[Principles of radical surgery]

Radicality is the decisive aim in oncologic surgery. From a surgical point of view radicality provides the only chance of healing for the patient. Radicality can be defined and objectified. That means absence of tumor in all 3 dimensions of the primary tumor, that is the tumor bed as well. In the area of lymphatic drainage a most favourable lymph node ratio has to be achieved. At least the borderline lymph nodes must be free of tumor. However, an improvement of prognosis can only be achieved if the lymph node ratio is below 0.2. If the aim of a so-defined radicality cannot be safely achieved in a case of an advanced tumor stage, preoperative multimodal therapy can be tried. In responders, the aim of radicality can still be reached by these means. Postoperatively radicality is objectified by the pathologist. His findings are the objective basis for every further therapeutic consideration.