Role of surgery in times of precision oncology

Background: Biomolecular methods allow for the exact genetic classification of gastrointestinal cancers, thus, resulting in the possibility for targeted therapy. For therapeutic decisions, genetic findings gain importance over the location of tumors. For small subgroups, healing already seems possible without surgery. Objectives: The significance of surgical approaches in the treatment of gastrointestinal cancers must be re-evaluated. Materials andmethods: The future relevance of surgical approaches is demonstrated based on examples. Results: Minimally invasive surgery can also be performed with palliative intention and in patients with other pre-existing medical conditions as it causes less stress. In the presence of treatable genetic alterations, surgical resection can be performed in advanced tumor stages as well as in case of tumor relapse. Furthermore, initially irresectable tumors can be successfully down-staged with targeted therapies, thus, increasing the number that qualify for surgery. In selected cases, solid organ transplantation may be an adequate treatment for gastrointestinal cancers. Conclusion: Indications for surgery are shifting. While on the one hand resection is no longer the only chance for cure, new indications for the treatment of advanced tumors are emerging. Detailed knowledge of molecular markers and targeted therapies are essential for oncologic surgeons in order to choose proper treatment.