When surgery is the customary, or in extreme cases, the only salvage procedure available for a patient, there are many factors which determine if it can actually be done or not. If it is the usual procedure, it may not be done for reasons of tumor location for instance, accessibility can be an issue. It might also not be chosen because the mass of tissues which would have to be resected/removed is just too large, and the structural devastation to the patient is too extreme to consider. They would therefore choose an alternative treatment, say radiation. But in patients who have already had radiation, we are now down to surgery and chemo. In many head and neck, and particularly oral cancers, chemo has not proven to be an effective, definitive treatment to eradicate the disease completely, leaving surgery as an only option. But surgery can only be done if the area to be removed is small enough, and the loss of vital structures nearby are not also destroyed in the process. Usually when a doctor says something is not resectable he means that surgery would not yield the end results that are desired, or that the procedure itself would be too destructive to subject the patient to. Advanced head and neck cancers can fall into this realm. That is why you read so often here that the doctors are using radiation or chemo to reduce the size of the tumor so that it can be surgically dealt with afterwards. I had radiation first then surgery. This is in many cases considered backwards, but the physical damage from a surgical removal was going to be significant, and they did the rad first to get things down to a manageable size. When I had received the maximum dosage of radiation that my spinal column could take, they finally did the neck dissection to clean up the loose ends that were still around.

If a patient finds himself or herself in this situation, with an unresectable mass that has to be dealt with, many times it is best to consider clinical trials of new experimental or trial drugs to bring things under control. This becomes the patient