Surgery vs Systemic Treatment: A Critical Decision
For many cancers, the question of whether surgery, systemic treatment (chemotherapy, immunotherapy, targeted therapy) or a combination provides the best survival outcome is one of the most important decisions in oncology. The answer depends on the tumour type, stage, biology, patient fitness and available expertise.
When Surgery Provides Superior Survival
Early-stage solid tumours: Surgery is almost always the treatment of choice for early-stage cancers of the colon, rectum, stomach, liver, lung, kidney, breast and uterus. Peritoneal carcinomatosis: CRS+HIPEC provides significantly better survival than systemic chemotherapy alone in selected patients. Liver metastases: Resection of colorectal liver metastases provides 5-year survival of 30–50% versus median survival of 24–30 months with chemotherapy. Sarcomas: Surgery is the cornerstone — chemotherapy and radiotherapy play supporting roles. GIST: Surgery combined with imatinib is the standard curative approach.
When Systemic Treatment Should Come First
Neoadjuvant chemotherapy before surgery is standard for locally advanced rectal cancer (chemoradiotherapy), oesophageal and gastric cancer (perioperative FLOT), locally advanced breast cancer and high-risk soft tissue sarcomas. Systemic treatment may convert an unresectable tumour to resectable ("conversion surgery"). Response to neoadjuvant treatment is also prognostically informative.
The Importance of Multidisciplinary Decision-Making
The optimal treatment sequence — surgery first, systemic first, or concurrent — should always be decided by a multidisciplinary team including surgical oncologist, medical oncologist, radiation oncologist and radiologist. For complex cases, second opinions at specialised centres ensure all options are considered.
Unsure whether surgery or another approach is best for your case? At Quenet Torrent Institute our multidisciplinary team evaluates all options. Request a consultation or second opinion.