From the Desk of Editors: Surgical Oncology—Embracing Change and Enduring Relevance

Prof Pankaj Kumar Garg, Executive editor

Prof S P Somashekhar, Chairman/Editor-In-Chief

Since its inception, surgical oncology has been recognised as a discipline grounded in disease pathology rather than organ-specific specialisation, maintaining a consistently disease-centric approach to cancer care. It was born out of the understanding that cancer is not merely a pathological condition confined to an organ but a systemic biological phenomenon that demands an integrated, multidisciplinary, and biology-driven approach [1]. As we complete a quarter of the twenty-first century, surgical oncology is at a transformative crossroads, propelled by advances in systemic therapies, precision oncology, genetics, and evolving healthcare delivery models. The fundamental question before us is not whether surgical oncology will survive but rather how it must evolve to continue leading the charge in cancer care.

At its core is a profound idea: a surgeon operating on a cancer patient must understand tumour biology just as deeply as they understand anatomy and surgical technique. This includes the sound knowledge of multidisciplinary management, when to operate, when not to, the timing of surgery in relation to chemotherapy and radiotherapy, and how the biology of the tumour dictates the surgical margins, lymph node dissection, and approach. Unlike organ-based specialists, the surgical oncologist’s identity has always been defined by their holistic understanding of cancer and its behaviour—not by man-made anatomical territories. This philosophy remains central in 2025. If anything, it is more relevant now than ever before.

In today’s evolving oncological landscape, the future of surgical oncology is frequently questioned—primarily due to two key developments. First, the remarkable advances in medical and radiation oncology have expanded the scope of non-surgical treatments for solid tumours, often giving the impression that the role of surgery is diminishing. Second, there has been a rapid rise in organ-based surgical sub-specialities such as hepato-pancreato-biliary, breast, thoracic, endocrine, colorectal, head and neck, and gynecologic surgery, which has led some to speculate that surgical oncology, as a distinct speciality may lose relevance [2].

However, this perception does not align with global/regional realities. According to the Global Cancer Observatory, an estimated 19.96 million new cancer cases and 9.7 million cancer-related deaths were reported in 2022. By 2050, the number of new cancer cases is projected to exceed 35 million, reflecting a 77% increase [3]. As surgical intervention remains a foundational pillar of cancer treatment, it is estimated that around 80% of all cancer patients require surgery at some point during their treatment, often multiple times [4]. Despite its critical role, access to surgical oncology remains inadequate. In high-income countries, fewer than 25% of patients receive timely, affordable, and safe cancer surgery. The situation is even more concerning in low- and middle-income countries (LMIC), where access drops to 20% in middle-income and just 5% in low-income countries. Global cancer surgeries are projected to increase by 5 million procedures (52%), from 9.07 million in 2018 to 13.82 million by 2040 [5]. To meet high-income country benchmarks, these nations must quadruple their surgical workforce. Surgeon numbers will need to rise from 28,000 to 58,000 (107%) in low-income and from 166,000 to 277,000 (67%) in LMICs by 2040. In light of these challenges and projections, it is clear that the demand for trained surgical oncologists will not fade—rather, it will intensify over the coming decades.

The second major concern often raised about the future of surgical oncology relates to the rapid growth of organ-based surgical sub-specialities. These fields bring in-depth anatomical knowledge and procedural proficiency. However, they often lack comprehensive training in tumour biology, systemic therapies, and multimodal treatment planning that define a surgical oncologist. This divergence has led to speculation about whether surgical oncology might be gradually absorbed into these organ-specific disciplines, potentially losing its identity as a standalone speciality. Yet, such assumptions misrepresent the true essence and enduring value of surgical oncology. What we are witnessing is not the decline of the speciality—but its redefinition in response to a complex, evolving healthcare landscape.

Contemporary surgical oncologists serve not only as skilled surgeons but also as leaders in multidisciplinary oncology, contributors to health policy formulation, and key drivers of surgical capacity-building across both high-resource and resource-constrained settings. To remain at the forefront of cancer care, surgical oncologists must evolve beyond the confines of the operating rooms. While mastering advanced surgical techniques, several domains now demand their attention, leadership, and evolution:

The Unmet Need

In India and many other LMICs, cancer care remains heavily concentrated in metropolitan cities, where the majority of tertiary care hospitals, cancer centres, and trained specialists are located. Meanwhile, vast rural and semi-urban populations continue to have limited or no access to timely diagnosis, appropriate referrals, or surgical treatment. This results in patients presenting with advanced-stage disease, limiting treatment options and compromising outcomes. As metro cities become increasingly saturated with trained surgical oncologists, this shift opens the door for young surgical oncologists to establish themselves in areas where the need is high, competition is low, and the scope for clinical, academic, and community leadership is immense. Addressing the rural–urban divide is not just a moral imperative—it is a strategic opportunity for surgical oncologists to extend the reach of their expertise, strengthen their professional identity, and contribute to the evolution of a more equitable and accessible cancer care system in India.

Organ-Based Sub-specialisation with Core Oncology Knowledge

As cancer care becomes increasingly personalised, surgical oncologists will need to focus their practice on specific organ systems—not as a retreat into organ-speciality silos, but to keep pace with the explosion of data, techniques, and targeted interventions in each domain. Subspecialisation must be built on a solid foundation of oncologic principles.

Genomic Medicine and Risk-Reducing Surgeries

With the advent of genetic profiling, molecular diagnostics, and identification of hereditary cancer syndromes, the role of the surgical oncologist now extends into risk-reducing interventions. Prophylactic surgeries such as mastectomy, colectomy, and thyroidectomy in high-risk individuals are mainstream preventive strategies. Surgical oncologists must collaborate with genetic counsellors and molecular pathologists to guide patients in making life-altering decisions. In this capacity, the surgical oncologist must expand their role from a surgeon to a custodian of preventive oncology.

Palliative Surgery: Improving Quality of Life

Another under-recognised but vital domain is palliative surgical oncology [6]. Despite advances in systemic therapies, many patients still present with advanced, symptomatic disease —obstruction, bleeding, fungation, and pain. In these settings, surgical intervention may not be curative, but it plays a crucial role in alleviating symptoms and significantly enhancing quality of life. Palliative procedures, such as stoma creation, bypass surgeries, or debulking, can significantly improve quality of life, restore dignity, and allow patients to spend their remaining time comfortably. The surgical oncologist must master not just curative intent but also the art of meaningful palliation, a skill set that requires judgment, empathy, and multidisciplinary collaboration.

Leadership Role in Multidisciplinary Cancer Care

The multidisciplinary tumour board has become a key pillar of modern cancer care, allowing specialists from various fields—surgical, medical, and radiation oncology; pathology; radiology; genetics; psycho-oncology; palliative care; and other domains—to plan patient management jointly. These discussions help combine diverse expertise to develop evidence-based, patient-focused, personalised treatment plans that consider the biological, clinical, financial, and psycho-social aspects of each case [7]. The surgical oncologist holds a central and strategic role—not just as a surgeon, but as the one who often leads and navigates the patient’s journey right from diagnosis to treatment planning and beyond. They act as clinical coordinators and decision-makers, bringing together the inputs from all specialists and ensuring the overall treatment remains scientifically sound and personalised to the patient’s needs. While every team member plays a vital role, it is often the surgical oncologist who anchors the care pathway, making them a natural leader in the multidisciplinary management of cancer.

The Surgical Oncologist as a Clinician-Scientist

The surgical oncologist of the future must be more than a skilled surgeon—they must also be a scholar, a clinician-scientist, and a contributor to science [8]. Participation in clinical trials, registry data, prospective studies, and translational research is essential. With tissue being the currency of modern oncology, surgeons have a unique opportunity to facilitate biobanking, enable molecular analysis, and collaborate with researchers in defining new biomarkers, response predictors, and therapeutic targets. Active involvement in academic writing, guideline development, and policy shaping further enhances the impact of surgical oncologists beyond the operation theatre.

Embracing Artificial Intelligence

With the rapid growth of artificial intelligence (AI) in healthcare through large language models (LLMs) like ChatGPT, a new and important domain is emerging for surgical oncologists. In surgical oncology, LLMs can assist in generating structured reports, interpreting investigations, improving patient counselling, and contributing to multidisciplinary treatment planning [9]. Tools powered by such models may help patients better understand their diagnosis and treatment, support clinical workflows, and aid in follow-up care and monitoring. At the same time, their clinical use brings challenges such as privacy concerns, potential bias, data reliability, and the need for proper regulation [10]. As this field evolves, surgical oncologists must engage with AI not just as end-users but as active contributors—helping guide responsible implementation, identifying clinical uses, and ensuring that technological innovation remains patient-centred.

Training the Next Generation: A Core Responsibility

In the evolving landscape of cancer care, one of the most critical roles of the surgical oncologist is to mentor and shape the next generation. As custodians of a discipline that blends surgical precision with oncologic insight, today’s surgical oncologists must ensure that their successors are not just skilled surgeons but astute oncologists. Training must extend beyond the technical aspects of surgery, incorporating simulation-based learning, exposure to genetic counselling and palliative care, and mentorship in academic writing and clinical research to cultivate well-rounded surgical oncologists. In doing so, surgical oncologists safeguard the future of their speciality—not just by passing on skills but by inspiring leadership, innovation, and patient-centred thinking in those who will carry the discipline forward.

Community Oncology: Expanding the Reach of Surgical Oncologists

Surgical oncologists must accept community oncology as an essential component of their professional identity if they are to effectively address the rising cancer burden among India’s vast and diverse population. This evolving domain presents an important avenue for surgical oncologists to engage in community-oriented initiatives that support public awareness, cancer screening, early detection, and health education—particularly in rural and semi-urban settings where access to oncology services is limited. In the Indian context, low cancer awareness, social stigma, and prevalent misconceptions frequently contribute to delayed care-seeking behaviour. With their clinical expertise and credibility, surgical oncologists are well positioned to contribute to multidisciplinary efforts aimed at strengthening community-based education, improving early presentation, and facilitating timely referrals within the healthcare system. Another crucial area is the training and mentoring of primary care providers and local health workers, such as ASHAs, ANMs, and general practitioners. These frontline workers are often the first point of contact for patients and play a critical role in early suspicion and referral. Surgical oncologists can empower them with basic skills in recognising warning signs, performing clinical examinations, and navigating referral pathways. This approach ensures a wider reach and sustainability, even in resource-constrained settings. Importantly, community oncology is not merely a charitable activity—it is a strategic extension of surgical oncology practice. In a healthcare system as diverse as India’s, where a majority of patients are still diagnosed late, going to the community is not optional—it is essential. In this context, community oncology represents an emerging frontier where surgical oncologists have the potential to make a sustained impact—not only through individual patient care but also at a community level.

Global Health Diplomacy: Expanding Influence Beyond Borders

In today’s global village, cancer-related healthcare challenges are no longer confined by geography. Global health diplomacy has emerged as a critical platform where medical professionals, policymakers, and institutions collaborate to address health inequities across nations. Within this evolving framework, surgical oncologists must recognise and embrace their role as ambassadors of oncology care, contributing not just in operating rooms but also in the global dialogue on cancer control. Collaborations in oncology—such as twinning programmes between hospitals, academic exchanges, tele-mentoring, and international fellowships—are valuable opportunities to share experiences, exchange ideas, and develop innovative, sustainable solutions. By participating in such partnerships, surgical oncologists can help strengthen cancer care systems, both regionally and globally. Moreover, international conferences, virtual tumour boards, and collaborative research initiatives serve as valuable platforms for surgical oncologists to engage with global peers, exchange clinical insights, and remain abreast of emerging trends in oncologic care. Such engagement not only contributes to professional growth and academic enrichment but also facilitates the adoption of global best practices within local health systems, thereby enhancing the quality and consistency of cancer care delivery in their own settings. In essence, global health diplomacy is not just a foreign policy tool—it is a professional responsibility and opportunity for surgical oncologists. By contributing to global efforts, they help build more equitable, sustainable, and collaborative oncology systems worldwide, further affirming their role not only as surgeons but as global health leaders.

Integrating Survivorship into Surgical Oncology Practice

Advancements in early detection, multimodality management, and therapeutic innovations have substantially improved survival outcomes, resulting in a steadily increasing population of individuals living well beyond cancer treatment. As survivorship becomes a growing reality, surgical oncologists must re-envision their role—not merely as providers of surgical intervention but as lifelong partners in the cancer care continuum. Survivorship care includes monitoring for recurrence, managing long-term surgical and treatment-related side effects, addressing psychosocial concerns, and promoting healthy lifestyle changes to reduce the risk of secondary cancers. Surgical oncologists must also play a role in coordinating survivorship care plans, ensuring smooth transitions from active treatment to follow-up, especially in systems where oncologic follow-up is fragmented. In many cases, they remain the most trusted point of contact for the patient, and their guidance is invaluable in navigating complex survivorship needs, including fertility preservation, body image issues, lymphedema management, and returning to daily life. In India and many LMICs, formal survivorship programmes are still underdeveloped. This creates an opportunity for surgical oncologists to lead the way in developing structured follow-up protocols, collaborating with allied health professionals, psychologists, physiotherapists, and palliative care teams to create comprehensive survivorship models tailored to regional needs. Integrating survivorship into routine surgical oncology practice reflects an essential shift in perspective—acknowledging that the effects of cancer care extend beyond surgery, and so too must the surgeon’s role. This approach is central to delivering comprehensive, compassionate, and continuous care.

Digital Health and Tele-oncology

The digital revolution has significantly transformed healthcare delivery across the globe, and oncology is no exception. Integrating digital health tools and tele-oncology into surgical oncology practice has opened up new avenues for enhancing patient care, improving access, and streamlining communication—especially in a country like India, where geographic and infrastructural barriers often limit timely care in remote regions [11]. Tele-oncology, in particular, has proven to be a powerful tool for extending specialist consultations beyond urban tertiary centres. Surgical oncologists can now provide pre-operative counselling, post-operative follow-up, second opinions, and multidisciplinary tumour board participation virtually. This not only reduces the burden on patients who would otherwise have to travel long distances, but also ensures that decision-making remains timely and collaborative. Moreover, digital health platforms—including electronic health records (EHRs), patient portals, remote monitoring tools, and mobile health apps—offer surgical oncologists greater efficiency in tracking recovery, identifying complications early, and coordinating care across departments. Surgical oncologists can also participate in virtual CME programmes, tele-mentoring, and training sessions for local health workers, general practitioners, and district surgeons—thereby strengthening cancer care systems at the grassroots level. However, the successful adoption of digital tools in surgical oncology also requires attention to digital literacy, data security, infrastructure support, and medico-legal frameworks. It is essential that surgical oncologists remain aware of these challenges and advocate for ethical and equitable digital health policies.

In conclusion, the future of surgical oncology is not one of decline but of dynamic transformation. Its boundaries may shift, but its core values must endure. Surgical oncologists who embrace the broader dimensions of cancer care—tumour biology, prevention, palliation, genomics, community engagement, and research—will remain indispensable leaders in this field. As we move through 2025 and beyond, surgical oncology will continue to thrive as a vital, adaptive, and patient-focused speciality. The path forward is clear—not to resist change, but rather, to embody the change that the future of oncology so urgently demands.

Declarations

Conflict of Interest

None to declare.