Surgery

Surgery

Early surgical techniques were radical, removing both the cancer and surrounding healthy tissue, often resulting in long recovery times, life-changing disability, and in some cases, severe cosmetic disfigurement. Today's surgical techniques and technologies are more precise with fewer complications. Women with early-stage breast cancer can now avoid disfiguring mastectomies, people with colon and rectal cancer can maintain their bowel function, and men with prostate cancer can often avoid incontinence and loss of sexual function.

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2015

More extensive surgery helps patients with early oral cancer live longer

More extensive surgery helps patients with early oral cancer live longer

A large study resolves a decades-long debate, confirming that for patients with certain types of early oral cancers, it’s better to remove both the primary tumor and nearby lymph nodes during initial surgery for oral cancer, rather than postponing lymph node removal until the cancer comes back. The study finds that performing more extensive surgery initially lowers the risk of cancer returning and extends survival. However, the study also noted this surgical approach has a higher risk of health complications, including difficulty moving the neck and shoulders and problems with talking and swallowing.

2010

Pre-surgery chemotherapy proven an effective option for women with advanced ovarian cancer

Pre-surgery chemotherapy proven an effective option for women with advanced ovarian cancer

Major European trial reports that giving chemotherapy prior to surgery (called neo-adjuvant chemotherapy) or after surgery (called adjuvant chemotherapy) is equally effective in women with advanced ovarian cancer. These results resolve long-standing debate and provide an important treatment alternative, particularly for women with larger tumors. In this group, giving chemotherapy first can shrink the tumors so that less extensive surgery is needed later on in the course of therapy.

Removing fewer lymph nodes for some breast cancer patients does not impair survival

Removing fewer lymph nodes for some breast cancer patients does not impair survival

Two large clinical trials confirm that less extensive lymph node surgery in women with early-stage disease does not reduce their likelihood of survival. Specifically, researchers find that removing additional underarm lymph nodes to look for breast cancer in women with limited or no disease spread in the "sentinel" node – where cancer is most likely to spread – does not make a significant difference in survival, compared to removing fewer nodes. Removing fewer nodes decreases the risk of side effects, such as pain and swelling in the affected arm.

2009

Preventive surgery confirmed to reduce breast and ovarian cancer risk in women with BRCA gene mutations

Preventive surgery confirmed to reduce breast and ovarian cancer risk in women with BRCA gene mutations

A major review of previously published studies confirms that surgical removal of the ovaries and fallopian tubes in healthy premenopausal women with BRCA gene mutations reduces the risk of breast cancer by 51 percent and the risk of ovarian and fallopian tube cancers by 79 percent. Among postmenopausal women with BRCA gene mutations, this surgery is found to significantly reduce the incidence of ovarian cancer but not breast cancer.

Without the surgery, women with inherited mutations in the two BRCA genes have up to an 84 percent lifetime risk of breast cancer and up to a 46 percent risk of ovarian and fallopian tube cancers. With these data, women with these mutations have a proven option for reducing their cancer risk, although it comes with many side effects (including early-onset menopause) and prevents women of child-bearing age from having children.

2008

Refined eligibility criteria for liver transplantation leads to longer survival
Minimally invasive surgery shown to be effective for cervical cancer

Minimally invasive surgery shown to be effective for cervical cancer

In a small study, researchers find that two minimally invasive techniques – laparoscopic and robotic radical hysterectomy (removal of the uterus) with radical pelvic lymphadenectomy (removal of surrounding pelvic lymph nodes) – are as effective as traditional radical hysterectomy and lymphadenectomy in women with cervical cancer. The procedures, which are performed through small incisions, are associated with less blood loss and shorter hospital stays than traditional, open surgery. While both of the new techniques had already been put into limited practice, this study provided evidence to support their widespread use.

2007

Lymph node sampling for staging is refined

Lymph node sampling for staging is refined

Researchers determine that at least 12 abdominal lymph nodes need to be removed and analyzed during colon cancer surgery to accurately determine the stage of the tumor. This study finds that the more lymph nodes that were sampled, the longer a patient lived on average following therapy. Accurate staging is necessary to identify which patients are at high risk of recurrence and are therefore candidates for adjuvant chemotherapy following surgery.

2006

Chemically "illuminating" glioma tumors during surgery postpones recurrence

Chemically "illuminating" glioma tumors during surgery postpones recurrence

The use of 5-aminolevulinic acid, a substance that reacts with and illuminates malignant glioma cells, is shown to improve surgeons' ability to remove tumor tissue. Patients treated with this technique during surgery were significantly less likely to have any tumor growth after six months, compared to those who underwent conventional surgery.

2005

Removal of additional lymph nodes shown to help improve survival

Removal of additional lymph nodes shown to help improve survival

While gastric cancer surgery had long involved removal of both the tumor and surrounding lymph nodes to prevent further spread, an open question was whether removing lymph nodes further away from the tumor – to find additional signs of cancer's spread and guide treatment decisions – could help improve survival.

In 1999, Dutch researchers initially report no survival benefit with more extensive lymph node surgery, a procedure known as D2 surgery, compared to removal of just the nearby lymph nodes (known as D1). However, longer follow-up from the same study ultimately reveals that the more extensive D2 dissection is in fact associated with fewer recurrences and gastric cancer-related deaths. Today, D2 resection is the global standard for gastric cancer surgery.

2004

Laparoscopic colon cancer surgery effective, better tolerated

Laparoscopic colon cancer surgery effective, better tolerated

A study by researchers at multiple cancer centers finds that laparoscopic surgery to remove colon tumors was as effective as conventional open abdominal surgery, and was associated with shorter hospital stays and less pain after surgery. Laparoscopic surgery involves removing the tumor through multiple small incisions and a telescoping camera device. This less-invasive approach is now widely used.

2003

Chemotherapy "wafer" active against malignant gliomas

Chemotherapy "wafer" active against malignant gliomas

Use of a surgically implanted biodegradable wafer containing the anticancer medication carmustine (BCNU) is found to delay tumor growth and improve overall survival in some patients with gliomas. The wafer provides continuous chemotherapy directly to the tumor site to kill remaining cancer cells and to prevent or slow regrowth of the cancer. Today it is used in patients with recurrent malignant glioma and newly diagnosed glioblastoma, a highly aggressive form of glioma.

2002

Chemo-embolization offers improved survival for select patients

Chemo-embolization offers improved survival for select patients

Unlike other organs, the liver has two major sources of blood supply, instead of one. For unknown reasons, cancer only develops around the lower of these arteries, the hepatic artery, and uses this blood supply to fuel its growth. Doctors have long debated whether temporarily blocking – or embolizing – this artery to starve the tumor of blood can improve overall outcomes.

In 2002, two studies show that repeatedly (every 2-6 months) injecting the chemotherapy drug doxorubicin and then embolizing the hepatic artery increases survival in a set of patients whose tumors cannot be removed surgically. However, the approach is still debated by researchers, who question its overall impact.

2000

Combination of kidney removal and immunotherapy extends life

1997

Laparoscopy provides less invasive way to assess and treat stomach tumors

Laparoscopy provides less invasive way to assess and treat stomach tumors

Researchers begin to utilize this minimally invasive surgical procedure for "staging" of gastric cancer patients. Laparoscopy is found to be roughly as effective as more invasive approaches, but requires a much smaller incision and allows an easier and shorter recovery time for patients. With laparoscopy, a surgeon inserts a thin, lighted tube through a small incision to examine the abdominal organs.

As surgeons become more adept with the technique, many patients with gastric cancer are able to be surgically treated using laparoscopy, which is far less invasive than traditional open surgery on the stomach.

Surgery found to cure some patients with advanced colorectal cancer

Surgery found to cure some patients with advanced colorectal cancer

In general, metastatic cancer is difficult or impossible to treat with surgery because tumor cells have spread throughout the body. But in a 1997 study, researchers find that some colon cancer patients with tumors that have spread to the liver alone can be cured with surgery. In a study of nearly 300 such patients who underwent surgery between 1960 and 1987, about one in four were still alive five years later, and nearly of all of these patients were found to have been essentially cured. A later study finds that use of positron emission tomography, or PET scanning, can identify some liver metastases that would have gone unnoticed before, helping surgeons in the study to achieve a cure rate above 50 percent for patients with metastatic disease.

1996

Advances in liver transplantation offer long-term survival for certain patients

Advances in liver transplantation offer long-term survival for certain patients

Disproving long-time skepticism, researchers conclusively demonstrate that liver transplantation is an effective treatment option for certain patients with cirrhosis and tumors that are confined to the liver. Specifically, investigators show that 85 percent of such patients live at least four years following the procedure. Liver transplant selection criteria are based on tumor size, the total number of tumors, and other factors, which are later refined to benefit a greater number of patients.

Sentinel lymph node biopsy introduced to assess breast cancer spread

Sentinel lymph node biopsy introduced to assess breast cancer spread

An important study establishes a technique called sentinel lymph node biopsy as a standard part of breast cancer surgery. The procedure involves removing the lymph node closest to the primary tumor – the "sentinel" node – and examining it under a microscope for evidence of cancer. If the sentinel node is cancer-free, no further lymph nodes are removed and the patient is spared the previous practice of removing a large number of nodes and possibly larger sections of the breast. This more conservative approach allows for easier recovery and reduces the risk of postoperative side effects such as lymphedema, a painful swelling of the arm. If cancer is found, additional nearby lymph nodes are assessed, and often removed, and the patient is treated with additional chemotherapy after surgery. Recently, studies have shown that for some women, removing just the sentinel node may be sufficient.

1992

Sentinel lymph node biopsy introduced to assess the spread of melanoma to nearby lymph nodes

Sentinel lymph node biopsy introduced to assess the spread of melanoma to nearby lymph nodes

A surgical technique called sentinel lymph node biopsy becomes a less invasive way to assess whether early-stage melanoma has spread to surrounding lymph nodes. The procedure involves surgically removing the lymph node(s) that receives lymph drainage from the primary tumor – the "sentinel" node – and then examining it under a microscope for evidence of cancer. If the sentinel node is cancer-free, no further lymph nodes are removed and the patient is spared the previous practice of removing multiple lymph nodes. This more conservative approach is easier on patients and reduces the risk of post-operative side effects such as lymphedema. Later studies show that results of sentinel lymph node biopsy are one of the most important predictors of risk for melanoma recurrence. This information helps doctors determine which patients should be treated more aggressively to prevent their cancer from returning.

1990

New surgical technique allows most men to maintain their sexual function, fertility

New surgical technique allows most men to maintain their sexual function, fertility

After identifying the lymph nodes where testicular cancer is most likely to spread, surgeons begin using a new surgical technique – called nerve-sparing or modified retroperitoneal lymph node dissection – to remove the cancerous testicle and the affected nodes. Whereas previous surgical techniques generally left men unable to ejaculate following surgery, this new approach spares key nerves and tissue. Over time, refinements to the approach enable 95 percent of men with testicular cancer to maintain their sexual function and fertility.

Laparoscopic surgery minimizes pain, recovery time for several cancers

Laparoscopic surgery minimizes pain, recovery time for several cancers

Beginning in the 1990s, laparoscopic surgery – in which a surgeon makes several small incisions and uses telescoping equipment to remove tumors – emerges as an alternative to traditional open surgery for some cancers, including kidney, prostate and colorectal cancer. This new approach allows patients to recover faster and experience less pain, without sacrificing effectiveness.

1989

Less extensive stomach surgery offers same chance of cure

Less extensive stomach surgery offers same chance of cure

While surgery had long been established as the only chance of cure for gastric cancer, physicians had debated whether the full stomach needed to be removed (gastrectomy) or if removing only the part of the stomach containing the tumor (partial gastrectomy) would be sufficient.

In 1989, research shows that for patients with tumors in the lower (distal) part of the stomach, partial gastrectomy combined with removal of the surrounding lymph nodes is as effective and results in fewer complications than total gastrectomy.

1988

New ultrasound device offers minimally invasive cancer evaluation and treatment tool

New ultrasound device offers minimally invasive cancer evaluation and treatment tool

Doctors begin using advanced ultrasound techniques to assess the size, depth and spread of gastric cancers. In a procedure call endoscopic ultrasound, a thin, lighted tube is passed through the patient's mouth and into the stomach. The device then uses sound waves to create an image of the inside of the stomach.

Subsequent refinements to the procedure enable doctors to obtain small tumor biopsies or even to remove early-stage gastric tumors and precancerous lesions, a process known as endoscopic mucosal resection.

1987

New surgical technique helps more men with bladder cancer maintain sexual function

New surgical technique helps more men with bladder cancer maintain sexual function

Previously, nearly all men who underwent surgery to remove their bladder also lost sexual function. But in the late 1980s, researchers map out the nerves surrounding the bladder and prostate and develop a new surgical technique that spares key nerves involved in male sexual function. As this approach is refined, as many as 80 percent of properly selected young men who undergo bladder cancer surgery are able to maintain their potency.

1985

Minimally invasive approach useful for some rectal cancers

1984

Surgical advances improve bladder cancer survival

Surgical advances improve bladder cancer survival

Researchers identify the first multi-drug chemotherapy regimen to extend survival for patients with advanced bladder cancer, offering cures in some cases. The regimen – called MVAC – involves a combination of the drugs methotrexate, vinblastine, doxorubicin, and cisplatin. Researchers later confirm that MVAC is superior to single-drug chemotherapy with cisplatin, although the combination regimen causes more side effects.

Less extensive surgery found effective for removing melanoma tumors

Less extensive surgery found effective for removing melanoma tumors

Instead of the traditional practice of surgically removing up to two inches of skin and tissue surrounding a melanoma tumor, clinical trials show that margins of three-quarters of an inch or less around the tumor are sufficient. This refinement makes recovery easier and helps reduce the cosmetic impact of surgery.

1983

Tumor ablation helps patients who cannot undergo surgery

Tumor ablation helps patients who cannot undergo surgery

A new technique called tumor ablation proves successful for shrinking and, in some cases, destroying smaller liver tumors in patients who are not eligible for surgery, due to the tumors' location or other factors. In some patients, this strategy can prevent the need for major liver surgery. With this technique, a surgeon uses an imaging device to guide administration of an anticancer treatment directly to the tumor while the patient is sedated. Initially, physicians use a technique called alcohol ablation, in which an ethanol solution is injected directly into the tumor, dehydrating and killing the cancer cells. A decade later, a new technique called radiofrequency ablation (RFA) is introduced, in which heat and intense radiofrequency waves are used to attack the cancer. RFA has since become the standard of care in this setting.

1982

New surgical approach helps preserve sexual and urinary function
Limited surgery helps rectal cancer patients avoid colostomies

Limited surgery helps rectal cancer patients avoid colostomies

A new procedure called total mesorectal excision emerges as a new standard surgical treatment for many patients with rectal cancer. The procedure involves removing only the cancerous region of the rectum, allowing patients to maintain normal bowel function. Previously, nearly all patients with rectal cancer had to undergo permanent colostomies (elimination of waste through an opening in the abdomen connected to a colostomy bag).

1980

Reconstructive bladder surgery offers improved quality of life

Reconstructive bladder surgery offers improved quality of life

Based on pioneering preliminary studies conducted as far back as the 1950s, surgeons begin to offer a “neobladder” to select patients needing surgery (cystectomy) for bladder cancer. This procedure provides a functional replacement for the bladder using tissue fashioned from the small bowel that allows the passage of urine through the urethra. This procedure is further refined over the next decade. Prior to the introduction of this procedure, patients who underwent cystectomy needed an external device to collect urine.

1978

Modification of standard surgical technique leads to fewer complications for patients with early-stage pancreatic cancer

Modification of standard surgical technique leads to fewer complications for patients with early-stage pancreatic cancer

Surgeons refine the standard surgical approach for removing pancreatic tumors, called the "Whipple" procedure. The modified pylorus (stomach)-preserving approach takes less time to perform, requires a shorter hospital stay, and results in similar survival outcomes. Patients treated with this new approach also have a lower risk of long-term side effects, which can include gastrointestinal distress, ulcers, cramping and dizziness.

1977

Removing just part of the cancerous kidney is proven safe and effective

Removing just part of the cancerous kidney is proven safe and effective

Studies indicate that some patients with early-stage malignant tumors in one or both kidneys are candidates for partial nephrectomy – surgery in which the tumor and only part of the kidney is removed, as opposed to removing the whole kidney. This refined approach revolutionizes treatment of such tumors, preserving patients' kidney function and helping many to avoid the difficult experience of long-term dialysis.

Many women can opt for breast-conserving surgery

Many women can opt for breast-conserving surgery

Studies show that a procedure called lumpectomy – involving the removal of only the tumor, and not the entire breast – followed by radiation therapy is as effective as mastectomy for women with early-stage breast cancer. The finding helps dramatically reduce the physical and cosmetic side effects of breast cancer treatment and enables women to recover more quickly after surgery and return to their normal lives.

1971

More limited mastectomy proven effective for early-stage breast cancer

More limited mastectomy proven effective for early-stage breast cancer

While radical surgery had been routinely used to treat breast cancer, a more limited surgical procedure called total mastectomy (removing just the breast tissue instead of removing the breast, chest wall muscle and underarm lymph nodes) is confirmed to be as effective for women with early-stage breast cancer. The procedure reduces pain after surgery and speeds recovery for patients. This advance paves the way for future breast-conserving surgeries.

1964

Partial liver surgery introduced

Partial liver surgery introduced

In 1957, the first comprehensive description of the liver – including the identification of its eight functional sections – is published. This new tool ushers in a new era of surgical treatment advances for liver cancer.

With a more precise understanding of the liver's anatomy, over the next two decades surgeons are able to develop and hone techniques for safely removing only specific segments and sub-segments of the liver where cancer or other disease is present while sparing healthy liver tissue – an approach that makes curative surgery possible for many patients.

1963

First liver transplant performed

First liver transplant performed

Dr. Thomas Starzl performs the first-ever liver transplants in three patients, one of them with liver cancer. Although these initial patients survive less than a month following surgery, the approach becomes far more successful as it is refined over subsequent decades. By the 1990s, liver transplantation is a standard treatment for certain patients with liver cancer, extending many patients' lives for years and sometimes leading to cure.

First evidence that surgical removal of kidney is effective for early-stage cancer

1956

Early bladder removal surgery introduced

Early bladder removal surgery introduced

Surgeons report one of the first effective techniques for surgically removing the bladder (cystectomy) and surrounding tissue where cancer is most likely to spread. While this early approach carries many risks and results in month-long hospitalizations, it lays the groundwork for many surgical advances in bladder cancer surgery.

1905

Radical hysterectomy used to treat early cervical cancers

Radical hysterectomy used to treat early cervical cancers

British surgeon Ernst Wertheim introduces a new surgical technique, the 'Wertheim radical hysterectomy,' reporting that more than 30 percent of cervical cancer patients who underwent the surgery remained free of cancer after five years. This result is considered a monumental feat for the time, despite the fact that about 15 percent of women died during the procedure. The surgery, which involves the removal of the uterus, cervix and surrounding lymph nodes through an abdominal incision, soon becomes the standard treatment for uterine and cervical cancers. Over the following decades, however, it is refined to dramatically reduce the risk of complications, improve outcomes and leave more healthy tissue intact. The highly refined approach is still used today for patients with early-stage cervical cancer.

1884

Radical mastectomy ushers in more aggressive surgical approaches for cancer

Radical mastectomy ushers in more aggressive surgical approaches for cancer

Baltimore surgeon William Halsted pioneers a new approach to removing breast tumors, radical mastectomy, in which the entire breast and the surrounding lymph nodes and chest muscles are removed. This helps reduce recurrences of the disease, which was previously nearly always fatal. Halsted's work also leads to similar approaches for other cancers, in which both the tumor and surrounding tissue are removed. These techniques are still an important part of treatment for some cancers today. For breast cancer, however, surgeries have become far more conservative and effective, enabling many women to avoid mastectomy altogether.

1881

First successful surgery performed for stomach cancer

First successful surgery performed for stomach cancer

In 1881, the Austrian physician Theodore Billroth partially removes the stomach of a 43-year old woman suffering from a gastric obstruction. Sixteen years later, Carl Schlatter takes the surgery further and completes the first total gastrectomy, or complete removal of the stomach.

For nearly a century afterward, gastrectomy remains the only treatment available for gastric cancer. While it offers a chance of cure for patients whose tumors have not spread, patients are limited to eating only small amounts of food at a time and are at risk for vitamin B deficiency, chronic low blood sugar and anemia.

1846

Advent of general anesthesia opens the door for modern cancer surgery

Advent of general anesthesia opens the door for modern cancer surgery

In October 1846, a Boston dentist named William T.G. Morton provides the first public demonstration of ether as a general anesthetic, allowing surgeons to remove a tumor from a patient's jaw without pain. This advance gains immediate and widespread attention, ultimately eliminating the excruciating pain experienced by surgical patients until that time, and making the modern era of surgery possible.