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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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

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.

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.

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.