Was The Cancer Surgery a Success?

Note by Dr Suraj Manjunath: This is a guest post by Dr Vivekanandan Jayakumar.  The article helps you understand how to assess the outcome of a cancer surgery and the concept of “success” or “failure” in this context. Dr Vivekanandan is a highly skilled cancer surgeon who is exceptionally dedicated to his patients, and it has been a pleasure for me to work with him in the Department of Surgical Oncology at Vikram Hospital, Bangalore.

A harrowing wait in the secluded waiting area of the operating theatre. The sweaty doctor finally walks out, tears his mask away (maybe not in the era of covid) and you pop the question that’s been weighing so heavily on you- “Was the surgery a success?”  While you hope to hear a “yes” and pray not to get a “no”, the answer in reality almost always is more nuanced.  This article helps you understand the intricacies of an often complicated answer from your surgeon, and why the surgical outcome has several layers to it beyond traditional views of success and failure.

The first step to understand the outcome of surgery is to have a clear discussion with the surgeon before the surgery, regarding three important aspects :

1. The goal of surgery
2. Chances of Complications
3. Cure of cancer/timeline to establish such outcomes.

1. The goal of surgery: Whether the goal is –

1. Investigative (obtain a piece of tissue to establish a diagnosis),
2. Curative (to remove the tumor completely to offer the best chance at complete cure), or
3. Palliative ( to control symptoms or prolong life but without achieving a cure, eg. tackle an intestinal obstruction, control pain, or relieve jaundice).

Understanding the goal is a critical aspect to understand the outcome and whether it has been achieved or not (“success”).

2. Complications: Potential complications are part and parcel of any surgical procedure. You should have had an open discussion with your surgeon beforehand about the possible complications and the chances of these complications happening.

At the end of the surgical procedure, your surgeon will inform if there were any intra-operative complications (injury to a vital structure, bleeding, etc that occur during the surgery and are tackled at that moment itself). Some complications occur in the post-operative period and the doctor will wait for a full recovery before confirming the procedure as successful. While it is a good practice to discuss the possible common complications beforehand, trying to know each and every complication can be daunting as the list may seem never-ending and scary.

3. Cure of The Cancer: This is something which despite performing the best surgery no surgeon can predict (Click here to know why does cancer recur despite all treatment). However, if the preset goal of surgery was cure, and the surgery went ahead as planned, there is a good chance of long-term cure. In addition, after the surgery, it is also possible to know a more accurate stage of the disease, how aggressive the cancer is, and a clearer idea of the chances of recurrence (most of this information will be available after the post-operative pathology report – say in about a week). Finally, the actual success may not be ascertained for long periods (most cancers are considered cured if there is no recurrence for 5 years).

Consequently, the surgical outcome has to be understood in the context of achieving the preset goals, overcoming any intra-operative and post-surgical complications, and watchful waiting for no recurrence. For instance, a tumor can be successfully and completely removed, but the surgery cannot be called a “success” if the patient succumbs to a surgical complication. Or the surgical course may be void of complications, but if the tumor could not be completely resected and the primary goal was not met, the cancer is most likely going to recur, leading to failure. In other cases, the tumor may be completely resected and the post-surgical course uncomplicated, but the cancer in itself may be very aggressive in recurring affecting the outcome of an otherwise flawless surgery.

Unfortunately, “success” in cancer surgery has many layers, and cannot be a simple “yes” or “no”.  But the right knowledge enables us to help our loved ones better in their fight against cancer.