Cancer Surgery - Science topic

Dear colleagues,

We would be grateful if you could fill up a short survey on pre-habilitation in oesophago-gastric cancer surgery.

Your help is much appreciated.

The numbers of elderly patients with oral cavity cancer is expected to increase in the future. Nowadays, surgery is the therapeutic mainstay for oral cancer. However, many elderly patients may not be considered as candidates for aggressive treatment. How old is the patient that is not recommended for oral cancer surgery?

The coronavirus pandemic has affected every aspect of our lives, I have seen a dramatic reduction in the number of cancer surgeries that we performed weekly. When the pandemic passes, will cancer mortality also increase exponentially?

What's the verdict on regional analgesia in breast surgery?

Is there any need to use it at all?

The 2018 Cochrane review concluded that synthesis of 18 RCTs favoured regional anaesthesia for the prevention of persistent pain three to 12 months after breast cancer surgery with an OR of 0.43 (95% CI 0.28 to 0.68, 1297 participants, low‐quality evidence).

However, the recent 11-year RCT published in the Lancet 2019 with 2132 patients across 13 hospitals internationally showed there was no difference in incisional pain:

Incisional pain was reported by 442 (52%) of 856 patients assigned to regional anaesthesia-analgesia and 456 (52%) of 872 patients allocated to general anaesthesia at 6 months, and by 239 (28%) of 854 patients and 232 (27%) of 852 patients, respectively, at 12 months (overall interim-adjusted odds ratio 1·00, 95% CI 0·85-1·17; p=0·99). Neuropathic breast pain did not differ by anaesthetic technique and was reported by 87 (10%) of 859 patients assigned to regional anaesthesia-analgesia and 89 (10%) of 870 patients allocated to general anaesthesia at 6 months, and by 57 (7%) of 857 patients and 57 (7%) of 854 patients, respectively, at 12 months.

If it doesn't reduce chronic post surgical pain, is there any point in using it?

(Note: these studies involved paravertebral regional analgesia)

Surgical plume or smoke are produced by use of electrocautery, laser and high energy devices during surgery. They may contain toxic materials including bacteria, virus and viable cancer cells. Inhalation of these fine particles may spread diseases to surgeons and other health care workers. It is still controversial. But it is a real possibility. Are there any definite evidence available? Any one can explain or provide any evidence.

A milestone by Theodor Billroth in surgery and cancer surgery.

It is

- the 139th anniversary day (Jan 29, 1881)

performed

the first successful distal gastrectomy

for gastric cancer within 90 min

However, we may should be aware that everything in medicine surgery cancersurgery science needs teamwork

We are nothing without the Team!

I'm working on breast cancer surgery, and I'm going to estimate wound healing process time in different groups after breast cancer surgery. Here I want to know the parameters that are required to estimate the time. Based on which parameters we can able to confirm the healing time as delayed.

Transhiatal esophagectomy was championed by American Dr. Orringer since 1976. The issues were: inadequate field exposure; inadequacy of node clearance, use of blind & blunt dissection & (rarely) azygos vein tear. Benefits: avoiding thoracotomy and all the morbidity associated with it.

So, what is the current opinion?

What is the Difference between decompression and defunctioning

For example :

loop iliostomy

According to the Mayo clinic research, is laparoscopy the gold standard for colon/rectal cancer surgery? what is your approach regarding colonic neoplasia, right of left side or rectal cancer, there is any place for laparoscopy in your practice?

thank you for give me the full article"Disrupted sleep before gynecologic cancer surgery and increased postoperative pain"

Please share your personal vision of developments in glioblastoma therapy within the next decade. Do you feel that meaningful refinements of surgical technique, operating room technology and radiation therapy are still possible? Will immunotherapy, targeted therapy, drug cocktails or modifications of the blood-brain barrier play a more important role? Or will we still be using temozolomide as the mainstay of treatment? Thank you very much for your opinions.

indication of perctaneous tracheostomy 

In patients with operable breast cancer, mastectomy and axillary clearance is the role in most cases in our country?

Does the use of Harmonic shear provide advantages over electrocautery dissection?

A thorough review, congratulations. I am particularly interested in patient's motives for adjuvant chemotherapy. From the fact that the minimum absolute increase in survival that participants considered sufficient to make an adjuvant chemotherapy (aCT) worthwhile ranged from 0.1% to 7%, i.e. a factor 70, one might conclude that a good many participants took this decision purely driven by emotions. A sizable portion even seemed to accept (have accepted) for little or no benefit. This I find very disturbing, much more disturbing than what you called disturbing, i.e. that expectancy of better survival was a driving factor in patients who preferred MAST over BCS. MAST and BCS have the same (very low) operative low mortality and morbidity (excluding psychic effects of grade of mutilation). This cannot be said of aCT compared to no-aCT. Most patients have been familiarized more or less with loss of hair and other conspicuous complications of aCT, but do not know that people die from aCT and many of them months or even years earlier than they would have without it. They do not know how aCT might drive you sick to death, how deeply tired people may feel after this treatment and so forth. Many chemotherapists sell aCT still as a kind of security: “You probably have been cured anyway by your surgery but in case there still are some cancer cells left, this cure [a misleading term] will take care of them”. Sounds irresistible, doesn’t it? When doctors are prepared to give their patients more insight they frequently do not use absolute but relative percentage numbers that of course are much higher and thus misleading as well. So, in my mind all your recommendations listed under the heading “Clinical implications” should be taken to heart by all doctors who treat patients with cancer.

Measuring 'quality' in surgery has become important, as its only with measuring 'quality' that we can begin to make improvements in care.   Various measures have been suggested, such as 

Mortality

Length of stay

Reoperation rate

Readmission rate

Intra-operative injury rate (for example CBD injury / ureteric injury)

Rate of laparoscopic surgery

Rates of conversion to open surgery

to be measured to compare quality in surgery specifically.

Lots of these factors can vary naturally, with a hospitals patient population (rich, poor, age group, comorbidities, hospital size, urban, rural, delays in presentation, access to healthcare etc) and other factors such as surgeon training / experience etc and many other reasons.    So variability in these factors is to be expected.

What makes a good 'quality marker' in surgery?

Your thoughts would be appreciated. 

All the best

Ewen

Thanks in advance.

This year ISEF competition was won by 15-year old boy for his method for detection of mesothelin which is associated with early diagnosis of pancreatic cancer:

Many experts believe rectal washout to be a measure that reduces implantation of intraluminal shed tumor cells and thus results in decreased anastomotic recurrence. Do you think rectal washout is effective and how do you perform it, in particular:

- Timing, whether at beginning of surgery or just before resection.

- Whether performed after clamping distal to tumor or not.

- Washout agent used, betadine, chlorhexidine or water.

We have recently re-examined this question for Mesothelioma surgery in Thorax.

Intraperitoneal chemotherapy has beneficial effects in gastric cancer and is widely used but a form of readily available and cheap chemotherapy to reduce peritoneal mets is on demand .