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cancer surgery

Indications: - malignant neoplasm susceptible to resection Procedure: - care take to prevent seeding of metastases - mass spectrometry-assisted surgery [2] (intelligent knife) - handheld diathermy device is applied to tissue to create a small 'surgical aerosol' of compounds that is transferred through a suction tube to a mass spectrometer - the mass spectrometry patterns (particularly lipid metabolite analysis) distinguish different types of tissue with 100% sensitivity & specificity [2] Complications: - relative risk of cancer deaths exceeds that of noncancer deaths for older adults after cancer surgery [3] - no increase in risk of noncancer death early after cancer surgery [3] Comparative biology: - inflammation during wound healing after surgery may disrupt ability of T-cells to keep metastasing tumor cells in check - anti-inflammatory treatment reduces metastasis in mice [1] Notes: - no benefit of perioperative palliative care surgical for newly diagnosed cancer patients scheduled for curative surgery [4] - perioperative palliative care may be better reserved for frail elderly

General

surgery

References

  1. Krall JA, Reinhardt F, Mercury OA et al. The systemic response to surgery triggers the outgrowth of distant immune-controlled tumors in mouse models of dormancy. Sci Transl Med 2018 Apr 11; 10:3464. PMID: 29643230 http://stm.sciencemag.org/content/10/436/eaan3464
  2. Tzafetas M, Mitra A, Paraskevaidi M et al. The intelligent knife (iKnife) and its intraoperative diagnostic advantage for the treatment of cervical disease. Proc Natl Acad Sci U S A 2020 Mar 31; 117:7338 PMID: 32179675 Free PMC Article https://www.pnas.org/content/117/13/7338
  3. Chesney TR, Coburn N, Mahar AL et al All-Cause and Cancer-Specific Death of Older Adults Following Surgery for Cancer. JAMA Surg. 2021;156(7):e211425 PMID: 33978695 PMCID: PMC8117065 (available on 2022-05-12) https://jamanetwork.com/journals/jamasurgery/fullarticle/2779970
  4. Aslakson RA, Rickerson E, Fahy B et al Effect of Perioperative Palliative Care on Health-Related Quality of Life Among Patients Undergoing Surgery for Cancer. A Randomized Clinical Trial. JAMA Netw Open. 2023;6(5):e2314660. PMID: 37256623 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2805450 - Haas B, Rubenfeld GD Early Palliative Care Consultation Before High-risk Surgery. JAMA Netw Open. 2023;6(5):e2314627. PMID: 37256628 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2805455