THE DEFINITION OF INOPERABILITY OF CANCER

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Abstract
The definition of inoperability of cancer has an important influence on end results. The point of view of the surgeon plays a significant role in determining whether or not a given patient should be subjected to operation and attempt at surgical removal of the cancer. A distinction should be made between absolute inoperability due to distant dissemination of the cancer and obvious incurability, and relative inoperability due to local technical difficulties. No surgeon should perform an exploratory operation unless he is qualified to proceed with the actual removal of the tumor if encountered. Excisional surgery should be available for cancer patients of advanced age if they can be prepared for such an ordeal, as old age alone is not a sufficient excuse to deny these patients the only opportunity to overcome an otherwise fatal disease. The condition of the patient may present seemingly serious hazards from the surgeon's viewpoint, but with the current improvement in preoperative and postoperative management, the dangers are often reduced to the point where major surgical procedures may be safely performed. The stage and extent of the cancer complicate the judgment of the surgeon, but if the cancer is removed whenever technically possible, occasional cures are surprisingly obtained. Palliative resections of the stomach, colon, and rectum afford a great deal of relief to many patients even though small metastatic foci are detected in the liver. Involvement of multiple organs by cancer has been given as a reason for inoperability, but one should attempt by every means possible to remove such cancers which are adherent to any adjacent structures or viscera that may be sacrificed by excision in continuity with the organ involved. Some patients who have had exploratory laparotomy for cancer with abandonment of the operation and pronouncement of incurability are entitled to another chance or effort by a different surgeon if the former surgeon classified the cancer as inoperable because of technical difficulties. Case reports are inserted to illustrate the arguments throughout this thesis.

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