The Preoperative Conferencerence

Preoperative evaluation of the patient shouldshould bebe made by a multidisciplinary team

Whenever possible, a preoperative diagnosisgnosis should be established based on biopsy resultsresults

A treatment plan is outlined that may consistconsist ofof preoperative chemotherapy or radiotherapyerapy (called neoadjuvant therapies) or primaryary surgery fallowed by adjuvant therapy

Preoperative Preperation of the PatientPatient

CONDUCT OF OPERATIONION

Determination of Stage

Every attempt must be made at the time ofof operationoperation to assess the extent and spread of the cancerncer.. Complete operative exploration is mandotorytory

Confirmation by frozen section of suspiciousus lymphlymph nodes must be made if the presence of cancerancer inin them will alter the operative approach

A biopsy of metastatic nodules in the liverr shouldshould bebe done routinely to avoid confusion later

If the operation will be abondoned becausese ofof thethe spread of the cancer, histologic proof of thehe diagnosisdiagnosis is mandatory

Conduct of operationn

Curative Operation

When it is determined that resection for cure is feasibleasible,, itit isis undertaken without hesitation.

Palliative Operation

The most difficult decisions made at the operating tabletable cancerncancern the cancer that cannot be resected because of its invasioninvasion intointo aa vital structure or its fixation to the retroperitoneumm oror spinespine

Palliation should be undertaken when life can be prolongedprolonged oror aa patient made more comfortable

Obstruction of the gastrointestinal tract is an absolutelute indicationindication for palliation. Obstruction of the biliary tract is a relativeelative indication, but palliation should be accomplished whenwhen feasiblefeasible