Oncological surgery vs systemic treatment: which improves survival more?
One of the questions cancer patients ask us most often is: what improves my survival more, surgery or chemotherapy? The answer is not simple, because it depends on many factors specific to each type of tumour and each patient.
At Quenet Torrent Institute we use a multidisciplinary approach that assesses each case individually to decide the best treatment strategy, which often combines surgery and systemic treatments, one after the other or at the same time.
When surgery is the treatment of choice
Oncological surgery is the treatment with the greatest curative potential in most solid tumours when it is performed at early or locally advanced stages without distant metastases.
Tumours in which surgery is the main treatment:
• Colon and rectal cancer: Complete surgical resection is the only potentially curative treatment. In stages I-III, surgery with adequate lymphadenectomy gives 5-year survival of 60-90% depending on stage. More on colon cancer.
• Ovarian cancer: Cytoreductive surgery is the mainstay of treatment. Optimal cytoreduction (no residual tumour) greatly improves survival compared with chemotherapy alone.
• Abdominal sarcomas: Complete R0 resection is essential. Without surgery, survival is very limited. Our team frequently operates on large sarcomas.
• Peritoneal carcinomatosis: The combination of complete cytoreductive surgery with HIPEC makes it possible, in selected cases, to treat with curative intent a disease that used to be considered terminal.
When chemotherapy takes priority
There are situations where systemic treatment with chemotherapy, targeted therapies or immunotherapy is the first treatment option:
Chemotherapy-sensitive tumours:
• Lymphomas and leukaemias: Chemotherapy and immunotherapy are first-line treatments with high cure rates
• Germ cell tumours: Highly chemosensitive, with cure rates >90% even at advanced stages
• Systemic metastatic disease: When there are multiple metastases in several organs, systemic treatment takes priority
• Locally unresectable tumours: Neoadjuvant chemotherapy can shrink the tumour and make it operable
The combined approach
Today most patients benefit from multimodal treatment that combines surgery with chemotherapy, radiotherapy and/or targeted therapies:
Neoadjuvant chemotherapy + surgery:
Giving chemotherapy before surgery can reduce tumour size, eliminate hidden micrometastases and allow less aggressive operations. Examples: rectal cancer, advanced gastric cancer, stage IV ovarian cancer.
Surgery + adjuvant chemotherapy:
After complete surgical resection, adjuvant chemotherapy eliminates residual microscopic tumour cells, reducing the risk of recurrence. Standard in stage III colon cancer, breast cancer and ovarian cancer.
Cytoreductive surgery + HIPEC:
At Quenet Torrent Institute we combine complete surgical resection with hyperthermic intraperitoneal chemotherapy in the same operation for peritoneal carcinomatosis, significantly improving survival.
Factors that determine the best strategy
Histological type of the tumour: Each type of cancer has a different sensitivity to surgery and chemotherapy
Stage of the disease: Localised tumours: surgery. Disseminated tumours: systemic or combined treatment
Molecular biology: Specific mutations (BRCA, HER2, RAS, etc.) determine the response to targeted therapies
Patient's functional status: Physiological reserve to tolerate major surgery vs systemic treatment
Experience of the surgical team: Complex operations require specialised teams at high-volume centres
The importance of a second opinion
Because the decision between surgery, systemic treatment or a combination of both is complex and has a direct impact on survival, it is advisable to ask for a second opinion at specialist centres.
At Quenet Torrent Institute we assess each case in a multidisciplinary oncology committee with surgeons, medical oncologists, radiation oncologists and radiologists, to decide on the treatment for each patient.
Scientific evidence and results
The quality of oncological surgery is an independent prognostic factor. Some examples:
• In ovarian cancer, achieving complete cytoreduction (R0) increases median survival from 18 to 45 months
• In peritoneal carcinomatosis, adding HIPEC to cytoreductive surgery improves survival by 12-18 months
• In colorectal cancer with liver metastases, complete resection gives 5-year survival of 30-50% vs <5% without surgery
• In sarcomas, negative surgical margins (R0) are the most important prognostic factor, more than histological grade
Do you need guidance on your treatment? At Quenet Torrent Institute we offer specialist second opinions with our multidisciplinary team. We review your case and explain the options you have, both surgical and systemic. Request an appointment.