English
Surgery Emerges from ‘Cinderella’ Status in Medical Care
Posted on Mar 03, 2014 by Ruth Loftus
Much of the medical research occurring today, especially the ‘breakthrough studies’ often reported in the press, have increasingly turned their focus towards aspects of genetics and biochemistry that are projected to have significant effects on the treatment of cancers, heart disease and of conditions such as dementia.
However, closer inspection of the majority of these reports often reveals that results come from tests on mice, rats or other laboratory animals and the process of applying new treatments to humans still remain uncertain and usually postponed until some unknown time in the distant future.
There is a concern among within medical circles that the focus on the fundamental causes of such conditions as cancer and heart disease, for example, means that the areas of medicine which can actually provide more immediate improvements to quality of life are failing to attract the attention that the deserve. Furthermore, this lack of attention tends to transfer into a lack of resources to develop and test other new techniques and approaches to care.
This is almost certainly the case with surgery. Fifty years ago, or even more recently, surgery was the glamorous pinnacle of medical practice. Whether it was the early triumphs of transplant surgery or the heroic removal of tumours, it was the surgeon - often charismatic and driven – who commanded attention. But as the focus of medicine moved from daring late intervention to more systematic early detection and prevention, surgery and surgeons received less attention. The consequence of all of this is that surgery has almost come to be viewed as a 'Cinderella' in medical research terms, although the situation has been slowly improving in recent years.
The reality is that surgery remains an essential option in the range of treatments available and that there are many conditions where it is considered a vital means of intervention – and one that can produce rapid and dramatic improvements for patients. A large majority of the UK population are likely to undergo surgery during their lifetime and surgery still cures more cancers than any other form of treatment. In addition, in fields ranging from the treatment of trauma to providing new joints in the wake of chronic disease, surgery has a significant value. However only about 5% of government funding for medical research is earmarked for improving surgery and developing new techniques.
It has also become the case that the lead time for the development and delivery of new surgical techniques can be much less than that for other research areas. The fact that the operating theatre is just as much a centre for new medical research as is the laboratory needs to be recognised and appreciated.
As a response to this, new centres to focus on clinical trials in surgery are being created across the United Kingdom and surgeons are actively seeking patients to allow them to test innovations and evaluate procedures, therefore enabling them to assess which techniques seem most likely to result in a full recovery.
These new centres will focus on many different types of surgery ranging through heart treatment and orthopaedic care, to transplants. One example of the approach these centres are pioneering is a study of patients with advanced bowel cancer to assess which patients should be treated with chemotherapy.
The current typical treatment for people with such a condition is for tumours to be surgically removed and then sessions of chemotherapy will be administered. However, if the cancer is already advanced before surgery, the cancer will often returns in the short or longer term. The new study will investigate if patients who undergo chemotherapy before their surgery experience a reduced likelihood of seeing the cancer recur in the relative short term (up to two years).
Significant surgical advances are equally as important regarding conditions that are not considered life threatening. For example, an Oxford research team have developed an approach which could have dramatic potential to improve surgical success rates for repairing soft tissues, especially shoulder related injuries. There are now some 10,000 shoulder repair operations every year in England and Wales, an increase of some 500% in the last decade. Results normally indicate, however, that a quarter of these procedures ultimately fail because the affected tendon undergoes a second tear.
The new approach uses modern techniques to produce very fine fibres which even have the capability to work on cells on older individuals, and encourage them to heal, whereas previously they didn’t seem to retain this capacity to heal.
The material in the specially designed ‘healing’ patch is degradable, and disappears after a few months. This is particularly important for middle aged patients who want to get back to work and continue to lead an active lifestyle.
The vital role of which surgery plays in a range of medical scenarios is underlined by these examples and it is important that research continues so as to enhance the medical acts that can be carried out with the help of surgery.