“Did you get clean margins?”
It’s one of the most important questions asked about cancer surgery. If the surgeon was successful, the tumor was completely removed along with all malignant tissue, leaving only healthy cells behind. If not, some cancer cells still remain in the body, and the patient may need a second surgery to fully remove it. It can be hard to tell where the line between healthy and cancerous cells lies, especially if the cancer is buried deep in the body and around sensitive structures.
This is such a problem that in many surgeries, the operating team sends the tissue to the pathology lab while the patient is on the table so the pathologist can quickly check it to confirm that the entire tumor was removed. That requires waiting with a patient under anesthesia for half an hour or more, which is always a risk, and possibly continuing surgery after getting the results to take out the rest of the tumor.
That approach might change, though, with a newly-developed surgical tool that’s pretty out there, and pretty darn cool. Researchers developed a surgical knife that uses heat to cut through tissue, which is nothing new, but this knife comes with a twist. Normally the smoke from such knives just creates an unpleasant and distinctive smell in the OR until it’s vented. In this case, though, it’s run through a mass spectrometer, which analyzes the contents of the smoke.
The device is sensitive enough to tell if the smoke is from cancerous or healthy tissue, and it provides nearly instant feedback. And poof, in a literal puff of smoke, a surgeon can see where the edges of a tumor lie, and cut well around them. Having such precise feedback also allows doctors to minimize the damage at the surgical site, which will reduce the risk of complications after surgery and add to the patient’s comfort. Think of it as precision targeting for cancer cells, because there won’t be any need to take big chunks of healthy tissue out with the tumor just to be safe.
This is particularly useful with brain tumors, which are notorious for invading healthy tissue and deftly hiding in plain sight. Neurosurgeons often struggle to find the margins of invasive and aggressive tumors, even with years of experience, making a smart knife a potentially critical tool in the operating room for helping them quickly and smoothly get tumors out of the brain. Given the delicacy of the operating area, this could also improve outcomes for patients, who would be less at risk of brain damage as a result of more deliberate precision at the surgical site in an already very precise field.
Don’t get too excited just yet: it’s still in clinical trials, and will require some extensive safety testing before it can be released in hospitals worldwide. At the moment, it’s also extremely expensive because of the equipment involved, though this may change if it goes into mass production. If it does get approval, though, it could be a tremendously valuable tool in the cancer toolbox, as ensuring the complete removal of tumors from the body is a key part of successful cancer treatment. The more of the tumor removed, the better the chance of a good outcome, and that makes developments like this great news for cancer patients.
Photo from Thinkstock