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In the Milan Institute, since the preliminary results of the first trial on the conservative treatment of early breast cancer [ 12] were reported to be as good as or better than more aggressive resections, this treatment became routine practice.
In the history of surgical oncology, survival benefit of extended lymphadenectomy has been a focus of debates in gastrointestinal carcinomas. 1 The fear for the invisible metastasis prompted surgeons to perform more aggressive resections with lymphadenectomy to control the disease locally.
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The more aggressive resection policies of these groups also certainly contribute to the difference in resectability rates.
Chemotherapy was rarely used in WD, and more aggressive resection was required in DD, while a third to half of all patients required multivisceral resection.
Specifically, confounding bias often arises, whereby the fittest patients may have been selected by their physicians to receive more aggressive resection.
This has led to more aggressive surgical resection and radiation therapy, thus requiring an accurate description of the anatomical boundaries of the tumour to guide therapy.
A selected subgroup of patients with limited metastatic disease may eventually derive benefit from more aggressive strategies, including resection of isolated metastasis.
The survival gain for CRC liver metastasis patients may be a result of intensified efforts in the multidisciplinary care of patients who benefit from improved systemic therapy and more aggressive approach in resection or ablation of the liver metastases.
The first aspect that has to be assessed is whether the patient has a superficial or a muscle-invasive tumour (≤T1 vs ≥T2), since infiltration beyond the lamina propria will require more aggressive treatment than transurethral resection.
These nodules can be followed to assess for long-term stability, although a more aggressive approach, including biopsy or resection, may be chosen.
7– 11 More aggressive surgical approaches employing wide resection of the involved bone may be chosen to achieve tumor removal and potentially decrease the risk of local recurrence, at the cost of greater functional compromise.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com