Overcoming the global challenges of cancer surgery

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Published: 17 Dec 2014
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Prof Richard Sullivan - King's College London, London, UK

Prof Sullivan talks to ecancertv at the UICC World Cancer Congress 2014 about the future of cancer surgery.

"What we discovered in most countries is that cancer surgery is not being properly supported," he says.

Particularly in low- and middle-income countries with emerging economies, cancer surgery has many unmet needs, from education to infrastructure.

The UICC has been engaged in a whole range of major public policy issues pertaining to global health and cancer over the last four or five years and without doubt one of the biggest issues at the moment that we’re dealing with is the future of cancer surgery globally. This is really on the back of a major commission looking at global surgery and global surgery encompasses all forms of surgery, whether this is to do with trauma and orthopaedic, surgery pertaining to maternal health, so caesarean section, all the way through to the most complex types of surgery and, in this case, cancer surgery.

So what we discovered in most countries cancer surgery really is not being properly supported in terms of the human resource training aspect, in terms of investment in operating theatres and, indeed, in systems of surgical care. We’re really looking at a very complex picture here, there are something like 476 different cancer surgical procedures spread across six different complexity levels. By that we mean some of the most simple cancer operations – removing a malignant melanoma, for example, which is quite a low complexity operation, all the way through to things like a Whipple’s procedure for removing the pancreas for pancreatic cancers. So this is a very, very wide range of complex surgical procedures.

What we’ve discovered is firstly that most countries do not have sufficient numbers of trained surgeons to cope with the ever-increasing cancer burden. When you think that in terms of solid cancers outcomes are absolutely dependent on surgical intervention in early stage cancer, this is a massive issue. Beyond that there’s also a major issue around education and training and the quality of surgery. If you look at cancer surgery in most low and middle income countries anywhere between 10-45% of the operative procedures that are carried out are incomplete. What that means is actually that the cancer is left behind at the end of the operation. Now this may be due to inadequate imaging, inadequate pathology but it also may be due to inadequate training of the surgeons themselves. So it’s quite a complex systems problem here and indeed only about 20% of operations for cancer in emerging economies and low income countries are carried out within the context of clinical guidelines.

So we’re finding a whole range of issues here and we’re looking indeed in the future in how on earth we can actually solidify and support cancer surgery across all emerging economies within the context of generally supporting surgery.