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Surgery for relapse

Many relapse are unfortunately beyond any therapeutic proposals.

However, occasionally, satisfactory or simply palliative excisions may be proposed when the tumour relapses after radiotherapy.

Some examples:

• for head and neck surgery (salvage total laryngectomy after conservative treatment),

• for certain gynaecological tumours treated by exclusive radiotherapy (total salvage pelvectomy with good quality excision is occasionally feasible),

• for breast carcinoma treated with lumpectomy: when late relapse occurs, a salvage mastectomy may be proposed.

Metastasis surgery

In the past, surgery was never performed on metastases.

The occurrence of metastases in the first months or years after tumour excision generally signifies that the metastasis was already present at the time of surgery but was too small to be identified by usual methods.

Improved knowledge of the biology of cancer enables the proposed excision of metastases with a good chance of success:

• When the primitive tumour is stable or has disappeared,

• When the free interval between primitive tumour treatment and metastasis occurrence is long enough to prove a slow tumour progression (minimum two years),

• When the metastasis is unique (or with two to three metastases in the same location),

• When the surgical procedure is relatively simple and does not require a particularly large excision (one hepatic segment, one pulmonary lobe, one cerebral peripheral metastasis).

A very good example is metastasis removal by partial hepatectomy for a unique colon carcinoma metastasis occurring several years after initial surgery. This (simple) procedure is often efficient enough to offer, without any other treatment, a long clinical remission with good quality of life.

A noticeable exception might be the presence of multiple pulmonary metastases of a testicular teratocarcinoma matured through chemotherapy (no uptake with FDG scintigraphy) and which could relapse later.

All of these surgical procedures have a 'curative' intent (or at the very least they offer relief with good survival and quality of life).