Surgery

Surgery is a medical specialty that uses operative tools and techniques to diagnose or treat patients with particular diseases. As it is invasive and may cause pain, surgery is often performed under anaesthesia – this can be general anaesthesia where a patient is completely asleep and does not feel or remember any events; or local anaesthesia in which a numbing agent is injected in the region of the intended surgery. Surgery may be performed for any organ in the human body ranging from the head and neck to the lungs and heart to organs within the abdomen – liver, stomach, small and large intestine, etc.

The purpose of surgery can be multifold:
(1) To investigate and confirm the presence of a disease
(2) To remove non-cancerous or cancerous growth
(3) In trauma or severe injuries
(4) Remove life-threatening infections
(5) For aesthetic purposes

什么是外科手术?

Cancer Surgery is performed for 2 main purposes:

(1) To cure cancer by complete removal of all cancer cells

(2) To relief symptoms that are caused by a cancerous growth

When cancer cells are confined within a region or organ and can be removed fully, surgery has the potential to cure cancer. It may be used in conjunction with chemotherapy or radiotherapy before or after surgery to ensure the best outcomes. Careful planning is required before surgery to ensure that the cancerous growth is removed with clear margins of normal tissue and the draining lymph nodes are removed as well.

When cancer is aggressive and cannot be fully removed from the body, curative surgery may not be possible. However, it can continue to grow and cause troublesome symptoms such as bleeding, pain, blockage or rupture. When these complications occur, surgery may be required to resolve the patient’s symptoms.

什么是癌症手术?

There are 2 main surgical approaches:

(1) Open Surgery: This is the traditional mode of surgery and involves a cut on the skin surface. The scar left behind may be small or large depending on the type of surgery required.

(2) Minimally invasive Surgery: This is also known as ‘key-hole’ or laparoscopic surgery where by only a small cut is needed to introduce a small instrument to perform surgery. The patient will have several small cuts on the skin surface as several working instruments are often required. The benefit of this approach is possibly less pain due to the smaller wounds. In the recent years, the ‘robot’ has also gained popularity and may be used to perform surgery. It produces wounds that are similar to the ‘key-hole’/laparoscopic approach.

癌症治疗的手术种类

Cancer can occur in any organ system. In Singapore, colon cancer is the most common cancer in man while breast cancer is the most common cancer in women. Surgery treatment differs according to the organ system involved. This table shows common cancers and their type of cancer surgery:

Cancer Type	Surgery Involved
Colon	Removal of portion of colon with good margins of normal tissue and draining lymph nodes. The remaining portions of the colon are then joined back together. Sometimes, a stoma (a portion of the small or large intestine) may be required and is considered on a case by case basis. This can be temporary or permanent.
Breast	Removal of part of or the entire breast with or without removal of lymph nodes that are at the underarm region. This can be followed by reconstruction of the breast by the plastic surgeons.
Head and Neck	This can sometimes be treated by radiation therapy. Surgery is performed but only for specific cancer types e.g. thyroid, tongue cancers or when the cancer recurs or does not respond well to radiation.
Stomach	Removal of part of or the whole stomach. To allow for future normal food intake, a portion of the small intestine is used to connect the remaining stomach or food pipe to the remaining small intestine.
Liver	Removal of a portion of the liver. Liver transplant surgery may also be performed – this involves removing the diseased liver and replacing it with a new liver from a deceased organ donor or a living donor.
Pancreas	Removal of a portion or the whole pancreas.
Kidney	Removal of a portion or the entire kidney. As there are 2 functioning kidneys, removal of one kidney is possible and the patient does not usually require dialysis.
Gynaecological Organs (Uterus, Cervix, Ovaries)	Cervical Cancer is treated with radiotherapy and surgery only reserved for patients whose cancer comes back despite radiation. In ovarian and uterine cancer, a common surgical approach is to remove both ovaries and the uterus. In patients that are still keen to have children, preservation of some gynaecological organs is possible and considered on a case by case basis.

常见癌症与手术

Complications may arise from anaesthesia given prior to surgery or from the surgery itself.

Complications of Anaesthesia include:
• Heart attack
• Stroke
• Allergic reactions
• Respiratory infections

Complications of Surgery include:
• Bleeding
• Wound infection
• Anastomotic leak: This refers to leakage of intestinal material due to a gap in between the joining that was created after removal of a portion of the intestine
• Injury to surrounding structures or organs
• There are also specific complications related to surgery performed for different organ systems. This should be explained by your performing surgeon.

手术后可能面对的并发症

After diagnosis of cancer is made, a clinical consult with a specialist surgeon is required to determine if a surgery is suitable for you.

Prior to surgery, blood tests and a chest X-ray are routinely performed to ensure that a patient is fit and ready for the surgery and anaesthesia.

Depending on the type of surgery performed, the patient will have to either be admitted to the hospital a day before surgery to ensure necessary preparations are made or on the morning of the surgery.

准备接受癌症手术

The cost of surgery depends on:
• Type of surgery performed
• Length of hospitalisation

手术费用

Immediately after Surgery

After surgery, the length of your hospitalisation depends on how big the surgery was and if there was any complications that occurred. You should expect to stay between 5 to 14 days.

Upon discharge, your surgeon should advise you when to resume your normal activities. As there will be wound from surgery, you should avoid heavy and strenuous activity or swimming to prevent wound infection and breakdown. Should you feel unwell, please do not hesitate to call the NCCS hotline to inform your primary surgeon.

A few weeks after

The cancerous growth would have been sent for testing and the stage of your cancer can be determined by 2 to 3 weeks after the surgery. Depending on the stage, you may require chemotherapy or radiotherapy after the surgery. This can be commenced when your surgical wounds are completely healed and there are no complications from the surgery.

A few months after

All cancer patients need to be followed up regularly for at least 5 years after curative surgery. This involves 3 to 6 monthly clinic visits, blood tests as well as regular surveillance computed topography (CT) or Magnetic resolution imaging (MRI) Scans.

Special tests and closer follow up may also be required depending on the patient’s cancer type.
The above measures help ensure the early detection of new cancer cells should the cancer relapses.

手术过后