Situations where open surgery is preferred
Choosing open surgery is a positive decision made for safety and completeness, not a lesser option.
- Tumour invading major vessels or multiple adjacent organs
- Extensive peritoneal metastasis needing full cytoreduction
- Dense adhesions after multiple previous laparotomies
- Emergency presentation with obstruction, perforation or bleeding
- Severe cardiac or respiratory disease limiting pneumoperitoneum and positioning
When surgery is not the first step
Rectal cancer often needs chemoradiotherapy first; locally advanced gastric and some ovarian cancers begin with systemic therapy; certain tumours are treated definitively without surgery. Operating at the wrong point in the pathway can reduce the chance of a complete resection later.
Shared decision making
Patients are given the realistic options, the trade-offs of each, and what happens if no operation is performed. Where a case has been declined elsewhere, the imaging and pathology are re-reviewed with the tumour board before any recommendation is made.
Common questions
- My surgery was refused at another hospital. Is a review worthwhile?
- Often yes — a case may be reconsidered after re-staging, systemic therapy or with a different surgical plan. Equally, a review may confirm that surgery is not in your interest, and that is said plainly.
Related reading
This page is general education, reviewed by Dr. Ishaan Allahabadi, MCh Surgical Oncology (Edge Hill, UK) · MS Surgery · MBBS (Accredited by the Royal College of Surgeons of England). It is not a substitute for individual medical advice. Treatment decisions are made after reviewing your imaging and pathology, in a multidisciplinary tumour board.