ preservation surgery may have applications in other cases. However, because of the extent of the disease, rapid progression, and risk of recurrence, organ preservation surgery is quite challenging in cancer patients. Organ preservation surgery can be done in several cancers, including breast cancer, laryngeal cancer, tongue cancer, pharyngeal cancer, throat cancer, and prostate cancer.
- Efficacy of organ preservation surgery: The efficacy of cancer preservation surgery depends upon several factors. These factors include the site and extent of cancer, its risk of recurrence, techniques used, and the experience of the surgeon. Further, the best surgical outcome can be achieved if the surgeon maintains an appropriate balance between the maximal functional outcome and effective control of loco-regional cancer. Further, the surgeons, for maximum positive results, should have a thorough understanding of the dynamic and static anatomy and physiology of the organ to be operated on.
