Surgeons' News Editor John Duncan writes; the President’s Meeting heard from specialists about numerous aspects of oncology care, including new possibilities in individually tailored treatments that could bring a dramatic shift in the battle against cancer.
Half of the population born after 1960 will be diagnosed with cancer during their lifetime. Cancer prevention and cancer treatment are, therefore, important to us as individuals as well as professionals. Surgeons have been talking about modern cancer care for centuries. Joseph Lister and William Halsted, performing radical mastectomy 150 years ago, were providing modern cancer care for that time. During my training, controversy surrounded the use of conservation surgery in breast cancer that now would be regarded as standard care. In modern practice, the issues relate to the individualisation of treatment for patients, and the possibility of using genomics or tailored immunotherapy to radically improve cancer outcomes. Determining the optimal size for cancer treatment units to enable both access to care and optimal outcomes for patients remains an issue. The President’s Meeting programme addressed these subjects.
Against: Tom Treasure Professor of Cardiothoracic Surgery, University College London (pictured left)
For: Graeme Poston Professor of Surgery, University of Liverpool, and Consultant Hepatobiliary Surgeon, Aintree University Hospital, Liverpool (pictured right)
The case against
Surgeons should only recommend procedures that meet the accepted standards of evidence. By these standards, metastasectomy is not proven because the only evidence is from observational data – there are no randomised controlled trials (RCTs). The selected patients had characteristics associated with better survival: few metastases, long disease-free interval and response to chemotherapy. This is not a single assessment, but is made over months. Progression excludes further patients, so inherent likelihood of survival is itself a confounding factor in survival analysis.
A summary of Professor Timothy J Eberlein’s McKeown Lecture on delivering high-quality oncology treatments in 2015
These are challenging times for cancer research, with declining cancer funding and fewer cancer specialists per capita. However, we are on the cusp of redefining the way we think of cancer care and research. This is due to the explosive growth of technology in the field of genomics.
After 40 years serving in the NHS, Mr Rami Seth (pictured) gained a deeper understanding of healthcare when he received devastating news
I was enjoying my retirement in 2004 when I had painless hematuria, which ended up with my right kidney and ureter being taken out. Unfortunately, a year later I had metastases in my liver in four places, and the inferior vena cava was also invaded through the caudate lobe. I knew it was inoperable, and my colleagues and a second opinion confirmed this. I had a course of interferon, which fortunately worked and my tumours shrank. A surgeon at St James’s Hospital in Leeds also removed part of my liver and explored my inferior vena cava. Then, in 2008, I had metastases in my right lung, which was removed. In 2009, I had a tumour in my other lung, which turned out to be a primary carcinoid. I have now been free of cancer for more than five years and it’s wonderful to be alive every day.
Four specialty sessions covered treatment for a range of cancers from vascular oncology to bone sarcomas
BOA, SCTS and Vascular Society Chaired by Mr Alastair Gibson and Mr Robert R Jeffrey
Belfast-based vascular surgeon Mr Bernard Lee presented interesting data regarding the treatment of retroperitoneal sarcoma on behalf of the Vascular Society. He emphasised the importance of complete tumour excision, stating reported five-year survival of less than 30%. He said it was rare for radiological characteristics to lead to a specific tissue diagnosis. Clinical outcomes from treatment strongly correlated with both the quality of surgical excision and whether treatment was undertaken at a specialist centre. Indeed, 30-day mortality at a low-volume centre was reported as being twice that at a high-volume centre. He emphasised the importance of a tissue-based network organisation.