What Is Perioperative Chemotherapy?

Abstract

The first panel discussion at the Symposium dealt with the definition of perioperative chemotherapy and with the aims of this combined-modality approach to cancer. Perioperative chemotherapy — in a broad sense — includes any chemotherapy around the time of surgery, e.g., preoperative, intraoperative, and immediately postoperative chemotherapy. Most surgeons would agree that perioperative measures, by definition, are those that interfere with the surgical procedure itself by influencing surgical morbidity through clotting activity, immunocompetence, wound healing, etc. Depending on the chemotherapy regimen used and the surgery performed, this perioperative period may be only 1 or 2 days in one case, or a few weeks or even months in other instances. Therefore, it was unanimously felt that this type of functional definition of perioperative chemotherapy is not suitable for oncologic practice. At this point, some participants proposed omission of the term perioperative and a clear statement of the timing of chemotherapy as preoperative, intraoperative, or immediate postoperative. Based on the rationale of perioperative chemotherapy (see below) given as an adjuvant to potentially curative surgery, it was concluded that, more strictly speaking, perioperative chemotherapy should be started as soon as possible after tumor resection. Usually, surgery is the best tool in establishing the histopathological diagnosis, in staging the extent of disease, and in reducing the tumor mass to a minimal tumor burden. Furthermore, chemotherapy given before surgery may lead to an unnecessary delay of potentially curative resection at least in nonresponding patients.