However, theoretically this is possible. However, gastrointestinal cancer also spreads to lymph nodes and may disseminate to peritoneal surfaces. If patients recur with lymph node involvement or with progressive disease at the resection site or on peritoneal surfaces, this is the surgeon's responsibility. Recurrent disease at either of these two sites indicates insufficient skill of the responsible surgeon. The hideous flaw that exists with inadequate gastrointestinal cancer surgery can be formulated as follows.
Many patients come to the surgeon with a contained malignancy.
Unfortunately, in a large proportion of gastrointestinal cancer operations, with unskillful resection the patient leaves the operating room with persistent cancer in lymph nodes or with a disseminated malignancy on the internal lining of the abdomen for which there can be no cure. This hideous flaw, inadequate surgical skill, is not currently anticipated by those who must undergo gastrointestinal cancer resection. If the surgeon is to perform surgery optimally, he must clearly visualize the primary cancer. There should never be a struggle for adequate visualization of the cancer or of the surrounding abdominal or pelvic viscera. A large midline abdominal incision extending from xiphoid to pubis is required.