New surgical approaches to gastrointestinal cancer

The outlook for patients with gastrointestinal malignancies has not altered appreciably over the past three decades. Surgery offers the only possibility of cure; it is important that, as less-invasive techniques are introduced, survival is not compromised. Most patients will have occult disseminated disease at presentation, and it is therefore important to evaluate adjuvant therapies. Regional therapy offers considerable potential for patients with advanced or recurrent disease. Better surgery, better staging, more appropriate surgery, the use of adjuvant therapy, and new approaches to the problem of advanced disease are likely to result in the reduction of mortality over the next decade. The surgical oncologist has an important role in defining optimum treatment of individual patients and in evaluating new therapies.