Some cancer surgeries require a more technically challenging operation than others. Examples of these procedures include liver resections, removal of the pancreas, lung, esophagus, or sphincter saving surgeries for rectal cancer. A large body of literature has accumulated demonstrating improved outcome for patients who receive their care for these malignancies by a Surgical Oncologist rather than a general surgeon. Hospital stay and complications, as well as risk of recurrence and survival are well documented to be improved when surgery and care is delivered by someone whose entire practice and career focus is the care of people with cancer.
General Surgeons spend most of their time removing gallbladders, fixing hernias, and obstructed blood vessels, and doing emergency surgeries, not cancer care. Frequently, general surgeons in most communities care for patients with “common variety” cancers because it's simple, routine, and just needs to be "cut out". Right? WRONG! What difference does it make? An enormous difference! These cancers are often felt to be "common variety" or "routine" by everyone but the patient and Surgical Oncologists.
A study reported in the Annals of Surgical Oncology in 2005 examined the outcome of 29,666 women with breast cancer cared for in Los Angeles County (Annals of Surgical Oncology 10:606-615). This study examined the difference in long term outcome depending only on whether a patient was cared for by a general surgeon or a Surgical Oncologist. Treatment by a Surgical Oncologist resulted in an astounding 33% reduction in the risk of death at five years compared to when a general surgeon delivered care.
In another study at the University of Massachusetts ( Annals of Surgical Oncology 5:28-320) the impact of Surgical Oncology care was examined by determining the quality of breast cancer surgery at the University in women with cancers that could not be detected by physical exam. Surgical Oncologists achieved a much lower rate of positive margins at the time of cancer removal (25% vs 41%), required fewer second operations (18% vs 48%), and achieved a higher rate of breast conservation (88% vs 70%) than did general surgeons. Similar improvement in outcome has been documented in Great Britain (Br J Cancer 90:1920-25) when care there is by Surgical Oncologists.
Adequate surgical management of breast cancer as well as all other cancers is fundamental to improving outcome. Knowing what to do, when to do it, how to do it, and how what is done impacts subsequent care and outcome is the key. Coordination of care and surgery by a specialist who devotes his career and all his attention to comprehensive cancer care leads to fewer recurrences, a better chance of survival, and less stress on patients. They undergo fewer procedures; therefore the cost to our patients and health care system is dramatically less as well.