Teaching pack: Surgery & Interventional

Surgery cures more cancers than any other modality. Advances are in precision (robotics, fluorescence guidance, intraoperative margin assessment), de-escalation (less surgery when systemic therapy has done the work), and minimally invasive ablation (radiofrequency, microwave, cryo, HIFU, irreversible electroporation).

• Active surveillance: For low-risk prostate cancer, monitoring with PSA, MRI, and repeat biopsy instead of treating, because most such cancers never cause harm.
• Active surveillance of papillary microcarcinoma: Watching very small papillary thyroid cancers with ultrasound instead of operating, because most never grow and almost none cause harm.
• Bariatric surgery and cancer incidence: People with severe obesity who have weight-loss surgery develop about a third fewer cancers over the following decade, especially womb and other hormone-related cancers, than similar people who do not.
• Biliary stenting and drainage: A small tube placed by endoscope or through the skin reopens a blocked bile duct, relieving jaundice so chemotherapy can be given.
• Colposcopy and excisional treatment (LEEP/LLETZ, cone): Looking at the cervix with a magnifier after a positive screen, then removing the abnormal patch with an electric wire loop in a clinic visit.
• Cystoscopy, blue-light imaging & TURBT: Cystoscopy and TURBT mean looking inside the bladder with a camera and shaving off tumours through the urethra. Blue-light dyes make flat tumours easier to see.
• Electrochemotherapy: Brief electric pulses applied to a tumour open pores in cell membranes so that a tiny dose of bleomycin or cisplatin floods in; used for skin metastases and, increasingly, for deep tumours.
• Endoscopic resection (EMR / ESD): Removing very early cancers of the oesophagus or stomach from the inside with an endoscope, so the organ is kept intact.
• Enhanced recovery (ERAS) and perioperative nutrition: Instead of starving patients before and after an operation, modern surgical pathways feed them early, give carbohydrate drinks the night before, and get them walking the next day. Complications and hospital stays fall.
• Extended pleurectomy/decortication & radical mesothelioma surgery: Pleurectomy and decortication are operations that strip the tumour-bearing lining from the lung and chest wall. They were long assumed to help; the MARS 2 trial showed they do not.

• DESKTOP III / ENGOT-ov20 (phase 3, n=407): Overall survival: 53.7 months vs 46 months, HR 0.75
• SANO (phase 3, n=274): Overall survival at 2 years (non-inferiority): pending
• OVHIPEC-1 (phase 3, n=245): Overall survival: 45.7 months vs 33.9 months, HR 0.67
• MSLT-II (phase 3, n=1,939): Melanoma-specific survival at 3 years: 86% vs 86%
• EMERALD-3 (phase 3, n=725): Progression-free survival: pending
• EMERALD-1 (phase 3, n=616): Progression-free survival: 15 months vs 8.2 months, HR 0.77