Role of Surgery in a Multidisciplinary Approach

  • Eric H. Liu
  • Irvin Modlin
Part of the Medical Radiology book series (MEDRAD)


Surgical therapy is an essential therapeutic option in all malignancies. Using it in the context of systemic and local regional treatments can provide the best chance for cure, disease control, and palliation. Careful evaluation of the patient by a multi-disciplinary team can determine the optimal sequencing of treatment. The risks and benefits of surgery should be determined in relationship with the other treatments. The combination of nuclear systemic therapy with surgery is a novel treatment strategy that may have great potential and warrants further testing.


Sentinel Lymph Node Biopsy Wedge Resection Radionuclide Therapy Pancreatic Neuroendocrine Tumor Pseudomyxoma Peritonei 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. A comparison of laparoscopically assisted and open colectomy for colon cancer (2004). N. Engl J Med 350:2050–2059Google Scholar
  2. Adams S et al (1998) Intraoperative gamma probe detection of neuroendocrine tumors. J Nucl Med 39:1155–1160PubMedGoogle Scholar
  3. Ahmed A et al (2009) Midgut neuroendocrine tumours with liver metastases: results of the UKINETS study. Endocr Relat Cancer 16:885–894PubMedCrossRefGoogle Scholar
  4. auchmanova L et al (2004) Andrenocortical carcinomas: twelve-year prospective experience. World J Surg 28:896–903CrossRefGoogle Scholar
  5. Barber TW, Hofman MS, Thomson BN, Hicks RJ (2012) The potential for induction peptide receptor chemoradionuclide therapy to render inoperable pancreatic and duodenal neuroendocrine tumours resectable. Eur J Surg Oncol: J Eur Soc Surg Oncol Br Assoc Surg Oncol 38:64–71CrossRefGoogle Scholar
  6. Bleyer A, Welch HG (2012) Effect of three decades of screening mammography on breast-cancer incidence. N. Engl J Med 367:1998–2005PubMedCrossRefGoogle Scholar
  7. Boudreaux JP et al (1999) Surgical treatment of advanced-stage carcinoid tumors: lessons learned. Ann Surg 241:839–845; discussion 845–836 (2005)Google Scholar
  8. Boz A et al (2001) Gamma probe-guided resection and scanning with TC-99 m MIBI of a local recurrence of follicular thyroid carcinoma. Clin Nucl Med 26:820–822PubMedCrossRefGoogle Scholar
  9. Bristow RE, Puri I, Chi DS (2009) Cytoreductive surgery for recurrent ovarian cancer: a meta-analysis. Gynecol Oncol 112:265–274PubMedCrossRefGoogle Scholar
  10. Butturini G et al (2008) Influence of resection margins and treatment on survival in patients with pancreatic cancer: meta-analysis of randomized controlled trials. Arch Surg 143:75–83; discussion 83Google Scholar
  11. Chamberlain RS et al (2000) Hepatic neuroendocrine metastases: does intervention alter outcomes? J Am Coll Surg 190:432–445PubMedCrossRefGoogle Scholar
  12. Chambers AJ, Pasieka JL, Dixon E, Rorstad O (2008) The palliative benefit of aggressive surgical intervention for both hepatic and mesenteric metastases from neuroendocrine tumors. Surgery 144:645–651; discussion 651–643 (2008)Google Scholar
  13. Eheman C et al (2012) Annual report to the nation on the status of cancer, 1975–2008, featuring cancers associated with excess weight and lack of sufficient physical activity. Cancer 118:2338–2366PubMedCrossRefGoogle Scholar
  14. Fong Y et al (1997) Liver resection for colorectal metastases. J Clin Oncol: Official J Am Soc Clin Oncol 15:938–946Google Scholar
  15. Giuliano AE, Kirgan DM, Guenther JM, Morton DL (1994) Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg 220:391–398; discussion 398–401 (1994)Google Scholar
  16. Givi B, Pommier SJ, Thompson AK, Diggs BS, Pommier RF (2006) Operative resection of primary carcinoid neoplasms in patients with liver metastases yields significantly better survival. Surgery 140:891–897; discussion 897–898Google Scholar
  17. Gupta PK et al (2011) Development and validation of a risk calculator for prediction of cardiac risk after surgery. Circulation 124:381–387PubMedCrossRefGoogle Scholar
  18. Hadi R et al (2006) Review of patients with peritoneal malignancy treated with peritonectomy and heated intraperitoneal chemotherapy. ANZ J Surg 76:156–161PubMedCrossRefGoogle Scholar
  19. Hodul PJ, Strosberg JR, Kvols LK (2008) Aggressive surgical resection in the management of pancreatic neuroendocrine tumors: when is it indicated? Cancer Control: J Moffitt Cancer Cent 15:314–321Google Scholar
  20. Simmonds PC et al (2006) Surgical resection of hepatic metastases from colorectal cancer: a systematic review of published studies. Br J Cancer 94:982–999PubMedCentralPubMedCrossRefGoogle Scholar
  21. Improved survival with preoperative radiotherapy in resectable rectal cancer (1997). Swedish rectal cancer trial. N. Engl J Med 336: 980–987Google Scholar
  22. Kaemmerer D et al (2009) Neoadjuvant peptide receptor radionuclide therapy for an inoperable neuroendocrine pancreatic tumor. World J Gastroenterol: WJG 15:5867–5870PubMedCentralPubMedCrossRefGoogle Scholar
  23. Kaemmerer D et al (2012) Radioguided surgery in neuroendocrine tumors using Ga-68-labeled somatostatin analogs: a pilot study. Clin Nucl Med 37:142–147PubMedCrossRefGoogle Scholar
  24. Kang T et al (2010) Does blue dye contribute to success of sentinel node mapping for breast cancer? Ann Surg Oncol 17(Suppl 3):280–285PubMedCrossRefGoogle Scholar
  25. Kapiteijn E et al (2001) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N. Engl J Med 345:638–646PubMedCrossRefGoogle Scholar
  26. Konstantinidis IT et al (2012) Pancreatic ductal adenocarcinoma: is there a survival difference for r1 resections versus locally advanced unresectable tumors? What is a true r0 resection?. Ann SurgGoogle Scholar
  27. Kwekkeboom DJ et al (2008) Treatment with the radiolabeled somatostatin analog [177 Lu-DOTA 0, Tyr3]octreotate: toxicity, efficacy, and survival. J Clin Oncol: Official J Am Soc Clin Oncol 26:2124–2130CrossRefGoogle Scholar
  28. Lee TH et al (1999) Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation 100:1043–1049PubMedCrossRefGoogle Scholar
  29. Mazzaferri EL, Jhiang SM (1994) Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med 97:418–428PubMedCrossRefGoogle Scholar
  30. Moertel CG, Weiland LH, Nagorney DM, Dockerty MB (1987) Carcinoid tumor of the appendix: treatment and prognosis. N. Engl J Med 317:1699–1701PubMedCrossRefGoogle Scholar
  31. Morton DL et al (1992) Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg 127:392–399PubMedCrossRefGoogle Scholar
  32. Ohrvall U et al (1997) Intraoperative gamma detection reveals abdominal endocrine tumors more efficiently than somatostatin receptor scintigraphy. Cancer 80:2490–2494PubMedCrossRefGoogle Scholar
  33. Ollila DW, Gleisner AL, Hsueh EC (2011) Rationale for complete metastasectomy in patients with stage IV metastatic melanoma. J Surg Oncol 104:420–424PubMedCrossRefGoogle Scholar
  34. Rees M, Tekkis PP, Welsh FK, O’Rourke T, John TG (2008) Evaluation of long-term survival after hepatic resection for metastatic colorectal cancer: a multifactorial model of 929 patients. Ann Surg 247:125–135PubMedCrossRefGoogle Scholar
  35. Salvatori M et al (2003) Radio-guided surgery for lymph node recurrences of differentiated thyroid cancer. World J Surg 27:770–775PubMedCrossRefGoogle Scholar
  36. Sarmiento JM et al (2003) Surgical treatment of neuroendocrine metastases to the liver: a plea for resection to increase survival. J Am Coll Surg 197:29–37PubMedCrossRefGoogle Scholar
  37. Schomas DA et al (2009) Intraperitoneal treatment for peritoneal mucinous carcinomatosis of appendiceal origin after operative management: long-term follow-up of the mayo clinic experience. Ann Surg 249:588–595PubMedCrossRefGoogle Scholar
  38. Singer PA et al (1996) Treatment guidelines for patients with thyroid nodules and well-differentiated thyroid cancer. Am Thyroid Assoc Arch Intern Med 156:2165–2172Google Scholar
  39. Soper JT et al (1985) Intraperitoneal chromic phosphate P 32 suspension therapy of malignant peritoneal cytology in endometrial carcinoma. Am J Obstet Gynecol 153:191–196PubMedCrossRefGoogle Scholar
  40. Sowa-Staszczak A, Hubalewska-Dydejczyk A, Tomaszuk M (2013) PRRT as neoadjuvant treatment in NET. Recent results in cancer research. Fortschritte der Krebsforschung. Progres dans les recherches sur le cancer 194:479–485Google Scholar
  41. Stoeltzing O et al (2010) Staged surgery with neoadjuvant 90Y-DOTATOC therapy for down-sizing synchronous bilobular hepatic metastases from a neuroendocrine pancreatic tumor. Langenbeck’s archives of surgery/Deutsche Gesellschaft fur Chirurgie 395:185–192PubMedGoogle Scholar
  42. Sugarbaker PH (2005) Peritoneal surface oncology: review of a personal experience with colorectal and appendiceal malignancy. Tech Coloproctol 9:95–103PubMedCrossRefGoogle Scholar
  43. Sugarbaker PH, Zhu BW, Sese GB, Shmookler B (1993) Peritoneal carcinomatosis from appendiceal cancer: results in 69 patients treated by cytoreductive surgery and intraperitoneal chemotherapy. Dis Colon Rectum 36:323–329PubMedCrossRefGoogle Scholar
  44. Travagli JP et al (1998) Combination of radioiodine (131I) and probe-guided surgery for persistent or recurrent thyroid carcinoma. J Clin Endocrinol Metab 83:2675–2680PubMedCrossRefGoogle Scholar
  45. van Hagen P et al (2012) Preoperative chemoradiotherapy for esophageal or junctional cancer. N. Engl J Med 366:2074–2084PubMedCrossRefGoogle Scholar
  46. van Leeuwen BL, Graf W, Pahlman L, Mahteme H (2008) Swedish experience with peritonectomy and HIPEC. HIPEC in peritoneal carcinomatosis. Ann Surg Oncol 15:745–753PubMedCrossRefGoogle Scholar
  47. Veronesi U et al (2003) A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N. Engl J Med 349:546–553PubMedCrossRefGoogle Scholar
  48. Walsh TN et al (1996) A comparison of multimodal therapy and surgery for esophageal adenocarcinoma. N. Engl J Med 335:462–467PubMedCrossRefGoogle Scholar
  49. Wang YZ et al (2012) Radioguided exploration facilitates surgical cytoreduction of neuroendocrine tumors. J Gastrointest Surg: Official J Soc Surg Aliment Tract 16:635–640CrossRefGoogle Scholar
  50. Weaver DL et al (2011) Effect of occult metastases on survival in node-negative breast cancer. N. Engl J Med 364:412–421PubMedCentralPubMedCrossRefGoogle Scholar
  51. Wheeler JM et al (2004) Preoperative chemoradiotherapy and total mesorectal excision surgery for locally advanced rectal cancer: correlation with rectal cancer regression grade. Dis Colon Rectum 47:2025–2031PubMedCrossRefGoogle Scholar
  52. Zogakis TG, Norton JA (1995) Palliative operations for patients with unresectable endocrine neoplasia. Surg Clin North Am 75:525–538PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Department of Surgery Vanderbilt University Medical CenterNashvilleUSA
  2. 2.School of MedicineYale UniversityNew HavenUSA

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