Challenges of immunotherapy for surgeons

Resumen

Until a few years ago, many of us who are practicing surgeons today were convinced that the only solution for many solid tumors was limited to the potential of their primary resection, which is why we made great efforts to optimize the quality of pre-surgical images, including tomography, magnetic resonance, and echoendoscopy, tools that are still valid and essential in our work. However, over the years, we also learned that many of those patients with large or unresectable tumors could become potentially treatable and, why not, curable by receiving neoadjuvant therapies. Thus, diverse chemotherapy schemes emerged, as well as combinations of chemotherapy and radiotherapy, local therapies for less advanced lesions, and, more recently, immunotherapy.

Similarly, we grew up thinking that scalpels would not be used to operate on genes or mutations so that, possibly, we would not have to deal with this, at least not our generation. However, the vertiginous development of medicine and the sciences supporting it has once again changed our perspective for the benefit of our patients, motivating us, as surgeons who treat cancer, to view tumor biology with less indifference, given that it is fundamental today to understanding tumor behavior and determining the most efficient treatment strategy and the best time to operate when required.