Category: Surgeries & Procedures

Categories : Obstetrics & Gynaecology Surgeries & ProceduresTags :

“Two-for-one” C-section and Tummy Tuck Idea Alarms Surgeons

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Photo by Jonathan Borba on Unsplash

The ‘mommy makeover’ is trending, and a growing number of patients are now asking whether cosmetic procedures such as a tummy tuck, liposuction, or breast augmentation can be performed at the same time as a Caesarean section. But surgeons warn that combining elective cosmetic surgery with a C-section can sharply escalate risk during an already vulnerable period for the body.

Professor Chrysis Sofianos, a triple-board certified plastic surgeon and Academic Head of the Division of Plastic and Restorative Surgery at the University of the Witwatersrand, says procedures such as a tummy tuck should only be considered once the body has adequately recovered after childbirth – typically around six months after delivery, depending on individual healing.

“Our practice is seeing a growing number of patients ask whether body-contouring surgery can be performed while they are already in theatre for a C-section. But this reflects a dangerous misunderstanding of surgical safety and postpartum physiology.

“While the idea may appear efficient or financially attractive, pairing medically necessary obstetric surgery with elective cosmetic procedures significantly increases operative risk at a time when the patient is physiologically vulnerable.”

Combining surgeries and compounding risks

C-sections account for around 75% of private sector hospital births in South Africa. Professor Sofianos notes that because there is often an overlap between women accessing private medical care and those who may later consider elective cosmetic procedures, more patients are likely to ask whether these operations can be combined.

“However, the more important question is whether they should. And the simple answer is no,” he says. “A C-section is already a major abdominal operation. Introducing additional surgical trauma before the body has recovered would introduce excessive strain and substantially raise the risk of complications.”

Pregnancy and the immediate postpartum period are associated with a hypercoagulable state, meaning the blood has an increased tendency to clot. Postpartum women therefore face a markedly elevated risk of venous thromboembolism, particularly in the first six weeks after delivery. Prolonging operative time and increasing tissue disruption may further elevate this risk by contributing to immobility, tissue stress, and inflammatory response.

A C-section on its own carries recognised complications, including haemorrhage, infection, anaesthetic complications, and clotting risk. Adding abdominoplasty (tummy tuck) can introduce additional risks such as bleeding, fluid accumulation, wound breakdown, delayed healing, and blood clots.

Liposuction also introduces risks, such as fluid imbalance, internal injury, infection, and, in rare but serious cases, fat embolism – a potentially life-threatening condition in which fat enters the bloodstream and compromises vital organs.

The false economy of combining procedures

Professor Sofianos also notes that combining procedures rarely provides the financial or practical advantages patients may assume.

“There is a common a misconception that theatre and anaesthetic fees can be consolidated if surgeries are combined into a single session. In reality, longer operative times, greater monitoring requirements, and the potential for complications may result in far higher medical costs. More importantly, financial reasoning should never supersede patient safety.”

He adds that the combined recovery period can also be far more demanding than patients anticipate.

“Recovery after a C-section already places significant physical, emotional, and psychological demands on a new mother. Adding major cosmetic surgery to that recovery period can complicate mobility, wound care, and pain management at a time when the patient must also care for a newborn.

“A more intensive recovery process may further require extended postoperative care, closer medical oversight, and additional support at home, all of which can add to the existing financial burden.”

Finally, he warns that operating during the immediate postpartum period might not produce the optimal long-term aesthetic result a patient may be looking for, and could expose them to unnecessary revision surgery later.

“Medically and ethically, I do not believe combined C-section and ‘mommy makeover’ surgeries should ever be considered. No responsible surgeon should minimise the compounded risks associated with performing such procedures. Ultimately, safe, staged care remains the gold standard for medical care, or allowing the body to recover fully before elective cosmetic surgery is undertaken.”

Categories : Mental Health Surgeries & ProceduresTags :

Mental Health Issues Before Surgery can Affect Memory and Cognition

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Photo by JD Mason on Unsplash

Depression and other psychological factors may be linked to the risk of postoperative confusion in older adults. This is shown in a new systematic review from Karolinska Institutet, published in the British Journal of Anaesthesia. The study summarises results from more than 6700 patients.

Older individuals undergoing surgery face an increased risk of developing cognitive complications, such as postoperative delirium. Delirium is characterised by sudden changes in attention and awareness, and can lead to longer hospital stays and reduced functioning. The new study analyses 30 previously published works in which researchers examined whether preoperative psychological factors, such as depression, anxiety, stress, and personality traits, may influence these complications.

Depression most common

The review identified four groups of psychological factors. Depression was the most common and appeared in nearly all studies. In the statistical meta-analysis, no clear association between depression and delirium was observed, but when the researchers used alternative statistical synthesis methods, they found evidence suggesting that psychological factors play a role.

“Our results show that depression is the most consistently reported psychological risk factor, even though the pooled statistical analyses did not demonstrate a significant effect,” says Anahita Amirpour, PhD at the Department of Neurobiology, Care Sciences and Society.
“At the same time, we saw that anxiety, stress, and personality traits may also play a role, although the research base there is more limited.”

Postoperative delirium

In total, the study included 6714 patients from 16 different countries. Postoperative delirium was the most common outcome measure and occurred in between 9 and 55% of patients, depending on the study. Very few studies examined other cognitive complications, such as long-term effects on memory and attention.

The researchers emphasise that the results should be interpreted with caution. Many of the included studies varied greatly in how they measured both psychological factors and cognitive outcomes, and only two studies examined time periods extending beyond the immediate postoperative phase.

Source: Karolinska Institutet

Categories : Surgeries & ProceduresTags :

High-risk Patients Account for 80% of Post-Surgery Deaths

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Photo by Natanael Melchor on Unsplash

A major new study, led by Queen Mary University of London and funded by the National Institute for Health and Care Research (NIHR) has been published in The Lancet Public Health. It found that out of the five million surgical procedures performed each year by the NHS, around 300 000 are carried out on individuals considered high-risk, and within 90 days of surgery, these high-risk patients account for:  

  • four out of five deaths
  • over half of all hospital bed days 
  • nearly one-third of emergency readmissions 

While surgery is safer than ever for most people and remains the best treatment option for many conditions, this study highlights the urgent need to identify high-risk patients earlier, to provide care that is better tailored to their individual needs, and for doctors and patients to have more open, honest conversations about the risks and long-term outcomes for surgery at an individual level.  

It also shows that high-risk patients, who tend to be older and live with several long-term health conditions such as heart disease, have poor outcomes not because of technical failings in surgery or anaesthesia, but due to post-operative complications relating to chronic health conditions, age and frailty. Therefore, the findings demonstrate the need for greater investment in specialist perioperative services that focus on the care of older, high-risk patients before, during and after surgery. 

Rupert Pearse, Professor and Consultant in Intensive Care Medicine at Queen Mary University of London and Barts Health NHS Trust, and co-lead of the study said: “While surgery is safer than ever before, our findings clearly show that high-risk patients are more likely to have poor outcomes and experience harm after surgery than those deemed low-risk.  

“Although these patients make up fewer than one in ten surgical cases, their numbers are increasing as the population ages and more people live longer with chronic illness. It is therefore vital that we work to improve care for this group of patients, pre- and post-surgery, including having open conversations with patients about the individual risk of their procedure.”

He continues: “For many years, surgical success has often been judged by survival at thirty days. Our study shows that this measure does not give the full picture of what happens to many high-risk patients in the months and years after surgery. By looking at longer-term survival and other factors such as time spent in hospital and quality of life, we could make a real difference to patients and potentially help relieve pressure on the wider NHS.” 

The study is one of the largest analyses of surgical outcomes ever carried out in the UK. It analysed health records from 13 million adults who had 16.1 million surgical procedures in England, Scotland and Wales between 2015 and 2019. 

Source: Queen Mary University of London

Categories : Neurology Surgeries & ProceduresTags :

Making Neurosurgeons Even Better at Removing Brain Tumours

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In a leap for personalised medicine, scientists have discovered a simple and valuable way to improve brain cancer surgeries.

Taylor Furst, MD, observes a brain mapping procedure in progress at the University of Rochester’s Strong Memorial Hospital. Credit: Matt Wittmeyer

When removing cancerous tissue in the brain, neurosurgeons often use “awake brain mapping” to minimise the risk of causing unintended disruptions to a patient’s quality of life while removing as much tumour as possible. This practice, which has been used for decades, involves waking a patient up mid-surgery to test their neurocognitive functions in real time by stimulating the brain surface and assessing for functional changes.

A new study published in the journal Science Advances details a promising new avenue toward improving awake brain mapping results by investigating the tiny, nearly imperceptible variabilities in patient behaviour that occur during the procedure. This work, led by Carnegie Mellon University researchers, points to a future where brain surgeries are not just safer, but more precisely tailored to protect each patient’s speech, movement and quality of life.

How awake brain mapping works

As cancer grows in the brain, it rarely keeps to itself. Cancerous cells can be found in the seemingly healthy brain tissue surrounding a tumour, presenting neurosurgeons with a dilemma. They need to remove as much tissue infiltrated by cancer as possible, but they also need to avoid the removal of too much tissue since it can cause permanent harm to a patient’s ability to hold a fork or a conversation.

During awake brain mapping, surgeons gently stimulate the brain with small electrical impulses while the patient completes planned tasks. One of the most common applications of awake brain mapping is to identify where language is represented in a patient’s brain, which is done by having the patient name pictures or read words while their brain is being stimulated. If the patient can respond quickly and correctly, the clinicians know the part of the brain they stimulated can be safely removed. If the patient slurs or becomes unable to speak, then that part of the brain may be essential for language. Surgeons require a significant amount of experience to understand the nuances of this complex technique.  

While the method may sound extreme, the brain has no sensory nerves, so patients do not feel their brain surgery as it is happening. Recent research also shows that for some types of brain cancer, improving a patient’s quality of life after surgery extends their expected survival into the future. This means that anything that can make awake brain mapping even more effective will translate into improved outcomes for brain cancer patients.

New measures show how slight changes in procedure affect patient behaviour

Based on a decade of research, the study authors uncovered new insights from examining the answers patients get wrong – and right – while undergoing awake brain mapping.

“We found that if you measure both the types of errors that patients make, as well as how fast they respond even when they do not make errors, more granular inferences can be drawn about language organization from an awake brain mapping procedure,” said Bradford Mahon, a cognitive neuroscientist at CMU’s Neuroscience Institute and Department of Psychology and senior author of the study. “We also found that physical parameters of the direct electrical stimulation delivered to the patient’s brain – such as its duration, and when it started and stopped relative to the task the patient is performing – were tightly related to small changes in patient behaviour that we could measure.”

Mahon and his team don’t yet know exactly what combination of parameters should be used to maximise the effect of direct electrical stimulation mapping. But they have discovered an intriguing signal hidden inside of the data that, until now, has gone unnoticed.

“What we have measured and formalised in our study is how slight changes in the awake mapping procedure can cause slight changes in patient behaviour. This is exciting because it is a new and meaningful signal that can be extracted from the data already being generated during awake brain mapping procedures,” said Mahon.

A new level of personalised medicine

The new study suggests that awake brain mapping may offer more informative and more personalized guidance for surgery than has been possible in the past.

“Stimulation has traditionally been treated as a binary test – either it causes an error, or it doesn’t,” said Raouf Belkhir, lead author and a psycholinguist who is completing the University of Pittsburgh-Carnegie Mellon University Medical Scientist Training Program. “But in reality, these effects are often more continuous than binary.”

For example, stimulating a particular area of the brain might reliably cause an error, never affect behaviour at all, or – more subtly – slow a patient’s response without causing an obvious mistake. In some cases, stimulation may affect behaviour at one moment, but not when tested again just seconds later.

“In other words, brain mapping isn’t always black or white,” said Belkhir. “Sometimes the most important information lives in the grey area.”

The nuance matters because every brain is different, which means every surgery is different, too. Understanding why stimulation has variable effects across different patients, and even within the same patient from one part of the surgery to another part of the surgery, may be key to protecting outcomes for future patients.

“Surgeons are seeking to optimise the balance between removing all of the cancerous tissue while preserving critical functions that may be represented by nearby brain regions,” said Mahon. “This research shows that by measuring aspects of patient performance that were previously not considered relevant for awake brain mapping, even better predictive models of brain organisation can be developed.”  

If clinical teams have better predictive models personalised to each patient, then the consequences of different surgical approaches on postoperative neurocognitive function can be simulated. This allows for patients and their caregivers to personalise decisions to what is most important to the patient.

In other words, Mahon said, a business manager may consent to a surgery that may diminish their motor skills, but not their speech, whereas a concert violinist may prefer the opposite.

Bringing standardisation to awake brain mapping surgery

Another important development from this research is the startup company MindTrace, which has built an integrated software platform that supports neurocognitive testing before, during and after surgery. It is working to build a longitudinal dataset of patient outcomes that will be used to train forecasting models. 

Tyler Schmidt, MD, study co-author and neurosurgeon at the University of Rochester, has used MindTrace in over a dozen awake surgeries since its release this year.

“In the beginning of brain tumour surgery, it used to be, ‘Can we remove any of this tumour safely?’” said Schmidt. ”But now in some brain tumour cases it’s, ‘Can we get you back to work potentially? Can we keep your quality of life close to what it was prior to your diagnosis? Can we hone in on the things that are most important to you and then try and protect them while getting the same oncological outcome?’” said Schmidt. “I think it’s a positive paradigm shift in how we take care of this patient population.”

The options today are measurably better than they were even 20 years ago. Clinicians now understand how to maximise the likelihood that patients have the best possible outcomes from brain cancer surgery.

“Ultimately, we are contributing toward the set of tools that clinicians will have that will enable them to map the brain with even greater confidence and precision, and personalised to each patient,” said Mahon. “The big goal is to translate scientific insights into solutions that improve people’s lives. We will meet that goal by building tools that enable the best possible outcomes in neurosurgery patients, both in terms of neurocognitive function and quality of life, and ultimately, in terms of survival.”

Source: Carnegie Mellon University

Categories : Cancer Surgeries & ProceduresTags :

Method Spots Early Signs of Infection in Post-mastectomy Reconstruction

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Rapid detection, treatment of infections could avoid complications, additional surgeries after mastectomy

Many of those women opt to have their breasts surgically reconstructed, most commonly with implants, but a relatively high percentage develop infections after implant surgery, requiring intravenous antibiotics and often removal of the implant. This can lead to additional surgeries, delays in cancer care and increased costs, as well as added emotional distress for women already under strain from cancer diagnosis and treatment.

To address this problem, researchers at Washington University School of Medicine in St. Louis have developed a new tool to detect reconstruction-related infections early, before they cause symptoms. This method, reported in the Journal of Clinical Investigation, could allow for preemptive treatment that preserves implants, improves patient outcomes and reduces the psychological and financial burden on patients.

Led by Jeffrey P. Henderson, MD, PhD, a WashU Medicine professor, the study identified biomarkers of infection in fluid drained from reconstruction patients’ breasts days or even weeks before symptoms appeared. This represents a major opportunity for improvement over existing diagnostic methods, which rely heavily on clinical symptoms, such as redness and inflammation, that take time to appear and can overlap with normal reactions to surgery.

The findings are available online and will publish in print Feb. 16 in the Journal of Clinical Investigation.

“The ability to identify with a molecular signature early on that a patient will go on to have an infection opens up the possibility of surveillance as part of standard care,” Henderson said. “This has the potential to enable earlier treatment that would be far more effective – and potentially curative – in patients who would otherwise progress to prolonged courses of treatment and surgery, or even implant removal and reconstructive failure.”

Small molecules, big impact

The study originated when Henderson’s WashU Medicine colleague Margaret A. Olsen, PhD, a retired professor of medicine in the Division of Infectious Diseases who studies hospital infections, noticed high rates of infection among US patients who had reconstruction with implants after mastectomy. The discovery prompted Henderson and Olsen, a co-author on the study, to ask WashU Medicine plastic surgeons who performed breast reconstruction what they would need to improve outcomes in these patients. Their answer was simple: a clear yes/no test for infection.

To develop such a test, Henderson and lead author John A. Wildenthal, an MD/PhD student, leveraged their expertise in metabolomics, the study of metabolites that are created or broken down during cellular processes in the body. Metabolites can indicate the presence of an infection because they include byproducts of both the body’s response to pathogens and the metabolic activity of the pathogens themselves. By analysing changes in metabolite levels, scientists can identify patterns that are characteristic of infections, enabling early diagnosis.

Henderson and colleagues coordinated with WashU Medicine plastic surgeons to obtain fluid samples from 50 patient volunteers during several routine follow-up visits after surgery. The patients included women who later developed infections after post-mastectomy reconstruction and those who did not.

The researchers analysed the samples for differences between the two groups and identified metabolites that were significantly associated with infection and that appeared days to weeks before clinical signs and symptoms of infection. Further, they found that the presence of certain metabolites indicated more serious infections that might require more aggressive treatment.

“Originating from clinical intuition and validated through a clinical study, the evidence in this paper now supports proactive, targeted interventions to predict and address infections before they become clinically significant,” said Justin M. Sacks, MD, a co-author on the paper. “Such interventions can substantially reduce the burden of complications, implant loss and reconstructive failures in these patients.”

For instance, the findings could lead to the development of a point-of-care test that could be provided during a woman’s routine post-operative visits, noted co-author Terence M. Myckatyn, MD, a professor of surgery at WashU Medicine, who performs plastic and reconstructive surgery for breast cancer patients.

“If the test is positive, antibiotics can be started preemptively in these select patients to thwart infection,” Myckatyn said. “And perhaps just as important, we would not give antibiotics to those with a negative test, thereby adhering to a thoughtful approach for antibiotic stewardship.” Such careful use of antibiotics is important for preventing antibiotic resistance, he said.

In the near term, the team is planning additional studies to validate the results. Then a diagnostic tool could be developed and tested in clinical practice. In the future, the broader metabolomic findings about the development of tissue infection in humans could allow physicians to more selectively target a variety of post-surgical infections, for example, by revealing new drug targets.

“While better techniques are always being sought, the reality is that infections still occur despite a meticulous surgical approach,” said Myckatyn. “To be able to identify biomarkers that can portend an infection days before it develops is huge.”

Source: Washington University

Categories : Cancer Surgeries & ProceduresTags :

Cancer Treatment Moving Towards Earlier Immunotherapy

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Killer T cells surround a cancer cell. Credit: Alex Ritter, Jennifer Lippincott Schwartz and Gillian Griffiths, National Institutes of Health (CC BY 2.0).

Immunotherapy given before or after surgery is increasingly used across several cancer areas. In an article published in the Journal of Internal Medicine, researchers at Karolinska Institutet present a comprehensive review of studies across seven tumour areas, showing how the field is moving towards earlier treatment.

For several years, immunotherapy has transformed the treatment of advanced cancer that can no longer be removed surgically. It is now used more frequently in earlier stages of disease as well – before surgery, known as neoadjuvant treatment, or after surgery, known as adjuvant treatment. In the new article, the researchers summarise findings from studies on several cancer diagnoses, grouped into seven tumour areas: skin cancer, lung cancer, breast cancer, gastrointestinal cancer, gynaecological cancer, head and neck cancer, and urological cancer.

Suggested benefits of treatment both before and after surgery

Several studies in recent years have shown that adjuvant immunotherapy after surgery can reduce the risk of the disease returning. Additional studies indicate that neoadjuvant treatment, given while the tumour is still in place, in many cases can provide the immune system with better conditions to recognise tumour cells. In several tumour areas, the results also suggest that immunotherapy given both before and after surgery may offer advantages compared with adjuvant treatment alone. 

At the same time, the authors emphasise that the results vary between different cancer types and that the treatment involves challenges, such as the risk of side effects and the possibility that some patients may receive more treatment than necessary if surgery alone would have been sufficient.

“We see that immunotherapy in early stages of disease is developing rapidly across many tumour areas. By bringing together studies from many cancer types, it becomes clearer how the field is evolving and what experiences can be shared between different specialties,” says last author Hildur Helgadottir, researcher at the Department of Oncology-Pathology at Karolinska Institutet.

How the researchers carried out the review

The work behind the article is a collaboration between 14 researchers at the Department of Oncology-Pathology, Karolinska Institutet. All of them also work with cancer treatment in clinical care. Because the researchers come from seven different tumour areas, the article gathers experiences from many parts of cancer care.

“It is valuable that we have come together from so many different tumour areas. This gives a broader understanding of how immunotherapy is used across cancer care and can, in the long term, support both clinical decision-making and future research,” says Hildur Helgadottir.

The researchers also point to areas where more knowledge is needed. One of these is the development of biomarkers, measurable characteristics that can help healthcare determine which patients benefit from immunotherapy, both before and after surgery. They also discuss how introducing immunotherapy at earlier stages raises questions about costs, side effects, and whether healthcare resources will be sufficient, questions that current studies do not yet clearly answer.

Information about funders and potential conflicts of interest can be found in the scientific publication.

Publication

Perioperative immune checkpoint inhibitor therapy across tumors: Insights and shared lessons from a rapidly evolving field.
Björkström K, Matikas A, Svedman FC, Björgvinsson E, Zupancic M, Villabona L, Eriksson H, Skribek M, Fernebro J, Lindskog M, Frödin JE, Ullén A, Ekman S, Helgadottir H
J Intern Med 2026 Feb;():

Source: Karolinska Institutet

Categories : Cancer Surgeries & ProceduresTags :

Novel Laser Therapy Device Shows Promise in Prostate Cancer Clinical Trial

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Credit: Darryl Leja National Human Genome Research Institute National Institutes Of Health

Because treatment of the whole prostate can lead to long-term side effects in patients with prostate cancer, interest in minimally invasive, focal treatment options has been growing for certain patients. A clinical trial published in BJU International generated promising results for a type of focal therapy, which directly targets the cancer and spares the remainder of the unaffected prostate gland.

The ProFocal Laser Therapy for Prostate Tissue Ablation (PFLT-PC) trial is the first pivotal trial of ProFocal®, a novel, cooled laser focal therapy device for prostate cancer treatment.

In the 100-participant trial, 84% of patients had no clinically significant prostate cancer on their 3-month post-treatment biopsy. The treatment provided similar cancer-related outcomes to those that have been reported for other focal therapy devices, but with an improved safety profile and low rates of incontinence.

“This new technology is very promising with excellent cancer control while preserving patients’ quality of life,” said corresponding author Jonathan Kam, MD, of Nepean Hospital, in Australia. “Traditional radical prostatectomy and radiotherapy for prostate cancer results in very high rates of incontinence and erectile dysfunction. With this new technology, patients can have their prostate cancer treated with very low risk of suffering the side effects associated with traditional prostate cancer treatments.”

Source: Wiley

Categories : Neurology Surgeries & ProceduresTags :

New Neurosurgical Classification Reveals Pivotal Role of Glioma Volume Reduction

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International team develops system for a standardised assessment of operative success in treating certain brain tumours

Photo by cottonbro studio

Low-grade brain tumours known as IDH-mutant gliomas CNS WHO grade 2 are life-threatening despite their slow growth. Neurosurgeons across the globe are faced with the question as to striking the correct balance between a “radical” tumour resection and avoiding further neurological damage. An international research team from the RANO working group involving Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Uniklinikum Erlangen has developed a new classification that records the extent to which any residual tumour tissue influences the progression of the disease. The results were published in The Lancet Oncology.

As a rule, the initial treatment for an IDH-mutated glioma CNS WHO grade 2 is surgery. The aim is to remove as much of the tumour as possible without jeopardising important neurological functions. As the results of the operation only become apparent many years later, there has been a lack of clear data, which has led to a number of different approaches. “On the one hand, this is due to the fact that we must be very careful to weigh up the chances of potentially boosting a patient’s chance of survival against avoiding neurological deficits. On the other hand, there has been a lack of clear criteria for assessing the risk of surgery until now, meaning that recommendations for treatment range from taking as little tissue as possible for diagnostic purposes to removing as much tumour tissue as possible,” explains Prof Dr Oliver Schnell from Uniklinikum Erlangen.

New basis for assessing success of surgery

In order to standardise therapeutic decisions, the RANO working group has conducted a large international study and assessed the data of 1391 patients from 16 neuro-oncological specialist units.

Based on the comprehensive data collected, the new RANO classification categorises the extent of the surgery based on the volume of the tumour that remains visible in a special MRI sequence (T2-FLAIR) after the operation. “Until now, there was no common language available for describing surgical outcomes,” explains PD Dr Philipp Karschnia from Uniklinikum Erlangen. “The new classification provides clarity, as it is guided exclusively by the residual tumour tissue.”

Less residual tumor means longer survival

The analysis of the RANO working group shows: A low volume of residual tumor after the initial operation is one of the most important factors for the further progression of the disease. A positive effect was also demonstrated for removing as much of the tumor as possible in the case of oligodendrogliomas, that tend to have a more favourable progression and are highly sensitive to chemo and radiation therapy. “We were surprised to discover that even follow-up treatments such as chemotherapy or radiation therapy were not able to replace the influence of the operation,” admits PD Dr Karschnia.

Internationally verified and useful in a wide range of scenarios

The results were confirmed in an independent patient group at the University of California in San Francisco. The new classification supports surgeons in making more accurate decisions and paves the way for future studies: “The new RANO classification is a milestone that will make a significant impact on neuro-oncological research and care in the long term,” according to Prof Schnell.

The Response Assessment in Neuro-Oncology (RANO) Working Group is an international, multidisciplinary collaboration between experts from various disciplines who have been working together to develop standardised criteria for assessing brain tumours for more than a decade now. Experts involved in the study from Erlangen were Prof Dr Oliver Schnell and PD Dr Philipp Karschnia, who has been leading the surgical focus group of the RANO Working Group since 2024, Dr Nico Teske and Alfred Gramelt from the Department of Neurosurgery at Uniklinikum Erlangen.

Source: Friedrich–Alexander University Erlangen–Nurnberg

Categories : Surgeries & ProceduresTags :

TXA Reduced Number of Blood Transfusions for Non-cardiac Surgery

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Photo by Charliehelen Robinson on Pexels

When hospitals were randomly assigned to treat patients undergoing higher-risk non-cardiac surgery with tranexamic acid (TXA) or a placebo, patients who received TXA needed significantly fewer blood transfusions and saw no increase in potentially life-threatening blood clots (thrombosis) after 90 days of follow-up, according to research presented at the 67th American Society of Hematology (ASH) Annual Meeting and Exposition.

“Our findings confirm that TXA reduces the need for blood transfusion in patients undergoing higher-risk non-cardiac surgery,” said lead study author Brett Houston, MD, PhD, an assistant professor at the University of Manitoba and a scientist with the Paul Albrechtsen Research Institute in Winnipeg, Canada. “We were also able to show that giving TXA is safe and does not increase the occurrence of dangerous blood clots within the three-month high-risk period after surgery.”

TXA is a generic drug that promotes blood clotting, which is essential to stop blood loss from injuries or during surgery, but blood clots can be life-threatening.

A 2019 international study of 40 000 patients found major bleeding to be the most common life-threatening complication following non-cardiac surgery. Another large international randomised trial, known as POISE-3, showed that, compared with patients who received a placebo, patients who received TXA immediately before and after non-cardiac surgery had significantly less serious bleeding and needed fewer blood transfusions, with no significant increase in heart attacks, strokes, or blood clots at 30 days.

The current study, known as TRACTION, was designed to build on the findings of POISE-3, Dr Houston said. Participating hospitals – 10 medical centres in Canada – were randomly assigned to administer either TXA or a placebo to adult patients undergoing major non-cardiac surgical procedures that posed an elevated risk for post-surgical bleeding complications and blood clots. Every four weeks, hospitals in the TXA group switched to the placebo group and vice versa.

Patients received a first dose of TXA or the placebo intravenously within minutes of surgery initiation. At the discretion of the attending anaesthesiologist, they then received a second dose either at the conclusion of the operation or as a continuous infusion throughout the procedure.

The study’s primary endpoints were the number of patients needing blood transfusions during their hospital stay and the number diagnosed with blood clots within 90 days.

Secondary endpoints included the number of units of blood transfused; the number of patients diagnosed with a heart attack, stroke, or blood clot while in the hospital; the number of patients admitted to intensive care; the number surviving at 90 days after surgery; and patients’ length of stay in the hospital.

The study’s results are based on the evaluation of 8273 patients treated across the 10 participating hospitals. More than 60% of the patients underwent cancer surgery. Among patients treated with TXA, 7.4% received a blood transfusion while in the hospital compared with 9.8% of those treated with the placebo, a statistically significant difference. Patients treated with TXA needed significantly fewer units of blood (0.34 units on average) than those in the placebo group (2.5 units on average). The proportion of patients diagnosed with blood clots within 90 days was the same (2.1%) in both the TXA and placebo groups. No significant differences were seen in any of the secondary endpoints.

The finding that TXA use does not increase risk for blood clots during the 90-day post-surgical period of elevated risk may reassure many practitioners who have previously been hesitant to adopt the drug, Dr Houston said. “We hope this data will also set practitioners’ minds at rest that giving the drug is safe,” she said.

Although the study was limited to Canada, it evaluated bleeding risk across a broad range of types of higher-risk non-cardiac surgery, Dr Houston said, including gynaecologic, urologic, spinal, blood-vessel, and cancer surgery. In addition, participating hospitals included both academic medical centres and community hospitals.

A limitation of the study is that participation was restricted to hospitals with sophisticated electronic medical records systems in place to transmit study data.

Findings from other studies suggest that the use of TXA could be successfully introduced as a hospital-level policy in the same way that other surgical safety practices, such as antibiotic administration to prevent infection and the use of surgical checklists have been adopted, Dr Houston said. As a next step, she and her colleagues plan to work on educating physicians about the TRACTION findings and promoting the adoption of TXA administration as a standard practice during higher-risk non-cardiac surgery.

Source: American Society of Hematology

Categories : Cancer Surgeries & ProceduresTags :

Targeted Radiation During Surgery Reduces Pancreatic Cancer Recurrence

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Image of a what is targeted with radiation. Red represents the pancreatic tumor, which is contacting with a major nearby artery. Yellow represents the Baltimore Triangle, which is now targeted in all patients, in addition to red volume. Credit: Amol Narang, M.D.

Using targeted radiation during surgery – referred to as intraoperative radiation – to eliminate pancreatic cancer cells that have spread to areas around the pancreas, investigators at Johns Hopkins have been able to reduce the recurrence rate around the pancreas to 5%. This is believed to be the lowest ever reported for this population of patients, according to a preliminary study by the team from the Johns Hopkins Kimmel Cancer Center.

The study was presented at the American Society for Radiation Oncology annual meeting in September 2025.

The study enrolled 20 patients with borderline resectable or locally advanced pancreatic cancer. Patients received presurgical chemotherapy and radiation targeted to shrink the tumours away from the blood vessels. Then, during surgery to remove their tumours, patients received another dose of precisely targeted radiation using a robotic device that carries small radioactive beads inserted through catheters. The device enabled the team to pinpoint a triangular area near the pancreas, where recurrences commonly occur. Only one of the 20 patients experienced a recurrence around the pancreas at the 24-month mark – a major achievement for a cancer that, until recently, had lagged behind other cancers in treatment success.

By the time most pancreatic cancers are diagnosed, the tumours have spread to affect important blood vessels around the pancreas. Historically, patients with pancreatic cancers whose blood vessels were affected could not undergo surgical removal of their tumours. But in the past decade, clinicians at the Johns Hopkins Kimmel Cancer Center’s Skip Viragh Center for Pancreas Cancer Clinical Research and Patient Care have pioneered new approaches that use chemotherapy and radiation to shrink the tumours away from blood vessels, enabling more patients to undergo surgical removal of their tumours.

However, many of these patients continued to experience tumor recurrences, and Amol Narang, M.D., associate professor of radiation oncology and molecular radiation sciences, and his colleagues sought to determine why.

The team learned that the pancreatic cancer cells were spreading along nerves near the pancreas to a fatty, nerve-dense triangular area just above the pancreas, which Narang calls the “Baltimore triangle.” When he and his colleagues started targeting the Baltimore triangle with radiation before surgery to kill these stray cancer cells, pancreatic cancer recurrence rates in their patients dropped from 47% to 12% at two years post-surgery. Yet, in the 12% who experienced recurrences around the pancreas, the recurrences continued to occur in the Baltimore triangle.

To further lower recurrence rates, Narang and his colleagues decided to deliver an additional round of Baltimore triangle-targeted radiation to patients during surgery after removal of the pancreatic tumour. He explained that, during the surgery, surgeons remove a part of the duodenum, next to the pancreas, making it easier to access the Baltimore triangle without risking harm to surrounding organs. The combination of radiation targeted to the Baltimore Triangle prior to surgery as well as intraoperative radiation to the triangle during surgery allowed Narang to deliver ablative doses of radiation to this region.

“The combination of intraoperative radiation and targeting the Baltimore triangle has gotten us to a 5% recurrence rate, which is the lowest-ever reported recurrence rate around the pancreas for this population of patients to our knowledge. But I think we can drop to 0% in our next study,” Narang says. “We must do whatever we can to prevent recurrences from happening, because when pancreatic cancer comes back, it is often incurable. These results give us hope, though, that this can be done for a cancer where even decade ago, most thought this wasn’t possible.”

The only recurrence in the study occurred in the part of the Baltimore triangle that the team had difficulty reaching during the intraoperative treatment. Currently, the team is developing strategies to target this hard-to-reach part of the triangle, with the hopes of reducing recurrences to zero. Once they’ve mastered that refined approach, they would like to team up with other cancer centres across the US to run a larger clinical trial to confirm their results. 

Source: Johns Hopkins Medicine