The Role of Surgery
When Is Surgery the Right Choice?
Surgery is a local treatment — it addresses disease in a specific anatomic region. Whether and when it belongs in your care depends on biology, not just anatomy.
Surgery in the Context of Systemic and Other Local Therapies
For most hepatobiliary cancers, surgery does not happen in isolation. Chemotherapy, targeted therapy, immunotherapy, and radiation are systemic or regional treatments that address disease beyond what a scalpel can reach. Surgery and these therapies are often sequenced strategically — chemotherapy before surgery to shrink a tumor or test its biology, radiation to sterilize margins, systemic therapy after surgery to reduce recurrence risk. The decision is not “surgery or chemotherapy” but how they fit together and in what order.
Biology Beyond Anatomy and Technique
A surgeon trained in oncology evaluates a case differently than one focused purely on technical resectability. The question is not only whether a tumor can be removed, but whether removing it will benefit the patient — which requires understanding tumor biology, molecular markers, response to prior treatment, and likely behavior. A technically feasible operation performed on a patient whose cancer has already spread beyond what imaging shows offers no benefit and carries real risk. Bridging the technical and biologic requires oncologic training, not just surgical experience.
The Surgeon as Coordinator of Care — Even When Surgery Is Not the Answer
Many patients referred to a surgical oncologist will not undergo surgery at that time — or ever. That does not mean the consultation was unnecessary. A surgical oncology evaluation clarifies resectability, identifies what would need to change for surgery to become an option, and ensures the patient is not missing an opportunity. Often the most valuable role is coordinating the next steps: ensuring the right imaging was done, connecting the patient with the right medical or radiation oncologist, presenting the case at tumor board, and remaining available as treatment evolves.
Surgery During and After Cancer Treatment
Surgery occasionally becomes relevant not as the primary treatment, but to manage complications that arise during the course of cancer care. Bowel obstruction, hemorrhage, biliary obstruction, and perforation can occur as a result of the cancer itself or its treatment. In these situations, surgical judgment — deciding when to intervene, how to intervene, and when to defer — is as important as technical execution. A surgeon integrated into the care team from the beginning is better positioned to make those decisions quickly when they arise.
The Importance of Multidisciplinary Care and Tumor Boards
No single specialist has the full picture. Multidisciplinary tumor boards bring together surgery, medical oncology, radiation oncology, interventional radiology, pathology, and gastroenterology to review complex cases together. The recommendations that emerge from that process are more nuanced and more accurate than any single opinion. At Mount Sinai, complex hepatobiliary cases are reviewed at a dedicated HPB tumor board. Patients seen by Dr. Correa whose cases warrant multidisciplinary review are presented at that forum before a final recommendation is made.
Questions About Your Specific Case?
Every case is different. Contact our office to schedule a consultation and discuss whether and how surgery fits into your care.