SURGERY OF TUMORS AND BOUNDARY SITUATIONS

Abstract

The term “limit” applied to cancer surgery, denotes the ideological moment beyond which one cannot and should not propose any a g g re s s i ve treatment. Such limits may concern the operability of a patient and may be re p resented by some general chara c t e r i s t i c s independent of the patient’s current disease status (e.g. ve ry old age, poor perf o rmance status, poor cardiac, re s p i ra t o ry, renal hepatic or mental conditions). They may concern the neoplastic invo l ve m e n t of the organ affected by the tumor: if undertaken, surgery should g u a rantee a reasonable duration of life, and a quality of life that makes it worth living. Other factors to be taken in considera t i o n a re the possibility the tumor spread to local or distant sites, as we l l as certain extreme conditions such as cancer cachexia, live r / k i d n e y f a i l u re, irre versibile septic-toxic shock, ect. Mo re ove r, there may be limits related to the stru c t u ral conditions of the establishment w h e re the operation is to be carried out (facilities, equipment, p h a rmacological supplies, medical and paramedical personnel) and to the social enviromnent and the economic situation of the patient, in view of the assistance re q u i red following surgery. Lasly, a seve re assessment of one’s own fitness to perf o rm any specific task should be part of the daily preparation of any surgeon.