Improvements to preserve tissue and function
Advances in non-surgical management, such as
radiotherapy and chemotherapy, have prompted
surgeons to re-evaluate the scale of necessary
surgical interventions (Rosenberg 2008). This has
resulted in renewed emphasis on less invasive
procedures that maximise functional conservation,
while providing effective treatment strategies and
optimal outcomes (Desai and Gullapalli 2009).
Thus, the practice of surgical oncology has evolved
from major surgical interventions to more limited
resections aimed at preservation of function (Widder
and Pötter 2006).
This has become particularly pertinent in the field
of head and neck cancer, where surgical oncologists
use the concept of ‘functional inoperability’ as
a fundamental parameter for their therapeutic
decisions. It is anticipated that minimally invasive
surgical techniques, such as transoral laser ablation,
may further influence this concept of functional
inoperability in the future, by enabling tumours to
be removed with less surrounding tissue and with an
associated reduction in functional loss. Furthermore,
it is anticipated that future imaging techniques, such
as cine magnetic resonance imaging, could help to
better define the margins of functional inoperability
(Kreeft et al 2009).
Closely linked with function preservation is the
concept of quality of life. It is becoming increasingly
recognised that quality of life is ‘an equal goal
together with being cured’ and the achievement of
both must be the aim of oncological surgery (Gnant
2006). Rainsbury and MacNeill (2009) noted that
although improving cosmetic outcome is secondary
to attaining thorough tumour excision, innovative
techniques in oncoplastic surgery are making both
goals feasible.
Contemporary oncologists are much more
concerned with the effect of treatments on quality
of life, and future care is likely to become more
outcome focused. The use of outcomes will become
standard (Eberlein 2006), focusing not only on
readily measurable data such as operative mortality,
but also on improved peri-operative outcomes and
survival issues (Brennan et al 2009). In addition to
this, as a result of the projected increase in the older
population affected by cancer, the development of
surgical techniques that can be applied to patients
who have reached an advanced age is also of major
importance for the future (Bey 2000).
Improvements to preserve tissue and functionAdvances in non-surgical management, such asradiotherapy and chemotherapy, have promptedsurgeons to re-evaluate the scale of necessarysurgical interventions (Rosenberg 2008). This hasresulted in renewed emphasis on less invasiveprocedures that maximise functional conservation,while providing effective treatment strategies andoptimal outcomes (Desai and Gullapalli 2009).Thus, the practice of surgical oncology has evolvedfrom major surgical interventions to more limitedresections aimed at preservation of function (Widderand Pötter 2006).This has become particularly pertinent in the fieldof head and neck cancer, where surgical oncologistsuse the concept of ‘functional inoperability’ asa fundamental parameter for their therapeuticdecisions. It is anticipated that minimally invasivesurgical techniques, such as transoral laser ablation,may further influence this concept of functionalinoperability in the future, by enabling tumours tobe removed with less surrounding tissue and with anassociated reduction in functional loss. Furthermore,it is anticipated that future imaging techniques, suchas cine magnetic resonance imaging, could help tobetter define the margins of functional inoperability(Kreeft et al 2009).Closely linked with function preservation is theconcept of quality of life. It is becoming increasinglyrecognised that quality of life is ‘an equal goaltogether with being cured’ and the achievement ofboth must be the aim of oncological surgery (Gnant2006). Rainsbury and MacNeill (2009) noted thatalthough improving cosmetic outcome is secondaryto attaining thorough tumour excision, innovativetechniques in oncoplastic surgery are making bothgoals feasible.Contemporary oncologists are much moreconcerned with the effect of treatments on qualityof life, and future care is likely to become moreoutcome focused. The use of outcomes will becomestandard (Eberlein 2006), focusing not only onreadily measurable data such as operative mortality,but also on improved peri-operative outcomes andsurvival issues (Brennan et al 2009). In addition tothis, as a result of the projected increase in the olderpopulation affected by cancer, the development ofsurgical techniques that can be applied to patientswho have reached an advanced age is also of majorimportance for the future (Bey 2000).
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