[Rational of oncological surgery in multimodality treatment of cancers].
The infiltrative cancers permanently swarm circulating cancer cells, and in 2006 it is no more possible to consider that localized cancer exists. So, we must question our self about the place of a treatment like surgery, which is localized in the time and in the space. Moreover, it is now proved that surgery increases the number of circulating cancers cells, gives a transient immunodepression which promotes cancer implantations, and that the cicatrisation stimulates growth factors, which act also on tumor growth. In spite of these deleterious effects, the oncological surgery stays an important tool by achieving an optimal cytoreductive surgery which facilitates the effect of the adjuvant treatments, by eliminating the vascular sanctuaries present in the center of any big tumor, and because it is a striking-force very localized in the space and in the time. The role of the oncological surgery must be integrated in the new aspect of the biology of the tumors and must take in account the recent improvements concerning functional imaging, genomic and proteomic. It is currently only one of the different compounds of the multimodality treatments for cancers, and its modalities, as its timing must be reconsidered. At last, considering the future technologies, we must elaborate the future modalities of the oncological surgery.
Elias
Dominique
D
Département de chirurgie digestive carcinologique, Institut Gustave-Roussy, rue Camille-Desmoulins, 94805 Ville juif Cedex. elias@igr.fr
D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy / Q000379:methods; D006801:Humans; D007108:Immune Tolerance; D008207:Lymphatic Metastasis / Q000473:pathology; D008495:Medical Oncology / Q000639:trends; D009369:Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D009360:Neoplastic Cells, Circulating / Q000473:pathology; D013514:Surgical Procedures, Operative / Q000639:trends