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Clinical Programs

Approximately 80% of people with cancer require surgical services during their cancer treatment.

The Department of Surgical Oncology at Princess Margaret is the largest in Canada. Offering a broad range of surgical services using the most advanced surgical technologies and techniques, our team consists of close to 60 specialized surgeons who work across site groups. 

As an international leader in cancer care, Princess Margaret is continually advancing the frontiers of clinical practice. In 2010 Princess Margaret surgical oncologists formally implemented the hyperthermic intraperitoneal chemotherapy (HIPEC) program and transferred our ground-breaking Guided Therapeutics Lab (GTx Lab) to the MaRS Discovery District.  

In 2009, the Department of Surgical Oncology completed the implementation of the centre’s prostate and gynecologic cancer robotic programs. The program was expanded to the lung and gastrointestinal programs in 2011.  

Our more recently developed specialized clinical programs include: 

 

Guided Therapeutics Surgery Program under the TECHNA Initiative

The Guided Therapeutics (GTx) Program at Princess Margaret is a research platform pioneered by Princess Margaret researchers, physicists, engineers, medical imagers and surgeons. This program is dedicated to the development of real-time 3-D imaging combined with navigation and tracking, enabling novel therapy delivery. 

The GTx approach promises a better quality of life for patients, both during and after treatment, and supports the application of new technologies in cancer surgery, including molecular imaging and novel imaging technology incorporating biophotonics. GTx also enables interventional therapeutics, including minimal-interventional surgical techniques and robotics. 

In 2010 we transferred our GTx Lab to the MaRS Discovery District and completed a tender process for construction of the Translational Research Image Guided Operating Rooms (TRIGOR-A) in the surgical oncology operating rooms at the Toronto General Hospital.

 

Gamma Knife Radiosurgery

Housed at the Toronto Western Hospital, the Gamma Knife Centre is the only one of its kind in Ontario. As a unique collaboration between Neuroscience, Medical Imaging and the Princess Margaret Radiation Medicine programs, this state-of-the-art surgical treatment is available to people with benign and malignant tumours and other medical conditions.

The first oligometastases brain clinic was developed in 2009 through close collaboration between the Toronto Western Neurosurgery Department and the Princess Margaret Radiation Oncology Department to optimize management strategies for patients with brain metastases. This clinic focuses on providing the best tailored treatment strategy for patients with brain metastases using gamma knife radiosurgery or surgical intervention when indicated.  

Research is a fundamental part of the radiosurgery program and patients may be enrolled in one of four or five clinical trials at any given time.  

The clinic is dedicated to providing on-site neurosurgical care at Princess Margaret to ensure that surgical intervention for resection of brain metastases is provided within one week of referral to the clinic.  

Annually, we review approximately 1,000 new patients with brain metastases from around the province and treat approximately 200 patients using gamma knife radiosurgery. The program has a dedicated nurse specialist, clinical trials nurse, database manager and physicists, who together make up one of the largest partnerships in the surgical oncology team.  

The gamma knife program for non-malignant cranial disease is dedicated to outcomes research using the gamma knife and identifying prediction models related to use of radiosurgery for treatment of vestibular schwannomas, arteriovenous malformations and trigeminal neuralgia.

 

Robotic Oncological Surgery

The robotic surgery program at Princess Margaret has evolved as surgeons increasingly look to developing minimally invasive techniques aimed at improving patient outcomes. Robotic surgery can provide a magnified 3-D view with enhanced manual dexterity and tremor filtration. The current robotic platform builds on basic laparoscopic surgery and thus is associated with less pain, diminished blood loss and an earlier resumption of activities for patients after surgery. Optimal functional outcomes are achieved without compromising cancer control.  

“Throughout the world, robots are being used to provide patients with more accurate surgical procedures and better outcomes. As one of the top cancer research centres, we are in a perfect position to be leaders in gynecologic oncology robotic surgery – what better place than at the Princess Margaret to take advantage of this technology.” – Dr. Marcus Bernardini, surgical oncologist 

Integration of the Princess Margaret surgical oncology robotics program under the Surgical Oncology Guided Therapeutics Program will result in research and development to further enhance the technology such that techniques of image fusion and overlay (superimposing a previously obtained or real-time imaging, such as ultrasound or MRI) to the surgical field can improve oncologic outcomes. 

Laparoscopic pelvic surgery can be most challenging because of the fixed working space and acute instrument angles. Robotics has helped overcome some of these challenges.  

Currently, Princess Margaret uses robotics in surgeries for patients who present with urologic or gynecologic cancer. Emerging robotics programs in colorectal, thoracic and head and neck surgical oncology will continue to ensure that our surgical oncology program remains at the leading edge of research, education and patient care.

Our Surgical Oncology fellowship training programs include robotic training, marking a shift in the way surgical oncology services will increasingly be delivered in the future.

 

Plastic & Reconstructive Surgical Oncology

As a division of the Princess Margaret Surgical Oncology Department, the Plastic and Reconstructive Surgical Oncology program is a centre of excellence for the repair and restoration of both function and appearance using state-of-the-art techniques. This is a critical program for breast, head and neck and sarcoma oncology. Innovative reconstructive surgical therapies pioneered at the University Health Network for maxillary reconstruction and laryngeal and tracheal reconstruction have been led by our reconstructive surgical group. 

Our reconstructive surgeons work as part of surgical teams and inter-professional site groups to provide timely access and compassionate, top-quality care to people with cancer and to cancer survivors. Where possible, reconstructive surgery is done simultaneously with primary surgical cancer treatment.  

The Breast Restoration Program within the Division of Plastic and Reconstructive Surgery is the largest and most comprehensive program of its kind in Canada. Performing breast reconstruction procedures for approximately 300 women every year, our team has the expertise to excel in breast restoration techniques.

 

Peritoneal Membrane Malignancy Clinic

Peritoneal membrane malignancy is a spectrum of diseases involving the peritoneum, either primary or secondary to gastrointestinal or gynecological tumours. Aggressive cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) has been shown to improve survival and is a promising step forward in the management of these cancers. 

Peritoneal surface malignancies include a wide variety of tumours that involve the peritoneal lining (primary), such as malignant peritoneal mesothelioma, or more commonly spread secondarily from gastrointestinal or gynecological tumours, such as pseudomyxoma peritonei or peritoneal carcinomatosis.  

Often these tumours are confined to the peritoneal cavity and have not spread to other sites in the body. In these cases, aggressive cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) has been promising.

This multidisciplinary program is a collaboration between the Princess Margaret and Mount Sinai hospitals. Ours is the only program of its kind in Ontario and one of only six in Canada; we see patients from all over the province. This program offers hope to patients whose disease was previously considered incurable.