[Rationale for oncological surgery in multimodal cancer treatments]

The permanent dissemination of circulating cancer cells from infiltrative cancers renders the notion of localized cancer obsolete. This raises the question of the role of treatments such as surgery which are localized in time and space. Moreover, it is now proven that surgery increases the number of circulating cancers cells and produces transient immunodepression which promotes cancer cell implantation. In addition, the healing process stimulates growth factors, which also act on tumor growth. In spite of these deleterious effects, oncological surgery remains an important tool in the anti-cancer armamentarium. Optimal cytoreductive surgery facilitates the effect of adjuvant treatments by eliminating the vascular sanctuaries present in the center of any large tumor and by its effect as a striking-force very localized in time and space. Oncological surgery must evolve as an integrative part of our improving understanding of tumor biology, taking into account recent developments in functional imaging, genomics and proteomics. Modalities and timing must be reconsidered for oncological surgery to play its proper role as one of the many components contributing to multimodal cancer treatments. New modalities will undoubtedly be necessary with the development of future technologies.