A recently published study has compared a new surgical method, called cancer field surgery (Total Mesometrial Resection, TMMR), with the current standard treatment for primary management of cervical cancer.
The new TMMR method was developed over 20 years ago by Karolinska Institutet’s partners at the Leipzig University Hospital. Previous publications have suggested favourable results without the need for radiation therapy. Omitting radiation therapy could potentially improve quality of life for treated women.
In the study, the researchers demonstrate that TMMR is associated with improved oncological outcomes for early stages of cervical cancer. The data suggest that TMMR may replace current treatment strategies and radiation therapy could be spared for salvage treatment. This breakthrough motivates continued work in this field.
Research of this kind heavily relies on well-functioning collaborations with other researchers. Beyond providing essential data for the project, it also strengthens international cooperation, facilitating the dissemination of our findings. The researchers plan to further explore the potential of cancer field surgery in gynaecological cancer to establish the method in future treatment strategies.
The survival of patients with breast, pancreatic and certain other cancers could be extended if given the anti-nausea drug dexamethasone during surgery.
A drug with an already great range of uses including COVID treatment, dexamethasone is given to patients to prevent nausea and vomiting after surgery and during chemotherapy. Researchers found dexamethasone can improve mid- to long-term outcomes in patients with non-immunogenic cancers (those that don’t provoke a strong immune response) such as sarcoma and cancers of the breast, uterus, ovary, esophagus, pancreas, thyroid, bones and joints.
“Dexamethasone has positive and negative effects – it inhibits cancer growth, but also suppresses the immune system,” said senior author Maximilian Schaefer, MD, PhD. “Previous research has reported that in cancers in which the immune system controls cancer growth, the positive and negative effects of dexamethasone balance each other, so there is no benefit. Ours is the first large study to show that for a wide variety of cancers where the immune system does not play a major role, the positive effects seem to predominate.”
Researchers analysed the records of over 74 000 patients who had surgeries to remove non-immunogenic cancerous tumours, about a third of whom received dexamethasone during surgery. After 90 days, 209 (0.83%) of the patients who had received dexamethasone died vs 1543 (3.2%) of patients without the drug.
After accounting for confounding factors, including that dexamethasone is often administered to younger patients, there was still a 21% reduced risk of dying within one year after surgery for those who received the drug. It was also shown to be particularly beneficial for patients with cancers of the ovary, uterus or cervix.
“Based on our data, physician anesthesiologists should feel more confident in administering dexamethasone to patients undergoing surgery for non-immunogenic cancers,” said Dr Schaefer. “It not only helps with nausea, but it also may result in improved survival.”
One in seven cancer patients around the world have missed out on potentially life-saving operations during COVID lockdowns, according to a new study led by the University of Birmingham.
Planned cancer surgery was impacted by lockdowns regardless of the local COVID rates at that time, especially in lower income countries. Though lockdowns have protected the public from COVID, they have had collateral impact on care for other patients and health conditions. Researchers in this study showed that lockdowns resulted in significant delays for cancer surgery and potentially more cancer deaths.
Researchers are calling for major global reorganisation during the pandemic recovery to provide protected elective surgical pathways and critical care beds that will allow surgery to continue safely, as well as investment in ‘surge’ capacity for future public health emergencies.
‘Ring-fenced’ intensive care beds would support patients with other health conditions and those with advanced disease (who are most at risk from delays) to undergo timely surgery. Investment in staffing and infrastructure for emergency care would mitigate against disruption of elective services.
The COVIDSurg Collaborative involved 5000 surgeons and anaesthetists around the world working together as part of the to analyse data from the 15 most common solid cancer types in 20 000 patients in 61 countries. The findings were reported in The Lancet Oncology.
The researchers compared cancellations and delays before cancer surgery during lockdowns to those during times with light restrictions. During full lockdowns, one in seven patients (15%) did not receive their planned operation after a median of 5.3 months from diagnosis – all with a COVID related reason for non-operation. However, during light restriction periods, the non-operation rate was very low (0.6%).
Patients awaiting surgery for longer than six weeks during full lockdown were less likely to have their planned cancer surgery. Frail patients, those with advanced cancer, and those waiting surgery in lower-middle income countries were all less likely to have the cancer operation they urgently needed.
Researchers analysed data from adult patients suffering from cancer types including colorectal, oesophageal, gastric, head and neck, thoracic, liver, pancreatic, prostate, bladder, renal, gynaecological, breast, soft-tissue sarcoma, bony sarcoma, and intracranial malignancies.
Lockdowns directly impact hospital procedures and planning, as health systems change to reflect stringent government policies restricting movement. The researchers found that full and moderate lockdowns independently raised the likelihood of non-operation after adjustment for local COVID case notification rates. They hope that this information will help guide future lockdowns and restrictions by governments.
