Surgery After Radiation Therapy from World Championship
Surgery After Radiation Therapy
There are few surgeons who will do prostatectomy after radiation therapy. The major problem is the fibrosis (scarring) caused by either surgery or radiation. It really does not matter what the first treatment is, the second treatment is typically always more difficult.
Surgery (composed of χείρ, "hand", and ἔργον, "work"), via Latin: chirurgiae, meaning "hand work") is a medical specialty that uses operative manual and instrumental techniques on a patient to investigate or treat a pathological condition such as a disease or injury, to help improve bodily function or appearance or to repair unwanted ruptured areas.
Surgery is a technology consisting of a physical intervention on tissues.
As a general rule, a procedure is considered surgical when it involves cutting of a patient's tissues or closure of a previously sustained wound. Other procedures that do not necessarily fall under this rubric, such as angioplasty or endoscopy, may be considered surgery if they involve "common" surgical procedure or settings, such as use of a sterile environment,anesthesia, antiseptic conditions, typical surgical instruments, and suturing or stapling. All forms of surgery are considered invasive procedures; so-called "noninvasive surgery" usually refers to an excision that does not penetrate the structure being excised (e.g. laser ablation of the cornea) or to a radiosurgical procedure (e.g. irradiation of a tumor).
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Types of surgery
Surgical procedures are commonly categorized by urgency, type of procedure, body system involved, degree of invasiveness, and special instrumentation.
Based on timing: Elective surgery is done to correct a non-life-threatening condition, and is carried out at the patient's request, subject to the surgeon's and the surgical facility's availability. A semi-elective surgery is one that must be done to avoid permanent disability or death, but can be postponed for a short time. Emergency surgery is surgery which must be done promptly to save life, limb, or functional capacity.
Based on purpose: Exploratory surgery is performed to aid or confirm a diagnosis. Therapeutic surgery treats a previously diagnosed condition. Cosmetic surgery is done to subjectively improve the appearance of an otherwise normal structure.
By type of procedure: Amputation involves cutting off a body part, usually a limb or digit; castration is also an example. Resection is the removal of all of an internal organ or body part, or a key part (lung lobe; liver quadrant) of such an organ or body part that has its own name or code designation. Replantation involves reattaching a severed body part.Reconstructive surgery involves reconstruction of an injured, mutilated, or deformed part of the body. Excision is the cutting out or removal of only part of an organ, tissue, or other body part from the patient. Transplant surgery is the replacement of an organ or body part by insertion of another from different human (or animal) into the patient. Removing an organ or body part from a live human or animal for use in transplant is also a type of surgery.
By body part: When surgery is performed on one organ system or structure, it may be classed by the organ, organ system or tissue involved. Examples include cardiac surgery (performed on the heart), gastrointestinal surgery (performed within the digestive tract and its accessory organs), and orthopedic surgery (performed on bones or muscles).
By degree of invasiveness of surgical procedures: Minimally-invasive surgery involves smaller outer incision(s) to insert miniaturized instruments within a body cavity or structure, as in laparoscopic surgery or angioplasty. By contrast, anopen surgical procedure such as a laparotomy requires a large incision to access the area of interest.
By equipment used: Laser surgery involves use of a laser for cutting tissue instead of a scalpel or similar surgical instruments. Microsurgery involves the use of an operating microscope for the surgeon to see small structures. Robotic surgery makes use of a surgical robot, such as the Da Vinci or the Zeus surgical systems, to control the instrumentation under the direction of the surgeon.
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Terminology
See also: List of surgical procedures
Excision surgery names often start with a name for the organ to be excised (cut out) and end in -ectomy.
Procedures involving cutting into an organ or tissue end in -otomy. A surgical procedure cutting through the abdominalwall to gain access to the abdominal cavity is a laparotomy.
Minimally invasive procedures involving small incisions through which an endoscope is inserted end in -oscopy. For example, such surgery in the abdominal cavity is called laparoscopy.
Procedures for formation of a permanent or semi-permanent opening called a stoma in the body end in -ostomy.
Reconstruction, plastic or cosmetic surgery of a body part starts with a name for the body part to be reconstructed and ends in -oplasty. Rhino is used as a prefix for "nose", therefore a rhinoplasty is reconstructive or cosmetic surgery for the nose.
Repair of damaged or congenital abnormal structure ends in -rraphy.
Reoperation (return to the operating room) refers to a return to the operating theater after an initial surgery is performed to re-address an aspect of patient care best treated surgically. Reasons for reoperation include persistent bleeding after surgery, development of or persistence of infection.
Surgery After Radiation Therapy
There are few surgeons who will do prostatectomy after radiation therapy. The major problem is the fibrosis (scarring) caused by either surgery or radiation. It really does not matter what the first treatment is, the second treatment is typically always more difficult. After any surgery, it is much more difficult to do a second surgery in the same area because of the fibrosis from the first surgery. It is also more difficult to do surgery after radiation because of fibrosis.
In general, radiation causes more problems because there is more fibrosis in the region than there is after surgery. In contrast, it is easier to do radiation after surgery because we can do a CT scan to see and localize the intended target, and the radiation can penetrate through the fibrosis to get to the target. There is still an increased risk of complications, but it is not at much as the surgery-after-radiation option.
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Frequently Asked Questions
Bladder Cancer: Side Effects of Radiation
Side Effects of Radiation to the Rectum
How Long After Radiation Can Tumor Keep Shrinking?
Is impotence a side effect of radiation for colorectal cancer?
Rectal stenosis after radiation to the prostate
Cystitis after radiation to the prostate
Proton Therapy vs. Conventional Radiotherapy
Preventing Radiation Proctitis
Radiotherapy is a common cancer treatment, but often results in unintended injury to overlying skin and contributes to poor wound healing. The mechanisms underlying these changes are complex, and existing treatment is limited. We aimed to systematically review the literature on the pathogenesis, management, and experimental treatment of delayed wound healing following radiation therapy.
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Chemotherapy
Chemotherapy (chemo) is a type of treatment that includes a medication or combination of medications to treat cancer. The goal of chemo is to stop or slow the growth of cancer cells. Chemo is considered a systemic therapy. This means it may affect your entire body. Chemo medications attack rapidly growing cancer cells, but they can also affect healthy cells that grow rapidly. The effect of these medications on normal cells often causes chemo side effects. For example:
A number of blood cells that divide rapidly can be damaged along with cancer cells during chemo:
White blood cells help protect the body from infection. A low white blood cell count is known as neutropenia. If your white blood cell count gets too low, you could get an infection.
Red blood cells carry oxygen throughout your body. A low redblood cell count is known as anemia. Anemia can lead to fatigue, chest pain, and more serious complications.
Platelets are structures in the blood that help stop bleeding. A low platelet cell count is known as thrombocytopenia. A low platelet count can cause bruising and bleeding.
Hair follicles have cells that can be affected by chemo, leading to hair loss, also called alopecia.
Cells lining your stomach can also be affected by chemo. This can cause vomiting and diarrhea, and may be associated with nausea.
Chemotherapy is the use of anticancer drugs designed to slow or stop the growth of rapidly dividing cancer cells in the body. The drugs may be used:
As a primary treatment to destroy cancer cells
Before another treatment to shrink a tumor
After another treatment to destroy any remaining cancer cells
To relieve symptoms of advanced cancer
Chemotherapy delivery methods
Some chemotherapy delivery methods include:
Orally (by mouth as a pill or liquid)
Intravenously (by infusion into a vein)
Topically (as a cream on the skin)
Injection
Direct placement (via a lumbar puncture or device placed under the scalp)
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List of Disease in alphabetic order
Preoperative care
Prior to surgery, the patient is given a medical examination, receives certain pre-operative tests, and their physical status is rated according to the ASA physical status classification system. If these results are satisfactory, the patient signs a consent form and is given a surgical clearance. If the procedure is expected to result in significant blood loss, an autologous blood donation may be made some weeks prior to surgery. If the surgery involves the digestive system, the patient may be instructed to perform a bowel prep by drinking a solution of polyethylene glycol the night before the procedure. Patients are also instructed to abstain from food or drink (an NPO order after midnight on the night before the procedure), to minimize the effect of stomach contents on pre-operative medications and reduce the risk of aspiration if the patient vomits during or after the procedure.
Some medical systems have a practice of routinely performing chest x-rays before surgery. The premise behind this practice is that the physician might discover some unknown medical condition which would complicate the surgery, and that upon discovering this with the chest x-ray, the physician would adapt the surgery practice accordingly.[5] In fact, medical specialtyprofessional organizations recommend against routine pre-operative chest x-rays for patients who have an unremarkable medical history and presented with a physical exam which did not indicate a chest x-ray.[5] Routine x-ray examination is more likely to result in problems like misdiagnosis, overtreatment, or other negative outcomes than it is to result in a benefit to the patient.[5] Likewise, other tests including complete blood count, prothrombin time, partial thromboplastin time, basic metabolic panel, and urinalysis should not be done unless the results of these tests can help evaluate surgical risk.[6]
An incision is made to access the surgical site. Blood vessels may be clamped or cauterized to prevent bleeding, and retractors may be used to expose the site or keep the incision open. The approach to the surgical site may involve several layers of incision and dissection, as in abdominal surgery, where the incision must traverse skin, subcutaneous tissue, three layers of muscle and then the peritoneum. In certain cases, bone may be cut to further access the interior of the body; for example, cutting the skull for brain surgery or cutting the sternum for thoracic (chest) surgery to open up the rib cage. Whilst in surgery aseptic technique is used to prevent infection or further spreading of the disease. The surgeons' and assistants' hands, wrists and forearms are washed thoroughly for at least 4 minutes to prevent germs getting into the operative field, then sterile gloves are placed onto their hands. An antiseptic solution is applied to the area of the patient's body that will be operated on. Sterile drapes are placed around the operative site. Surgical masks are worn by the surgical team to avoid germs on droplets of liquid from their mouths and noses from contaminating the operative site.
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Work to correct the problem in body then proceeds. This work may involve:
excision – cutting out an organ, tumor,[8] or other tissue.
resection – partial removal of an organ or other bodily structure.
reconnection of organs, tissues, etc., particularly if severed. Resection of organs such as intestines involves reconnection. Internal suturing or stapling may be used. Surgical connection between blood vessels or other tubular or hollow structures such as loops of intestine is called anastomosis.
Reduction – the movement or realignment of a body part to its normal position. e.g. Reduction of a broken nose involves the physical manipulation of the bone or cartilage from their displaced state back to their original position to restore normal airflow and aesthetics.
ligation – tying off blood vessels, ducts, or "tubes".
grafts – may be severed pieces of tissue cut from the same (or different) body or flaps of tissue still partly connected to the body but resewn for rearranging or restructuring of the area of the body in question. Although grafting is often used in cosmetic surgery, it is also used in other surgery. Grafts may be taken from one area of the patient's body and inserted to another area of the body. An example is bypass surgery, where clogged blood vessels are bypassed with a graft from another part of the body. Alternatively, grafts may be from other persons, cadavers, or animals.
insertion of prosthetic parts when needed. Pins or screws to set and hold bones may be used. Sections of bone may be replaced with prosthetic rods or other parts. Sometimes a plate is inserted to replace a damaged area of skull. Artificial hip replacement has become more common. Heart pacemakers or valves may be inserted. Many other types of prostheses are used.
creation of a stoma, a permanent or semi-permanent opening in the body
in transplant surgery, the donor organ (taken out of the donor's body) is inserted into the recipient's body and reconnected to the recipient in all necessary ways (blood vessels, ducts, etc.).
arthrodesis – surgical connection of adjacent bones so the bones can grow together into one. Spinal fusion is an example of adjacent vertebrae connected allowing them to grow together into one piece.
modifying the digestive tract in bariatric surgery for weight loss.
other procedures, including:
clearing clogged ducts, blood or other vessels
removal of calculi (stones)
draining of accumulated fluids
debridement- removal of dead, damaged, or diseased tissue
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