Overview
Some cancers involve multiple organs, vital structures, or large areas of the body. Treating these cancers safely and effectively often requires complex multi-team surgical resections and reconstruction. These operations bring together specialists from different surgical fields to remove cancer fully, protect important functions, and rebuild affected areas.
This approach is commonly required for head and neck cancers, abdominal cancers, paediatric solid organ tumours, and soft tissue sarcomas. The goal is to achieve the best cancer outcome with the safest operation and optimal long-term quality of life.
Why Multi-Team Surgery?
Certain cancers cross anatomical boundaries or involve structures that no single surgeon can manage alone. A multi-team approach allows specialists to combine their skills so that:
- Tumours can be removed completely and safely
- Vital nerves, blood vessels and organs are preserved whenever possible
- Reconstruction is planned in advance
- Function (speech, swallowing, movement, bowel/bladder control) is maintained
- Cosmetic and structural integrity is restored
This approach reduces complications and improves long-term survival.
Head and Neck Cancers
Head and neck cancers may involve structures that are essential for breathing, swallowing, speech and appearance. Multi-team surgery may be required for:
- Thyroid and parathyroid cancers with local invasion
- Salivary gland cancers
- Advanced skin cancers invading deeper neck structures
- Tumours involving major nerves or blood vessels
- Sarcomas of the head and neck region
Teams commonly involved:
- Head and neck (ENT) surgery
- Endocrine surgery
- Plastic and reconstructive surgery
- Oral and maxillofacial surgery
- Vascular surgery
- Neurosurgery (for skull base involvement)
Why teamwork matters:
- Tumours sit next to delicate nerves and critical airway structures
- Reconstruction may require microvascular free-flap surgery
- Collaboration ensures safe cancer removal and preservation of function
Abdominal and Pelvic Cancers
Many abdominal cancers involve multiple organs or require specialised reconstruction. Multi-team surgery is often required for:
- Retroperitoneal soft-tissue sarcomas
- Large or invasive abdominal tumours
- Cancers involving bowel, bladder, uterus or kidneys
- Recurrent or residual abdominal cancers after previous treatment
- Peritoneal surface malignancies
Teams commonly involved:
- Surgical oncology
- General/paediatric surgery
- Colorectal surgery
- Urology
- Gynaecologic oncology
- Vascular surgery
- Plastic and reconstructive surgery
Why teamwork matters:
- Tumours often cross compartments
- Combined organ resections may be needed
- Reconstruction (e.g., abdominal wall, urinary tract, bowel continuity) must be carefully coordinated
Soft Tissue Sarcomas
Soft tissue sarcomas arise in muscles, fat and connective tissue. They can grow to a large size or lie close to important structures. Multi-team surgery is often required for:
- Abdominal or pelvic soft tissue sarcomas involving multiple organs
- Truncal soft tissue sarcomas
- Head and neck soft tissue sarcomas
- Recurrent soft tissue sarcomas
- Paediatric soft tissue sarcomas requiring multi-organ coordination
Teams commonly involved:
- Surgical oncology / paediatric surgical oncology
- Plastic and reconstructive surgery
- Vascular surgery
- Thoracic surgery (for chest wall involvement)
- Neurosurgery (for spine or skull base involvement)
Why teamwork matters:
- Sarcomas may wrap around or lie close to major blood vessels and nerves
- Large resections create significant defects requiring advanced reconstruction
- Organ-preserving and function-preserving surgery often relies on involvement of multiple specialties
Paediatric Solid Organ Malignancies
Children with cancer often require complex operations because tumours can be large, rapidly growing or involve multiple structures. Common paediatric solid organ cancers requiring multi-team surgical care include:
Neuroblastoma
- Often arises near major blood vessels in the abdomen
- May require vascular or thoracic surgical involvement
Wilms' Tumour (Kidney Cancer)
- Can grow very large
- May involve the renal vein, inferior vena cava or adjacent organs
- Sometimes requires collaboration with urology, vascular surgery or reconstructive teams
Germ Cell Tumours
- Can arise in the pelvis or abdomen
- Surgery may involve paediatric surgery, gynaecology or urology
Paediatric soft tissue sarcomas involving solid organs
- Some soft tissue sarcomas may invade or compress solid organs
- Resection or reconstruction may require multiple teams
Why teamwork matters:
- Tumours may sit close to or wrap around major vessels
- Resection may involve multiple organs
- Reconstruction or organ-preserving approaches benefit from multidisciplinary expertise
How Multi-Team Surgery Works
Pre-Operative Planning
Before the operation, teams meet to:
- Review imaging (CT, MRI, PET)
- Understand the full extent of disease
- Plan the order and timing of surgical steps
- Identify key structures at risk
- Plan reconstruction
- Coordinate anaesthetic and critical care support
These decisions are usually discussed at a multidisciplinary team (MDT) meeting.
During the Operation
Surgery may occur in carefully coordinated stages:
*Team 1 – Tumour Resection*
- Removes the cancer completely
- Protects major organs, nerves and blood vessels
- Ensures optimal surgical margins
*Team 2 – Organ or Specialist Support*
- Vascular or thoracic surgeons reconstruct or repair major vessels or organs
- Urology, colorectal or gynaecology teams assist with complex pelvic or abdominal involvement
*Team 3 – Reconstruction*
- Plastic and reconstructive surgeons restore form and function
- Soft-tissue reconstruction or free-flap techniques may be used
- Abdominal wall or pelvic floor reconstruction may be required
Recovery After Complex Surgery
Recovery varies depending on the operation but commonly includes:
- A hospital stay of several days to several weeks
- Specialist wound care
- Physiotherapy and rehabilitation
- Speech or swallowing therapy for head and neck procedures
- Nutritional support
- Regular follow-up with surgical and oncology teams
Benefits of a Multi-Team Approach
Patients benefit from:
- Increased safety through combined expertise
- More complete cancer removal
- Organ-preserving or function-preserving surgery whenever possible
- Better reconstruction and cosmetic outcomes
- Comprehensive care throughout treatment
Outcomes are consistently better in specialised centres where multidisciplinary surgery is routine.
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