Surgical Oncology by Koray Topgül

Oncology

Surgical Oncology by Koray Topgül

Surgical Oncology is the field of medicine that concentrates on surgical methods to detect, stage and treat cancer.

Prof. Koray Topgül, M.D.

General Surgery

Gastrointestinal system which is the major field of interest of surgical oncology is a very complex environment where multiple organs and systems are working together, of which all of these organs may develop specific types of cancers. This complexity requires sub-specialization to be able to sustain high level of success by surgery. In Turkey this discipline is a sub-specialty recognized by Ministry of Health and surgeons are accepted to this program only after a solid experience in general surgery.

Diagnosis

Detection at the early stage is vitally important since the success rate of treatment increases when physicians can interfere early and also severity of the treatment itself reduces. Diagnosis is generally by biopsy with endoscopic methods and after the diagnose radiological and nuclear medicine modalities clarify the spread of cancer within the body.

Multidisciplinary Nature

The nature of cancer requires a high cooperation and collaborative decision making in between Surgeon, Medical Oncologist, Radiation Oncologist and the Radiology Specialist, to choose the best treatment option for each patient. In many cases chemotherapy and/or radiation oncology treatment accompany before and/or after the surgery, even during the actual surgery in some specific methods. Therefore in many hospitals there are Tumor Councils to determine and supervise the best treatment protocol for each individual.

Procedure

The surgical procedure varies widely due to the organ and system that tumor affects. Ultimate goal of the procedure is to create a tumor-free R0 resection that means not to leave any tumor cells behind. Although the target is this it is not always possible to reach a R0 resection. Both microscopic tumor remains than means R1 resection and gross remains that corresponds to R2 resection, require chemotherapy and/or radiotherapy following the surgery.

Treatment and Recovery Period

It is not possible to give a standard treatment or recovery period since surgical oncology covers a very wide range of surgical procedures, pre-operative or post-operative supporting treatments. Since every individual’s journey is different, it is best to hear expectations directly from your physician after the treatment plan is set.

Prof. Koray Topgül, M.D.

General Surgery

Medical School, Akdeniz University – Turkey
General Surgery, Ankara Training and Research Hospital – Turkey
Professor title from Altınbaş University – Turkey
Sub-specialty on Surgical Oncology
Works in İstanbul
ASM Anadolu Sağlık Merkezi Hospital

He focuses on oncologist surgery for the last 20 years of his professional life, especially on gastrointestinal system cancers. Since he focuses on Peritoneal Carcinomatosis (late-stage manifestation of several gastrointestinal malignancies including appendiceal, colorectal, and gastric cancer), he has wide experience with multiorgan resections and anastomosis of these, liver resections, bile duct cancer (Cholangiocarcinoma), Whipple surgery, colon/rectum, and stomach cancer surgeries.

He prefers the laparoscopic method for the above surgeries as long as it is conformable since minimally invasive surgery provides a faster transition towards the treatment following the surgery, faster recovery, and returning to normal life.

He mentions 2 topics for the success in surgical oncology:

Experience of the surgeon in the field of surgical oncology
The infrastructure and available resources that the hospital provides

Teamwork is an inseparable component of surgical oncology for Prof. Topgül and he mentions Medical Oncologists, Radiation Oncologists, Radiologists, sometimes Interventional Radiologists as his close counterparts.

Prof. Koray Topgül underlines the experience of the physician pointing at issues other than technical surgery skills. For him, a good surgeon is not only a good technician to perform the procedure but also should be sufficiently experienced to deal with decisions, timing, management of possible complications, creating solutions, and communicating these to the patients.

“For me, the basics are ethics in surgery and surgical formation. I believe patients are not statistics but people”

He lists questions of patients regarding “success percentage of the surgery” or “life expectancy” among the leading topics but he advises his patients not to focus so much on them. “We know that stage 4 colon cancer 5 years life expectancy is around 15% but we may never know who will stay at 85% and who will enter to that 15%”. He recommends his patient concentrate on their actual treatment and their motivation during this treatment.