Surgery & Interventional

For low-risk prostate cancer, monitoring with PSA, MRI, and repeat biopsy instead of treating, because most such cancers never cause harm.

Active surveillance watches papillary thyroid cancers of 1 cm or less with ultrasound every 6 to 12 months instead of operating, because about 90% stay stable over a decade and delayed surgery works as well when needed. It is not suitable for tumours next to the windpipe or the voice nerve, and uptake outside Japan and Korea is still low.

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.

A small tube placed by endoscope or through the skin reopens a blocked bile duct, relieving jaundice so chemotherapy can be given.

Two years after surgery, women reconstructed from their own tissue reported more satisfaction with their breasts than women with implants, by about 8 points on a 100-point scale. After radiotherapy the gap widens and so does the complication rate: 38.9 per cent of irradiated implant reconstructions had a complication within two years against 25.6 per cent of tissue ones.

A questionnaire built from what women actually said matters after breast surgery: satisfaction with how the breasts look and feel, and psychological, physical and sexual well-being, each scored separately. It is the reason reconstruction techniques can be compared on something other than complication rates.

Taking out a lobe takes away lung, and breathlessness on stairs is what people notice. Across 18 randomised trials and 1,795 patients, pulmonary rehabilitation after lung resection improved lung function, six-minute walk distance and physical quality of life, with bigger gains from programmes of twelve weeks or more.

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.

Arm or leg swelling after lymph node surgery or radiotherapy is managed with compression garments, specialised massage, skin care and exercise. Weight lifting, once forbidden, was shown in a randomised trial to reduce flare-ups rather than cause them.

Killing a tumour by freezing it through one or more needles, with the ice ball watched live on CT, ultrasound or MRI. It hurts less than heat, spares nearby nerves and collecting systems better, and is the usual choice for small kidney tumours, painful bone metastases and, in trials, small breast cancers.

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.

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 lifts an early cancer of the oesophagus or stomach with an injection and cuts it out from inside with a snare or electrosurgical knife, keeping the organ intact. It cures cancers confined to the mucosa (T1a) and gives a definitive depth reading; deeper invasion or lymph node spread still needs surgery.

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.

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.

Where an ear, an eye socket or a nose cannot be rebuilt from the patient's own tissue, a silicone prosthesis is made and held by adhesive or by titanium implants in bone. Implant failure differs sharply by site: across 3,630 implants, 3.5 per cent failed at the ear, 8.8 per cent at the nose and 18.7 per cent at the orbit.

For young women with the earliest, low-grade endometrial cancers, progestin pills or a hormonal IUD can clear the cancer and allow pregnancy before a later hysterectomy.

Injecting a dye that makes tumour glow so the surgeon can see exactly where to cut.

Destroying tumours from outside the body with tightly focused sound waves, using either heat or microscopic bubbles.

Sound waves plus microbubbles briefly open the brain's protective barrier so chemotherapy or antibodies can get to the tumour.

The small radiation detectors that make nuclear medicine and sentinel node surgery work: a pen-sized probe that clicks when the surgeon nears the radioactive lymph node, and the well counter in the hot lab that checks every dose before it is injected.

Removing a tongue, a jaw or a pharynx leaves a hole that will not close, so tissue is moved from the forearm, thigh or lower leg with its own artery and vein and joined under a microscope. In a series of 843 flaps the overall failure rate was 4.0 per cent, and in an older series of 1,000 flaps 7.6 per cent failed wholly or partly. Donor site disability measured years later is small.

Washing the abdominal cavity with heated chemotherapy during surgery to kill microscopic peritoneal deposits.

The pump and heater that circulate warm chemotherapy through the abdomen at the end of an operation for cancer that has spread across the abdominal lining, and the small nebuliser that sprays chemotherapy as an aerosol through keyhole ports when surgery is not possible.

Destroying a tumour mechanically with sound, rather than heat, leaves the debris intact enough for the immune system to learn from it.

Drinks enriched with arginine, omega-3 fats and nucleotides for a week before a big operation seem to reduce infections afterwards, though the trials are old and mostly industry-funded.

Cameras in the operating theatre that see dyes the surgeon's eye cannot: green dye lighting up lymph nodes and blood supply, pink glow marking a brain tumour, and even the faint light from a PET tracer in a removed specimen. They turn the dyes into a picture the surgeon follows.

Scanners built into or next to the operating theatre, so the surgeon can check during a brain tumour or spine operation how much tumour is left and remove more before closing.

Giving a single large dose of radiation directly to the tumour bed during surgery, with normal organs moved out of the way; used mainly in breast cancer as an alternative to weeks of external radiotherapy.

Irreversible electroporation uses short high-voltage pulses that punch permanent holes in tumour cells while sparing nearby vessels and ducts.

Isolating the blood supply of an arm or leg so that chemotherapy doses 15-20 times higher than the body could tolerate can be circulated through it, to save limbs with melanoma or sarcoma that would otherwise be amputated.

Laser interstitial thermal therapy guides a laser fibre through a small skull hole, monitored by real-time MRI, to heat and destroy deep brain tumours a surgeon could not safely reach.

Two commercial systems thread a laser fibre through a hole the width of a pencil into a brain tumour and cook it while the surgeon watches the temperature on live MRI. They reach tumours too deep or too risky to remove with open surgery.

Saving a limb with a metal endoprosthesis gives better walking efficiency and better return to normal living than an above-knee amputation, and studies that asked patients about overall quality of life found the two closer than expected. On the Toronto Extremity Salvage Score, lower limb amputees scored 72.2 against 85.5 after extended resection.

Removing a bone or soft-tissue sarcoma while keeping the arm or leg, rebuilding with metal implants, bone grafts or growing prostheses in children.

Replacing the whole diseased liver cures both the cancer and the cirrhosis underneath it, for patients whose tumours are small enough.

Two things have changed. Measuring the limb regularly after surgery, so that a month of compression can start before swelling is obvious, cut progression to full decongestive treatment from 19.2 to 7.9 per cent in a randomised trial. And joining lymphatics to small veins during the node operation cut new lymphoedema from 32 to 9.5 per cent, in a trial not yet finally reported.

Cooking a tumour from the inside through a needle. Radiofrequency current was the first method and is proven for small liver cancers; microwave energy heats faster, makes larger zones and is less troubled by nearby blood vessels carrying the heat away, so it is now the more common choice.

Dyes that glow under special light, so surgeons can see tumour edges and nerves in the operating theatre.

Most small kidney tumours found on scans grow slowly. Options range from watching them, to freezing or heating them, to removing just the tumour and keeping the kidney.

Isolating the liver's circulation with catheters and balloons so that high-dose melphalan can be pumped through it and filtered out before it reaches the rest of the body; approved in 2023 for eye melanoma that has spread to the liver.

Red or near-infrared lasers and lamps that switch on a light-sensitive drug sitting in a tumour. Each drug has its own colour, so the machine is matched to the drug: skin lamps for sun damage, fibre-optic lasers for the oesophagus, lung and bladder, and a new near-infrared laser for the head and neck.

Gold nanoshells that accumulate in a tumour and cook it when a near-infrared laser is shone on them.

Prehabilitation is a few weeks of structured exercise, nutrition and psychological preparation between diagnosis and surgery to make patients fitter for the operation and speed recovery.

Brighter, longer-lasting fluorescent particles and targeted microbubbles that make tumours visible during surgery or on an ultrasound scan.

Removing the pelvic organs together can cure a recurrence that nothing else will, at the cost of one or two stomas and a long recovery. About half of patients have a major complication within 90 days. Overall quality of life scores recover by six to twelve months in most published series, while sexual function, body image and distress do not, and there are no randomised trials of any of it.

Removing the fallopian tubes, where most ovarian cancer starts, during other pelvic surgery or in women at inherited risk.

Surgeons operate through small incisions using robotic arms with tremor-free precision and 3D vision.

A robot-guided flexible scope that reaches small lung nodules through the airways to biopsy them without a needle through the chest wall.

Removing just the first lymph node a tumour drains to, instead of all of them, to check for spread.

Most temporary stomas made to protect a join in the bowel are reversed, and a meaningful minority are not. In a series of 639 patients having sphincter-sparing surgery, 11.9 per cent still had a stoma two years later; the main reasons were the cancer progressing (52.4 per cent) and the patient deciding against it (19.0 per cent).

The operation that can cure gallbladder cancer: the gallbladder bed in the liver (segments IVb and V) is removed with the lymph nodes along the bile duct and hepatic artery, either at the first operation or as a second operation after a cancer is found by chance in a gallbladder removed for stones.

The surgeon sits at a console and moves wristed instruments through keyhole ports while a 3D camera shows the inside of the body magnified. Intuitive's da Vinci has dominated for two decades; Medtronic's Hugo and CMR's Versius are the first serious rivals, and single-port robots work through one incision.

Thermal ablation kills a tumour with heat or cold delivered through a needle, with no incision required.

Destroying precancerous cervical cells with a heated or frozen probe in under a minute, the tool that makes screen-and-treat possible where there are no surgeons.

A catheter threaded into the artery feeding a liver tumour delivers chemotherapy and then blocks the vessel, starving the tumour from inside.

A helmet of a thousand ultrasound emitters, or a small implant under the skull, that sends sound through the bone into the brain. Approved for tremor, it is being tested in brain tumours to open the brain's protective barrier for a few hours so that drugs can reach the tumour.

Transoral robotic surgery removes early (T1 to T2) throat tumours through the mouth with a robot and 3D endoscope, avoiding splitting the jaw or a tracheostomy. In HPV-positive oropharyngeal cancer the pathology then guides how much radiation to add, but randomised trials found it no better than radiation for swallowing, and surgeon volume matters.

Removing the larynx removes the voice and separates the airway from the mouth permanently. Speech is restored in most people by a one-way valve set in a small hole between the windpipe and the gullet, which lets breath out through the throat so the throat can vibrate. The valve is a consumable that needs replacing, and people who lose contact with the service stop using it.

The programme behind the best colorectal result was four weeks long, supervised in hospital, and had four parts: high-intensity exercise three times a week, a nutritional intervention, psychological support, and smoking cessation where it applied. Supervision is the ingredient the trials keep separating out, and the window is what the pathway leaves.

Training before an operation reliably makes people fitter for it. Whether it cuts complications depends on the operation and on who was recruited: a trial in high-risk abdominal surgery halved the proportion with complications, the largest colorectal trial cut severe complications from 29.7 to 17.1 per cent, and pooled home-based programmes improved the walking test and nothing else.