Your Dog Surgery Guide

Why Veterinarians Suggest Surgery

It may be scary to think of your dog going through surgery, but there is a reason veterinarians select surgery as the first treatment for many cancer types. Surgery has the best chance of curing cancer in many cases as it physically removes a large concentration of cancer cells from the body. The hope is that surgical removal of the cancerous tissue will be curative if the cancer has not spread yet.

If the cancer has already spread, surgery can still be helpful by removing a large amount of cancerous tissue from the body. This should slow growth and reduce the inflammation associated with the tumor. Once a larger mass is removed, chemo or radiation can be used to kill off the remaining cancer cells.

Common Examples of Dog Surgery for Cancer

There are different types of approaches to oncologic surgery. The most common types are as follows:¹

• Debulking: A debulking surgery does not completely remove the tumor but makes it smaller by taking as much tissue as possible. This is reserved for cases where it is not possible to take the entire mass due to its location. Debulking surgeries are not curative but can buy your pet time or may be paired with radiation or chemotherapy for better results. Some situations where this may be the best option are oral masses or invasive soft tissue sarcomas. Debulking is most helpful in cases where the mass is slow growing and has a low risk of metastasis.
• Marginal Resection: This is when the tumor is removed with narrow margins. It can work in some types of cancer but is best for more benign tumors like lipomas. Excisional biopsy (when a mass is removed to get a diagnosis before you know what type of tumor it is) is marginal resection.
• Wide Resection: This is when larger margins are taken to remove as much or all of the cancer in the surrounding tissues. This is the best approach when removing known cancerous solid tumors.
• Radical Resection: This is when the entire surrounding tissue area is removed along with the cancer. Some examples of this are splenectomy (removing the entire spleen) for hemangiosarcoma, amputation (removing an entire leg) for osteosarcoma, or removing an entire chain of mammary glands for mammary adenocarcinoma.

When Surgery is Recommended for Cancer

Surgery is the first line of treatment for most cancers as it has the highest chance of providing a cure. Surgery physically removes cancer cells from the body, preventing them from causing harm locally as they replicate or spread throughout the body.

If surgery is very complicated or is likely to harm your dog’s quality of life, your veterinarian may suggest palliative care, chemo, or radiation instead.

Veterinary Surgical Planning and Surgical Margins

Before your dog is even under anesthesia, your veterinarian will devise a surgical plan based on the tumor type, location, and the type of removal needed.

The goal is to remove as much of the cancer as possible. To achieve this the surgeon will remove normal looking tissue that surrounds the tumor in case the tumor reaches farther than can be seen with the naked eye. This buffer zone is referred to as margins.

The incision may be larger than you expect – for benign lumps like lipomas, surgeons generally take very narrow margins, but if something more aggressive like a mast cell tumor or melanoma is suspected, the surgeon will take the widest margins they can.

Margins are also influenced by tumor location and the surrounding anatomy. For example, a tumor located on the lower leg may not have as much surrounding tissue available, so it may be difficult to close a large incision. Meanwhile a tumor on the side of the body will allow for a larger amount of tissue to be removed.

There are two different types of margins. Lateral margins are the margins around the sides of the tumor. Deep margins are the margins underneath the tumor. Fat and muscle do not always provide a barrier to tumor cell invasion, while connective tissue like fascia is more protective. Thus, the general rule is to remove one fascial plane if possible.¹

Benign tumors and some carcinomas can be removed with 1 cm lateral margins. Soft tissue sarcomas should have at least 3 cm lateral margins. Mast cell tumors should have 2 cm lateral margins. If the tumor is on an organ, then a more aggressive approach such as removing the entire organ or a larger portion of it is often needed.

Cancers Surgery Is Commonly Used For

Surgery is used for most types of solid cancers including most sarcomas, carcinomas, and mast cell tumors.

Surgery is not useful for leukemias or lymphoma as they affect system-wide tissues like lymph nodes or bone marrow.

How to Get the Best Results

There are several things that you can do to prepare your dog for surgery:

• Make sure you have time off, if possible, the day of surgery for dropping your dog off and picking her up. Depending on the surgery, it may be beneficial to take a few days to a week after surgery or arrange for someone to help care for your pet during recovery.
• Discontinue any medication that may cause clotting issues prior to surgery and ask your vet about all supplements that your dog is currently taking.
• If your dog is anxious or hard to keep calm, ask your vet about anti-anxiety/sedation medications to give before or after the surgery.
• Make sure you follow surgical preparation instructions from your veterinarian and that all family members are aware of when to take away food and water before the procedure.
• Say yes to pre-anesthetic bloodwork. This ensures that your dog’s liver and kidneys are functioning properly and able to process anesthesia effectively.
• Practice having your dog wear an Elizabethan collar (cone) or surgical suit ahead of time so that she is comfortable wearing it during recovery.
• Prepare a quiet place for your dog to recover and heal. There shouldn’t be furniture that she can jump on or off, and avoid stairs as much as possible. You can use baby gates or get a free-standing crate or pen to confine your dog. Getting them used to this recovery area before surgery day is a good idea.

What Happens in Dog Surgery

Surgical intervention can range from minor to major, depending on the details of your dog’s cancer and the full treatment plan. Even so, most surgeries follow a similar basic plan.

Below, we will give a general overview of your dog’s experience on the day of surgery as well as cover the things the surgeon will be doing behind the scenes to prepare for the procedure.

Your Dog’s Experience of Surgery

Your dog will go through a lot during surgery, but also before and after. Here is the basic outline from beginning to end:

• Your dog will be fasted for 8-12 hours prior to surgery. While no one likes skipping breakfast, this is an important step for the safety of your dog. Many of the drugs needed before and during anesthesia can cause vomiting, and this could lead to aspiration pneumonia. No food in the stomach means your dog is less likely to vomit and less likely to have that vomit accidentally go down into the lungs.
• You will drop your dog off at the clinic early so your pet can have pre-surgical pain medication administered and a thorough pre-operative examination.
• Your pet will have an intravenous catheter placed and may receive intravenous fluid therapy to help maintain hydration and blood pressure. The catheter is an easy way for the staff to give medications during the procedure.
• Pain medication and a mild sedative will be given before surgery as a “pre-medication” to calm your dog and start the process of pain management.
• Your pet will be anesthetized, and a tube will be placed down the trachea (intubation) to ensure airway access. Once the tube is in they will be hooked up to gas anesthesia and oxygen for the duration of the procedure.
• Your pet will then be “prepped” which involves shaving the fur around the surgical site. This area is often much larger than expected, but it allows the veterinary staff to sanitize your dog’s skin to keep the surgery as sterile as possible.
• In the operating area your pet will be draped with sterile material with an opening in the middle for the surgeon to access the incision site. The drape creates a large sterile field so that the surgeon has room for instruments, gauze, and other supplies without touching any parts of your dog’s body that have not been sanitized. Your dog will also be hooked up to a variety of tools used to monitor his vital signs such as blood pressure, heart rate, oxygen levels, and temperature.
• If your dog is having a routine tumor removal (not cancer on an internal organ), these are likely the steps the surgeon will take:
  • A skin incision will be made around the tumor with a scalpel blade.
  • Then the tissue around and under the tumor will be dissected with surgical scissors, a scalpel, or electrocautery.
  • Any bleeding vessels or tissue will be clamped and tied off with suture or cauterized to stop bleeding.
  • Once the tumor is removed the area will be closed in 2-3 layers with suture.
  • The skin sutures may be visible, or at other times they will be buried under the skin. This depends on surgeon preference.
  • The tumor will be submitted for biopsy.
• Once the procedure is done your pet will recover with a warm blanket under supervision of a technician. Pain medications will be given again if needed.
• Depending on the circumstance, your pet may go home that evening or stay in the hospital.

The veterinary surgeon will be wearing a sterile cap, gown, and gloves during the procedure, as well as a mask. All of these measures help to protect your dog from infection.

As well as the surgeon, a technician will also be in the operating room to monitor your dog’s vital signs and anesthesia and to assist the veterinarian as needed.

Home Care After Dog Surgery

When you pick your dog up after surgery, you will be given a set of written discharge instructions with the details of your dog’s home care. This will include how long the vet expects healing to take, what medications need to be given when, and any special care instructions needed for recovery from his specific procedure.

Your dog will need to rest after having surgery. Set up his comfy “recovery suite” so that you can limit his activity and prevent running, jumping, and rough play with other pets until the incision has healed (this can take 10-21 days depending on the location of the incision and your dog’s overall health).

All walks during the healing period will need to be on a leash, even if you have a fenced yard. This is to prevent your dog from running and damaging the incision. Even the quietest dog can be enticed by a squirrel or stray cat running through the yard, so don’t take chances – use the leash.

Use an Elizabethan collar (cone) or body suit to protect the incision from licking, chewing, and scratching. A T shirt or shorts (good for incisions on the rear half of body) may be a suitable alternative for some dogs. Your dog should wear incision protection at all times until the sutures are removed – it only takes a second for a dog to rip open an incision, and then he will need to go back to the vet and go under anesthesia again to be sewed back up.

Make sure you have the numbers for emergency care on hand in case it is needed. It is also good to have a bottle of hydrogen peroxide and sterile gauze on hand in case the wound needs cleaning (note: hydrogen peroxide is great for cleaning blood off healthy skin, but keep it away from the incision itself as it can slow healing).

Follow the medication instructions from your vet. Pain medications and anti-nausea meds are usually more effective when given before your dog shows signs of discomfort, so don’t hesitate to give them.

And if you have questions once you get back home, don’t hesitate to call your vet! The staff will be able to answer most questions or can leave a message for the veterinarian to call you back when available.

Follow Up

You should expect a follow up appointment 1-2 weeks post op to look at the incision and remove sutures or staples.

In some cases, your vet may ask for a follow up sooner as well to look at the incision or check bloodwork. This is usually for dogs with fragile skin that the vet wants to be sure is healing, or for dogs who need frequent bloodwork checks to make sure they are responding to their medications and any other cancer treatments properly.

When to Not Do Surgery for Dog Cancer Patients

While surgery often plays an important role in cancer treatment, it is not always appropriate. Here are some situations in which you or your vet might decide that surgery is NOT appropriate:

• Surgery is generally not useful in systemic cancers like leukemia or lymphoma, because there is no centralized tumor to remove.
• It may be best to avoid surgery for terminal cancers that have already spread unless the tumor is dramatically effecting your dog’s quality of life. It may not be fair to your pet to put them through a big surgery and lengthy recovery. Vets frequently do imaging before surgery to check for any metastasis.
• If your dog has other conditions that put them at high risk for anesthetic or surgical complications it may be wise to consider if surgery is worth the risk.

Where to Get Dog Surgery

General practice veterinarians can perform surgery, but in complicated cases a surgical specialist may be needed.

Board-certified surgeons have additional training in surgery and often work at specialty hospitals. There are also traveling surgical specialists that will come to your general practice veterinarian’s office to perform the surgery there.

Safety and Side Effects

Surgery does have risks. Your veterinary team will do everything in their power to minimize risks, prevent adverse effects from happening, and treat any problems promptly, but it is good to be aware of the possibilities.

Risks of surgery include:

• Uncontrolled bleeding
• Anesthetic complications such as respiratory failure or cardiac arrest
• Incisional breakdown (incision opens back up)
• Infection
• Cancer more aggressive than anticipated, preventing a successful operation
• Dirty margins (cancer not fully removed)
• Allergic reaction
• Drug intolerance

The most common negative side effects of surgery are post-operative pain and/or drug reactions. Thankfully these issues are usually short-term and will resolve with time and appropriate medications. Chronic pain is possible after amputation or other more aggressive procedures such as a thoracotomy (opening the chest cavity).

Your veterinarian will discuss any concerns she has with you ahead of time, especially if she is concerned that your dog may not be able to survive the operation or might have trouble with anesthesia. Preanesthetic bloodwork is a great way to make sure that your dog’s liver and kidneys are functioning normally and able to clear the anesthesia from his system.

Feel free to ask questions about how the hospital monitors patients before, during, and after surgery. If you are nervous and/or have a lot of questions, either schedule an appointment to talk things over in depth, or give the veterinary staff some times that you are available so they can call you when the hospital is quiet and they aren’t running between patients. This will allow them to give you their full attention without sacrificing the needs of other patients.

Cost of Dog Surgery

The cost of surgery for dog cancer will vary greatly depending on the specific surgery. A simple tumor removal with a general practitioner may run around $700-$1500 dollars while a more complicated surgery may be closer to $4000. Specialty practice surgeries could range from $4000-$15,000 depending on the surgery, hospitalization needed, etc.

The hospital will provide you with an estimate beforehand. If finances are an issue, there are a variety of funds that help pay for cancer treatment for dogs and other strategies you can use to borrow money at low interest.