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Research in cancer surgery
Research in cancer surgery involves comparing surgical techniques, developing new surgical technology and studying quality of life after surgery. Researchers in cancer surgery try to answer key questions to help improve outcomes after surgery:
- How much tissue should be removed?
- When should we do the surgery?
- Which candidates, based on their health and fitness, can safely have surgery?
- What are the side effects and outcomes of surgery?
- How can surgery be used in combination with other treatments to improve outcomes?
Research in cancer surgery is about more than just treating cancer. Surgery can be used to:
- help prevent cancer by removing precancerous tissue
- improve quality of life
- reconstruct tissue to improve appearance and function after a previous surgery or other treatments
- help lessen symptoms caused by growing tumours that can’t be completely removed or cured
Robotic surgery and hand-assisted endoscopic surgery are 2 of the latest surgery trends used to treat cancer. Both are types of minimally invasive surgery. Minimally invasive surgery is done through small surgical cuts (incisions) instead of one large opening. Research has shown that people who have minimally invasive surgery have less pain, recover more quickly, have shorter hospital stays and have less scarring than those who have an open surgery using one large surgical cut.
Robotic surgery is often done by laparoscopy or thoracoscopy through 5 to 6 small surgical cuts (incisions). But robotic surgery can also be done through the mouth (called transoral robotic surgery) and other small openings in the body.
In robotic surgery, the doctor removes tissue while sitting at a computer station close to the operating table. At the computer station there is a monitor with live video and the doctor uses controls to move 2 or 3 robotic arms that are connected to surgical instruments.
The instruments used in robotic surgery are very advanced. They can twist and turn as if they were a person’s hand and wrist and fit into very small spaces. Like a standard laparoscopic surgery, the laparoscope used in robotic surgery also has a special HD camera that gives doctors a magnified 3D view of the area they are operating on. Robotic surgery can help doctors more accurately remove tissue, dissect cancerous tissue from surrounding tissue and stitch (suture) tissue together more easily than standard laparoscopy.
The main advantage of robotic surgery over regular laparoscopic surgery involves surgery where something is removed and a new connection is needed. Robotic surgery greatly simplifies stitching of the new connection. The cancer cure rates following robotic surgery are the same as open or laparoscopic surgery.
One drawback of robotic surgery is that doctors can’t feel the structures that they are operating on. They have to operate using information from what they see rather than what they see and feel.
Robotic surgery is also called robot-assisted laparoscopic surgery or computer-assisted surgery.
Robotic surgery has been most often studied in men with prostate cancer. Researchers are also studying robotic surgery to treat these cancers:
- adrenal gland
- fallopian tube
- liver, including both cancer that starts in the liver and cancer that has spread to the liver
Some groups of lymph nodes can also be removed by robotic surgery including ones in the armpit (axillary), back of the abdomen (retroperitoneal) and the chest (mediastinal). Researchers are also using robotic surgery techniques to perform biopsies.
Robotic surgery is only available in a few treatment centres in Canada.
Hand-assisted endoscopic surgery
Hand-assisted endoscopic surgery is a procedure done through several small surgical cuts (incisions) using a laparoscope or thoracoscope. But one of the cuts is large enough (about 5 or 6 cm) to allow the surgeon’s hand to pass through the opening. This allows the surgeon to feel with their hands while using endoscopic tools. Hand-assisted endoscopic surgery can be used to remove tissue that is more than 5 cm in size. This surgery seems to have the same benefits as laparoscopic surgery over standard surgery, including less pain, less blood loss, shorter operating time and shorter hospital stay.
Hand-assisted endoscopic surgery is a surgical treatment option for some types of cancer including colon, stomach, esophageal, prostate and kidney cancers.
Irreversible electroporation (IRE)
Irreversible electroporation (IRE) uses an electrical current to make tiny holes in the cell membrane. This causes a cell to die. IRE is a type of ablation therapy to destroy tissue and is also known by the name Nanoknife.
The procedure is done using a general anesthetic. Needles with electrodes are inserted through the skin and into the tumour. Sometimes surgery may be used to place electrodes for tumours that are deeper in the body.
Researchers are studying IRE to treat pancreatic, liver, prostate, lung, head and neck, and kidney cancers. These cancers may be difficult to remove with surgery, or sometimes they are close to important structures that other types of ablation therapies may damage. Researchers are also looking at whether IRE can make chemotherapy work better by helping chemotherapy drugs get inside cancer cells.
A procedure that uses an endoscope (a thin, tube-like instrument with a light and lens) to examine or treat organs inside the abdomen and pelvis.
Cells or tissue may be removed for examination under a microscope. Doctors may also use laparoscopy to perform different surgical procedures in the abdomen and pelvis.
The type of endoscope used for this procedure is called a laparoscope.
A procedure that uses an endoscope (a thin, tube-like instrument with a light and lens) to examine or treat organs inside the thorax (chest).
Cells, tissue or small portions of the organs inside the chest may be removed for examination under a microscope.
The type of endoscope used for this procedure is called a thoracoscope.
I’m extremely grateful to the Canadian Cancer Society for funding my research with an Innovation Grant.
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