Principles of oncological surgery

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Oncological surgery is probably the most interesting and multifaceted surgery a veterinary surgeon can carry out. This chapter covers the decision to use surgery; the role of oncological surgery; consideration for oncological surgery; future directions.

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6.1 The sarcoma in this cat required wide resection margins, including full-thickness resection of the body wall. Apprehension about closing the resulting defect (almost complete resection of the ventral body wall) could result in the surgeon’s compromising the resection margins in favour of being able to close the defect more easily.
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6.2 Management of an incompletely excised grade II mast cell tumour. The entire surgical scar and any adherent tissue must be considered contaminated. The surgical margins indicated for revision surgery on this tumour resulted in a much wider resection and subsequent tissue deficit than the original surgery.
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6.3 Local resection of a vaginal leiomyoma following an episiotomy approach. Ovariectomy is an important part of the approach to these tumours to prevent recurrence.
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6.7 The degree of local tissue infiltration varies with the tumour grade. The central tumour mass is the grossly visible and palpable part. Invisible to the naked eye are strands, or tentacles, of neoplastic tissue penetrating out into normal tissue. It is this infiltration that determines the required margins of resection, and the degree of infiltration varies with tumour type and grade. Tumour grade is generally designated as I, II or III, with III usually being the most aggressive. Other terms used are low, intermediate and high grade and well differentiated through to poorly differentiated. indicates the necessary peripheral or circumferential margin (usually a metric measurement) and the deep margin (usually measured in terms of fascial planes, also can be measured metrically). Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and are printed with her permission.
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6.8 Required resection margins often seem very large. This skin tumour has 3 cm margins marked out.
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6.9 Completed caudal superficial epigastric axial pattern flap being used in a dog to close a skin deficit resulting from tumour resection.
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6.10 Mesh being used to reconstruct the body wall defect created in Figure 6.2 .
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6.11 Summary of options for an analgesic approach to perioperative pain management in oncological patients.
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6.12 Prior to submitting any tissue to a pathologist, sutures can be used to ‘reconstruct’ the specimen (e.g. to replace displaced muscle in its original position). The underlying latissimus dorsi muscle tended to ‘slip’ off the specimen, exposing the ventral part of the mass. The muscle was resected as the uninvolved ventral margin to this mass.
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6.13 In this lip resection, the deep medial margins have been inked yellow to allow the pathologist to orient the sections so that he/she can comment on how far away any neoplastic cells are from the inked margins.
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6.14 Owners should be fully informed of the expected appearance of their pet following oncological surgery. The owner of this dog was fully informed of the expected appearance, and was very satisfied with the tumour-curing surgery performed (radical nosectomy for SCC).
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