Surgical Oncology: Sixth South Russian Rostov on Don October 2019

Four dimensions of surgical oncology are characterized: premalignancy, surgical stage of the disease, locally advanced, and metastatic disease. The unity of knowledge and surgical action are underlined.


Introduction
Surgical oncologist is a peculiar element of the varied community of the vigorously engaging specialists in the struggle with the lethal disease.As the surgery is a teamwork par excellence, he knows, that a chain is as strong as its weakest link: in the spheres in which a pessimist is crying, which is a situation than I am willing not to take into account; where an optimist ingenuously bumps against a new challenge of disease, he ought as a realist to recall the success in a way "one for all and all for one" arranging matters in compliance with that and the chain becomes suddenly not to be broken.Components of surgical oncology [1,2]  Decision making is not easy, but the surgical empiricism knows a rule of thumb: it is better to perform surgery unnecessarily than late.An example might be a diagnosis so "simple" as appendicitis, and a special example then a pulmonary coin lesion.

Surgical Treatment of Carcinoma with a Curative Intent
Preoperative counselling in the widest sense signifies offering and getting of all appropriate information, before an informed consent of the patient: I.
To communicate with the patient, having respect for all her/his personal (physical, psychical and spiritual), familiar, professional and social peculiarities.II.To cultivate permanent relationships with specialists of imaging, medical and radiation oncology, cytology and histopathology, medicine, clinical psychology etc., to find an optimal, generally valid and acceptable solution [6].
That should precede the following steps: exist themselves alone-simultaneously, independently, with the same level of significance-without superiority or inferiority without merging or separating-creating a sole integral entirety characterized with a high difference and a profound equality of their parts.Although each of them represents specific issue, all of them belong to the specialty.Surgical oncology would be ranked among the most comprehensive proficiencies supporting a view of legitimacy of the knowledge unity concept [3].That is not a case of golden hands.It is much more attractive.It includes the delicate handling with tissue and organs as well the whole patient's human being.They are harmonized there the information of multilayered variety of oncogenes processes categorized by medical and other sciences, natural as well as human, with an important participation of technologies, with non-negligible roles of intuition and empiricismincluding manual labour.It is influenced by feedbacks proper to surgery and medicine, in the widest sense of the words, by statistics, economics, psychology, sociology and obviously also by politics.Surgical oncologist saves tissue mindful of decrease of systemic inflammatory response to the operation.The observation of the development in the discipline welcomes every improvement in the patient care as a personal invitation.Introduce a multifaceted example of Non-Intubated Video-Assisted Thoracic Surgery (NIVATS): In this get enganged the knowledge of modern anatomy, physiology, pharmacology, and device technology with the courage of old masters.Through these physiological operative with respect to the function of the organs and tissue is presented.Despite of having had the roots in authentic tradition it is radically new.This provides impulses for further refinement in the surgery and anesthesy for mutual benefit of both.Old habits die hard, getting warm every plenary sessions up to the boiling point: Neither surprise nor discourage for persuaded protagonists of the new method.On the contrary, an occasion to argue using appropriate toolls : Modesty, Decency, Truthfulness.They look into the controversy intubated/non-intubated as two different accents of one common issue: profit for patient.Surgical Oncology is Created by Four Parts.Let's Define the Chapters in Single i. Surgery of premalignancy ii.Treatment of "surgical stage" of oncological disease iii.Surgery of locally advanced disease: Palliation, sanitation, devitalization, metaintervention iv.Surgical treatment of metastatic disease [4,5]: a. surgery of solitary metastasis by means of the strategy identical with the second chapter.b. surgery of general spreading of the disease, solving a local problem of the general extent by means of strategy like the saving treatments of the third chapter.To Remove the Focus before Cancer Emerges Sounds Call Word of the First Chapter I.The advanced premalignant changes are signaling a risk of cancer development in the tissue.Biopsy proof of the severe dysplasia leads to think about the presence of malignancy in the concerned focus with the whole appropriate surgical routine of work.II.Another scenario is represented by mild or moderate dysplasia, at a given moment clinically insignificant.Their biological development in the subsequent phase is used to be difficult to guess, especially at the earlier detections.The context faced dilemma of overdiagnosis/overtreatment versus underdiagnosis/undertreatment: a) The overdiagnosis represents clinically an irrelevant/ insignificant diagnosis, not requiring any treatment, because it would be superfluous-overtreatment, as express commonly used terms.b) The underdiagnosis includes all varieties of diagnosis underestimation, usually in connection with an insufficient treatment-undertreatment with all consequences.
a. Determination of one's own chirurgical strategy b.Explanation of general organization of the surgical concept and special details referring to the patient c.All that in accordance with up-to-date progress in the field of knowledge.It doesn't remain as to say, that the strategy of the contemporary surgical oncology usually recommends considering radical surgery with enough safety border of healthy tissue by the smallest biologically acceptable anatomical resection in connection with regional lymphadenectomy in block-expressed by the term curative resection.Heterogenous Surgical Interventions there are Involved in the third Chapter, All with a Common Denominator Locally considerably advanced, radically predominantly insoluble disease.Procedures used in this category represent prospect for survival of incurable patient with amelioration of the quality of life.Exceptionally, they can become to a qualified effort for its radical solution, even if close to the extreme.They are represented mainly by non-radical procedures: A. Palliation-classical examples: the avoidance of inoperable obstacle of GIT passage by entero-enteroanastomosis, laser recanalisation of bronchus obstructed with tumors mass, or artificial reinforcement by stenting of ureter compressed by tumor.B. Sanitation-the ablation of necrotic tumor mass even despite general spreading of disease, on account of massive secretion, of pungent odour, threatening to bleed to death.C. Devitalization-trying to dissolve the extensive inoperable tumors by interruption of their vascular supply.Even if the argumentation of devitalization followers is from the point of view of general oncology in some respects incomplete, its supremely surgical ethos can't be neglected.As there is also the case of metaintervention, below mentioned.Surely under condition of nil nocere.While the indications of pal liation and sanitation are obvious, devitalization can be always considered an enfant terrible.D. Radical intervention in the chosen cases of locally extremely advanced disease with excluded distant metastases represents a relative novelty.It requires trans anatomical access