Extreme surgery for advanced cancer: Do patients benefit?
Advanced cancer that has spread beyond the organ where it started can be very difficult to treat. Certain cancers that start in the abdomen in organs including the intestines, bladder, cervix, uterus, or prostate, may be able to spread throughout the abdominal area.
In severe cases, where initial surgeries, radiation, and chemotherapy have not been able to wipe out the cancer, an extreme type of surgery might be suggested. For these runaway cancers, a surgery called Total Pelvic Exenteration (TPE) can offer a chance to rid the body of the places where tumors have spread and started to grow.
Total Pelvic Exenteration (TPE) is a complicated surgery that involves the removal of all of the organs of the lower abdomen, including parts of the reproductive, urinary, and digestive systems. This dramatic surgery is only performed when all other treatments have failed to stop the spread of cancer. Although this type of surgery has been performed for many decades, there was not a national scale study to look at the results for patients across all of the relevant cancer types, until now.
To determine the outcomes from TPE surgery, Dr. Hari Vigneswaran, Resident Physician at the University of Illinois Chicago, and a team of physician-scientists, looked at results from over 2,300 patients to find out if these patients had positive outcomes.
Their published results show that the 30-day mortality was only 2%, meaning that the overwhelming majority of patients made it through the surgery and recovery period. Another finding was that 15% suffered major complications. This statistic is important because is reveals a way to improve the benefits of this surgery for patients. Specifically, medical complications could be reduced by improving patient care after the surgery.
Their study suggested that enhanced recovery after surgery (ERAS) protocols, multidisciplinary approaches involving surgeons, nurses, and anesthesiologists, might be key to reducing complications and improving results.
So, can patients with advanced cancer benefit from extreme surgery, like TPE?
The numbers show 98% survival, and 85% of patients do not have serious complication. If the benefit is wiping out a stubborn cancer, that seems to outweigh the risks. Also, if hospitals can continue to improve recovery plans, that could decrease the serious complications even more.
The female and male pelvis, rendered by Creative Director, Isabel Romero Calvo, MS, PhD, illustrates cross sections showing the anterior (front) and posterior (back) organs of the pelvic area. The organs shown may be removed during Total Pelvic Exenteration (TPE), an aggressive surgery to treat certain advanced cancers.