At the beginning of the treatment of tumors was the only surgical method. Moreover, in oncology adult patients, this method of treatment is still leading. At the dawn of the surgical treatment of childhood cancer survival rate of less than 20%. Reduction of traumatic operations and the use of combination therapy (with chemotherapy and radiotherapy) significantly improved the effectiveness of treatment. But unlike adults, children much of the cancer disease is generalized, which imposes restrictions on surgical techniques.
The choice of treatment of tumors, including surgery, depends on many conditions, so the most important to determine the spectrum of indications for intervention, to determine its location and relationship to alternative therapies. Radical removal of solid tumors (tumors that developed from the same fabric at this point) is the most important condition for successful treatment and prognosis.
Radiation and chemotherapy are sometimes preceded by surgical treatment. As in adults, and children it is necessary to reduce the size of tumors and control metastases. Such preoperative treatment improves prognosis and success of surgery in general.
Recently, surgical treatment of tumors undergoing major changes. This applies, above all, the development of methods that minimize the risk of "contamination" of tissues by tumor cells, especially with incomplete excision of the tumor. This principle of "ablastics" must have + Th is almost wholly the creation of conditions for further treatment by other methods. Another trend is to develop a radical, but the low-traumatic operations using modern surgical techniques. For example, laparoscopic surgery with minimal trauma can perform the most effective revision and excision of areas of possible cancer.
By surgical methods include biopsy and tumor tissues. This is a surgical procedure, allowing us to obtain sufficient tissue for special studies. There are open and closed biopsy.
Closed biopsy is performed with a fine needle. This type of biopsy is only used in the study of certain types of tumors, as has some significant drawbacks. For example, a small amount of material that could give a significant error in the reliability of the results of the study. In addition, the small amount of material there is no possibility of several types of research, which sometimes is necessary to clarify the treatment plan. The advantage of closed biopsy with minimal trauma research.
Biopsy. Running a special needle. However, after its execution increases the risk of complications such as bleeding, pneumothorax (atelectasis), perforation of the organ. When carrying out an adequate manipulation of the surgeon is able to obtain sufficient material for a full diagnosis.
An open biopsy is of two kinds - excisional (total) and incisional (partial). With small size of the tumor and its convenient location used a total biopsy, ie removal of all tumors for the study. If the tumor has no clear boundaries or requires extensive intervention is very traumatic for the complete excision, sometimes (especially in pediatric oncology) resort to a partial biopsy.
Endoscopic biopsies in recent years has become increasingly popular because of minimal trauma, the maximum information content and the possibility of not only the examination of the abdominal organs, but also the thoracic cavity.
For new surgical procedures include embolization of tumor vessels, intraarterial infusion, perfusion of isolated vascular preparations, cryotherapy (cold therapy), hyperthermia, laser therapy. What is new is not their very existence (the impact of these methods are known for a long time), and the specific techniques used by surgeons in oncology today. Their effectiveness and scope gradually grow and develop.
Special mention deserves the consideration and the issue of transplantation of hematopoietic stem cells of bone marrow, as well as gemokomponentnaya therapy. These types of surgery are particularly common in pediatric oncology, where significantly higher incidence of various hematological malignancies.