Organ sufficiency: how cancer surgeons are saving patients' quality of life
In recent years, oncologic surgery has increasingly developed a trend towards organ preservation - doctors save not only the patient's life but also the functionality of the affected organs at all costs. Even in complex situations, surgeons will explore options to remove only the tumor. How such decisions are made, whether it is possible to take risks in this situation and whether Russian doctors are trained to perform complex operations - in the material of "Izvestia" for the World Cancer Day, which is celebrated on February 4.
How the quality of life of cancer patients is preserved
In 26-year-old Mikhail (name changed), the tumor was located inside the kidney, to be more precise - it was located intraparenchymatously, that is, it was not visible on the surface of the organ. Even 20-25years ago the chances of saving the kidney in this patient were minimal, but now such operations have long since become routine, Anton Panin, a surgeon, oncourologist at the Neftyanik medical and sanitary unit in Tyumen, a graduate of the Pavlenko School, tells Izvestia.
- During the laparoscopic surgery we used an ultrasound diagnostic system designed just for use during laparoscopic minimally invasive surgeries. This allowed us to radically, i.e. completely, remove the tumor and preserve kidney function," he explained. - Thanks to the development of oncosurgery and the emergence of new approaches to diagnosis and treatment, it has become possible to do things that previously seemed difficult to accomplish.
Ilya Chernikovsky, head of the coloproctology department at Moscow City Oncology Hospital No. 62, president and mentor of the Pavlenko School, emphasizes that organ-preserving surgery became possible only after modern solutions for accurate diagnostics, such as MRI and CT diagnostics, became available.
The approach to treatment is also changing, says Deputy Director of the N.N. Blokhin Oncology Center. Alexander Petrovsky, deputy director of the N.N. Blokhin Research and Education Center for Oncology, member of the board of RUSSCO.
- For example, in mammology it used to be believed that a tumor larger than 2 cm could not be preserved in the breast," he said. - Now we understand that not only the size of the tumor is important, but also its ratio to the volume of the gland. In large mammary glands, organ-preserving treatment is possible even with large tumors.
It is often possible to save the organ in very difficult situations. In the NMI Center of Oncology named after N.N. Blokhin. N.N. Blokhin told the story of Olga, whose MEN II syndrome manifested itself in a tumor of both adrenal glands, and the neoplasm was much larger than the organ itself. However, the function was still preserved: doctors saved the healthy tissue of the right adrenal gland, which began to produce hormones.
Yan Vlasov, co-chairman of the All-Russian Patients' Union, notes that usually oncologic surgeries involve radical removal of all tissues located near the neoplasm, but now the level of oncological care in Russia and the world is at a very high level. Often it does not come to surgical intervention: mutilating amputations can be avoided by therapy. Anton Panin adds that, although the possibilities of modern medicine are not unlimited, they give most patients a chance to be cured and maintain an acceptable quality of life, even when the disease is irreversible.
-Over the past 15-20years, significant progress has been made in organ-preserving, minimally invasive and functionally sparing surgery, " the Izvestia interlocutor said. - This includes laparoscopic video-assisted, endoscopic and robotic surgeries. But traditional open surgery also retains a significant role.
How they determine whether an organ can be saved
Alexander Petrovsky noted that organ-preserving surgeries often depend on the stage of the disease. Early diagnosis significantly increases the chances of continuing a quality life.
-At early stages the organ can be saved without compromising the effectiveness of treatment, while at later stages it is not always possible, - said Deputy Director of the N.N. Blokhin Oncology Center. N.N. Blokhin.
Other factors are also important: the histological structure of the tumor; multicentricity of growth. Sometimes due to multiple disease rudiments, removal of the organ becomes inevitable.
Much depends on the localization of the tumor. The Izvestia interlocutor notes that if the organ is hidden inside the body, the patient, as a rule, trusts the choice of doctors. When it comes to externally visible organs - mammary gland, limbs, face - the patient is much more actively involved in making the decision.
Petrovsky added that now all medical care in Russia is based on clinical recommendations and standards. Clinical recommendations prescribe indications for organ-preserving surgeries, and standards of medical care prescribe the frequency of their use in various diseases.
- Since 2025, clinical recommendations are mandatory. Formally, they are still recommendations, but in fact their use is becoming necessary. But oncologists have been working in such a system since 2016," said Alexander Petrovsky.
Igor Khatkov, chief oncologist of Moscow, director of the A.S. Loginov ICRC, member of the presidium of the Russian Society of Surgeons, notes that the clinical recommendations leave enough room for maneuver when deciding on organ-preserving surgeries. Doctors proceed from the individual characteristics of the course of the disease and the patient's condition.
Anton Panin adds that the decision on treatment tactics is made collegially, involving many specialists - oncosurgeons, radiation oncologists and specialists in radiation diagnostics, chemotherapists, morphologists.
Whether the risk is justified in the desire to save an organ
Organ preservation is possible in the vast majority of localizations, especially in the early stages, says Igor Khatkov. Surgeons have learned to save the functions of the stomach, intestines, now there are opportunities for organ preservation treatment even in cancer of the female reproductive system, says Alexander Petrovsky.
Anton Panin notes that oncosurgery always involves inevitable risks, but the modern development of diagnostics of cancer diseases allows to assess them and minimize them for the patient. The key condition for treatment remains the safety of the patient's life, and in oncosurgery "this principle is strictly observed," he says.
However, it is not uncommon for patients to consciously choose organ-preserving treatment, even if it slightly increases the risk of recurrence, says Alexander Petrovsky. A compromise is possible if the risk of recurrence with organ preservation is only slightly higher. If it significantly reduces the chances of cure, the doctor will not go to the patient. Improperly performed surgery can lead to rapid progression of the disease and significantly reduce life expectancy.
- Therefore, it is important that the doctor clearly explains to the patient all the risks and treatment options, and the patient trusts the specialist and understands that doctors always act in his interests," he emphasizes. - If a person has doubts, they have the right to get a second or third opinion. But sometimes patients are looking for a doctor who will agree to their conditions, even if it worsens the prognosis. Unfortunately, such specialists are found.
In most cases, it is possible to find a compromise between the radicality of treatment and the aesthetic result, says the Izvestia interlocutor. This may require several stages of surgery, complex reconstruction methods.
It is also important to realize that organ-preserving surgeries are technically more complicated, continues Alexander Petrovsky.
- They require more time, experience, knowledge, as well as a competent choice of tactics, since there may be several possible options. Not all surgeons know all techniques, and this also affects decision-making," he said. - Education is key, but a commitment to prioritizing the patient's life and quality of life is also important.
In addition, resources are needed, says the deputy director of the Blokhin NMI Center. It's time, staffing, funding for hospitals.
How oncosurgeons are prepared for organ-preserving surgeries
Igor Khatkov notes that when it comes to complex surgeries for certain types of nosologies, patients may be sent to large high-flow federal centers where such interventions have already become commonplace.
- World studies show that the more complicated the operation, the more important the surgeon's experience becomes," he explained to Izvestia. - For example, for pancreatic surgeries, it is believed that if the number of surgeries is less than 30 per year, the number of complications increases significantly.
The interlocutor added that Russia now has a well-established routing of cancer patients, when a patient from a district polyclinic reaches the federal center for surgery.
But surgeons are now being trained to meet modern requirements for the treatment of cancer patients, including the trend towards organ preservation. Ilya Chernikovsky explains that oncologic surgeons undergo postgraduate training in residency programs. And here it is very important to find a good mentor.
- For those who want to continue their development after residency, there is our project. In the School of Practical Oncology, each resident is assigned a mentor for two years," he explained. - Such intraoperative education is very important for a surgeon, when a specialist learns right during surgery. In surgery, this experience is literally transferred from the hands of the mentor to the hands of the student - not for nothing in our profession there is an expression "to put hands".
Alexander Petrovsky adds that in different regions there are many residency programs, there are opportunities for advanced training. For example, in the NMI Center of Oncology named after N.N. Blokhin. N.N. Blokhin Oncology Center runs an educational project "Oncoacademy" - it is about 30 training conferences and master classes a year. There is also an annual forum "Innovative Oncology", where world-class surgeons speak.
- The approach to training can be different: a graduate of the Chita Medical Academy and a specialist trained at the N.N. Blokhin Oncology Center. N.N. Blokhin Oncology Center can each in their own way to assess the possibilities of organ-preserving treatment in a particular situation, - he said. - Nevertheless, the key principles of training are unified, they are enshrined in clinical guidelines and modern training manuals.
Anton Panin notes that many professional organizations are active in Russia, which both supervise young oncosurgeons and discuss different approaches to the treatment of cancer. Proven and tested treatment methods, including in the field of organ-preserving surgeries, are further reflected in clinical recommendations and treatment standards, he says.
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