The history of surgical oncology dates back to the time of the Greek and Roman empires, when people like Hippocrates started to recognize and treat cancers. The development of general anesthesia, analgesia, and aseptic technique dramatically improved the practice of surgical oncology and treatment of cancers. The surgical treatment of cancers is more than just a technical procedure. Surgery has become more aggressive in an effort to gain better local control, particularly after outcome data started to be analyzed and showed that conservative surgery resulted in local recurrence and death. But, with more aggressive surgery, it became obvious that patients failed because of metastasis despite good local control. Biologists, medical oncologists, pathologists, and geneticists have since improved our understanding of tumor biology, treatment options, and outcome following treatment. As a result, the modern surgical oncologist requires a knowledge of tumor biology, imaging techniques, and other treatment modalities, such as chemotherapy and radiation therapy. This is necessary to better understand and effectively treat cancer. As stated by Cody (1997): "Biology is King; selection of cases is Queen; and the technical details of surgical procedures are the Princes and Princesses of the realm who frequently try to overthrow the powerful forces of the King or Queen, usually to no long-term avail, although with some temporary apparent victories."
In veterinary medicine, there have been many people that have been responsible for advancing our knowledge of tumor biology and treatment of animals with cancer. This knowledge is also translatable and advances made by veterinarians in these areas have also improved the treatment of people with cancer. These improvements would not have been possible without advancement in imaging techniques, such as ultrasound, nuclear scintigraphy, and computed tomography and magnetic resonance imaging scans; anesthetic agents, equipment, and expertise; critical care techniques, including analgesia, use of blood products, and monitoring; and particularly clinical and anatomic pathology, especially histologic grading of tumors and margin assessment. Although by no means complete, the list of veterinarians who have made significant contributions to improve our understanding and treatment of cancers include surgeons like Drs. Brodey and Withrow; medical oncologists like Dr. MacEwen; radiation oncologists like Dr. Gillette; and pathologists like Drs. Misdorp, Patnaik, and Powers.
The surgical oncologist obviously still has a vital role in the diagnosis, treatment, and palliation of tumors. Surgery, as a single modality, cures more animals and people with cancer than any other modality. Major ablative techniques are now well described (e.g., maxillectomy, mandibulectomy, hemipelvectomy, scapulectomy, and chest wall resection) with good analysis of outcome and acceptance of cosmetic results by owners. The routine use of stapling equipment for hemostasis, resection, and anastomosis has facilitated the performance of more rapid and safe procedures. Parallel to more aggressive surgery has been the development of reconstructive surgical techniques, such as axial pattern and microvascular free flaps. Minimally-invasive procedures such as laparoscopy and thoracoscopy are being utilized regularly, and interventional oncology (image-guided procedures) has the ability to further revolutionize veterinary oncology.
Despite the improvement in surgical equipment and techniques, the art of surgical oncology is surgical judgment and how to integrate surgery with other treatment modalities to reduce morbidity and improve outcomes. There are a number of programs (or fellowships) in human medicine which provide specialist training in surgical oncology for residency-trained surgeons. These fellowships provide integrated education and training in tumor biology and pathology; diagnosis, staging, and treatment of cancers; and knowledge of the principles and practice of other modalities, such as radiation therapy, chemotherapy, and immunotherapy. Similarly, Colorado State University and the University of Florida offer 1-year post-residency fellowship training in surgical oncology for veterinary surgeons. To date, nearly 30 fellows have been trained at Colorado State University and the University of Illinois and these surgical oncologists play an important role in veterinary and collaborative research, education, and training. Furthermore, especially because surgical oncology is not a recognized specialty, there are a number of surgical oncology societies in human medicine and these societies play an important role in focusing attention on the surgeon's role in cancer research, education, and treatment. Similarly, the Veterinary Society of Surgical Oncology has been developed to highlight the role and value of trained surgical oncologists in treating animals with cancer, to coordinate and conduct clinical research trials to advance our knowledge and treatment of cancer, and to provide continuing education opportunities for referring veterinarians, general surgeons, and surgical oncologists.
For a more detailed history of surgical oncology in veterinary medicine, please read Dr. Withrow’s paper The Evolution of Surgical Oncology in Clinical Techniques in Small Animal Practice 13:1-3, 1998.