Specialising in breast cancer surgery

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Published: 24 Jan 2018
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Prof Riccardo Audisio - University of Liverpool, Liverpool, UK

Prof Audisio speaks with ecancer at the 10th BGICC in Cairo about specialising in breast cancer surgery, and implementing training guidelines.

He describes the importance of cancer surgeons in cancer care, and opportunities of breast cancer specialists in improving outcomes.

Prof Audisio outlines his views on the use of laparoscopic or robotic surgery, noting a lack of clinically proven benefit over other surgical techniques.

For more on the ESSO course for oncoplastic breast surgery, click here.

For more on breast cancer surgery, watch Dr Wu Jiong speak about the availability of breast surgery, and other treatment modalities, in Shanghai.

There is no doubt that we are working in a multidisciplinary panel. All specialties are crucially important with the aim of improving cancer survival, particularly in breast cancer. But so far surgery is the winning weapon in over 60% of breast cancer patients that are cured and we are aware that there is evidence of substandard surgery. Substandard surgery associates to reduced outcomes and these are probably 20%, they are far more important than medical oncology's achievement and radiation oncology. It's crucially important to have good cancer surgery.

Now this is the demand that breast cancer patients are putting forward. They helped the European Parliament in imposing the breast units. We do have breast units across Europe but we do not have breast surgeons. In a setting where there is a redundancy of self-proclaimed 'good' breast surgeons it is crucially important for the leading surgical cancer societies to set up a template and to set up guidelines and standards for the training and the implementation of good cancer surgery.
Breast surgery is hypothetically a confined specialty which is self-sufficient, contained in itself. Practically speaking, most surgeons who perform breast surgery are general surgeons, frequently poor general surgeons, in that breast cancer surgery isn't considered subcutaneous minor surgery and is not as challenging as intravisceral abdominal surgery or thoracic surgery. Other examples across Europe are gynae oncologists - Germany, Switzerland, Austria, somewhere in France. It's the gynae oncology, gynaecological surgeon who does breast and this is most frequently the case in those countries.

Otherwise, as I say, we are aiming to develop, and some countries do have these in place, a breast surgeon as a specialty on its own, an oncoplastic surgeon who does know how to better organise the glandular tissue when displaced and when excised.

Do you think that robotic surgery will be used for breast surgery in the future?

No, I don't. I don't think we have any evidence of the true value of robotic surgery whatsoever. I don't think that we have stronger results to support this. Particularly in the breast scenario there is nothing available and I dispute that there is a need for minimally invasive surgery in dealing with breast cancer. The issue here is associating technical skill, surgical skills, with a better understanding of the oncologic problems. So it's not really an acrobatic performance, it's mostly doing the right thing at the right time for the right patient.
In view of the extraordinarily good techniques that are now available in terms of reconstruction, I'm thinking of nipple sparing mastectomy where you have outstanding cosmetic results, even in the face of the most devastating mutilation, the role of minimally invasive or robotic surgery is really, really scant.

What does the future hold?

We are working hard on this. We have a strong network across Europe, we have the examination with ESSO and EUSOMA. There is a textbook that Lynda Wyld, the leader of the Education Training Committee has been putting together. As I said, there is an accreditation in place, we are just now about homogenising all these and putting this together because what we don't want is to invent the wheel in Greece, Turkey, Egypt, Italy and the UK. We want to work together jointly, we don't want to fight, we don't want to cause any abrasion but we want to progress and to reassure our patients that we are on track with developing good guidelines and good training for breast cancer surgeons.