publication date: Jun. 14, 2019
When Surgical Innovation Kills - Jun. 14, 2019

When Surgical Innovation Kills

By Matthew Bin Han Ong


ISSUE 20 – MAY 18, 2018PDF

Gynecology’s deadly surprise: Cancers are frequently missed prior to routine procedures

As they reach for surgical tools, gynecologists vastly underestimate the probability that their patients have undiagnosed uterine cancers, a study by Yale University researchers found.


Conversation with The Cancer Letter

Vanderbilt’s Alvarez: Gynecologists must properly assess all patients for cancer before surgery

I think that it probably represents a failure in our health care system. It just points out an opportunity, from a quality improvement standpoint, to make sure that everybody who is going to have a hysterectomy has the appropriate assessment for the risk of cancer preoperatively.


Conversation with The Cancer Letter

OU’s Mannel: Gynecologists must thoroughly evaluate postmenopausal women for hidden cancers

You want to pay attention to everybody, but who are the ones that you really want to pay attention to? And I think what the study’s telling you, older women, women who are obese—you need to really pay attention to.


Conversation with The Cancer Letter

Fox Chase’s Rubin: Don’t morcellate and you won’t have to worry about cutting up missed cancers

I think you’d have to overcome all those problems before you could say that women with fibroids ought to have a biopsy before they’re morcellated. Which, as I say, sounds like a good idea. I think the better idea is don’t morcellate the damn thing. That would solve the problem.


Conversation with The Cancer Letter

Yale’s Desai: Gynecologists must preoperatively workup and discuss the risks, benefits, alternatives

We hope that our study increases the awareness and discussion of occult cancer risk in the thousands of women undergoing hysterectomy and myomectomy annually. Morcellation of a specimen allows for the dissemination of cancer, having an informed conversation with patients preoperatively is essential to this process.


Conversation with The Cancer Letter

Olive: It’s true, gynecologists don’t biopsy masses as much as other surgeons

There are a lot of gynecologists who are not gynecologic oncologists who live in rural areas, who don’t have access to oncologists, or who just have big egos, who will operate on patients with known premalignant disease or early stage cancer—regardless of the fact that they know that it is cancer.


ISSUE 21 – MAY 25, 2018PDF

CDC announces review of pre-op diagnosis of uterine cancers by gynecologists

Robert Redfield, director of the Centers for Disease Control and Prevention, said the agency is reviewing the methods gynecologists use to identify women at risk of uterine cancers.


Noorchashm: Uterine cancers are not “occult” if gynecologists don’t bother to look

Dear Editor,

As you know, a team of gynecological researchers from Yale University recently reported that the incidence of “missed” cancers in women undergoing general gynecological operations of the uterus approaches 2%. Even more staggering is the reported 10% incidence in such women, over the age of 55.


ISSUE 41 – NOV 2, 2018PDF

Minimally invasive surgery lowers survival in cervical cancer, new studies show

Women who were subjected to minimally invasive surgery for early-stage cervical cancer were four times more likely to die from that disease within three years, three times more likely to have a recurrence within three years, and had shorter overall survival, compared to women who underwent open surgery, according to two groundbreaking studies published in The New England Journal of Medicine Oct. 31.


Conversation with The Cancer Letter

Ramirez: We no longer offer minimally invasive radical hysterectomy at MD Anderson

When cervical cancer patients were referred to MD Anderson Cancer Center for a prospective, phase III trial testing for noninferiority of minimally invasive vs. open abdominal radical hysterectomy, many requested the minimally invasive approach, because their referring physicians said it was better, said Pedro Ramirez, a professor of gynecologic oncology at MD Anderson.


Conversation with The Cancer Letter

SGO’s Kesterson: Future studies are needed to define role of minimally invasive surgery in cervical cancer

Gynecologic oncologists need to reduce oncologic risk, but it’s not going to happen without knowing why minimally invasive radical hysterectomies decrease survival of patients with cervical cancer, said Joshua Kesterson, chief of the Division of Gynecologic Oncology at Penn State Cancer Institute.


Experts: Minimally invasive procedures in gynecology gained universal acceptance before hard questions were asked

I think these investigators should be commended in doing this trial and coming up with these results. It shows that, in a clear way, we can’t make assumptions in anything we do. The assumption that robotic surgery would be just as good as open surgery is clearly demonstrated here that it’s not a fair assumption.


ISSUE 9 – MAR. 1, 2019PDF

FDA tightens regulation of robotic devices in minimally invasive surgery for cancer

Device manufacturers looking to market surgical tools for use in the prevention or treatment of cancer may now be required to study long-term oncologic endpoints in surgical trials, according to a safety communication published by FDA on Feb. 28.


ISSUE 14 – APR. 5, 2019PDF

Using a robot to perform mastectomies, a New Jersey surgeon sets off a firestorm over surgical outcomes

How much rigor should be required when surgeons innovate? FDA’s advisory asks for long-term cancer-related data.

Last August, Stephen A. Chagares, a breast surgeon, made an announcement that startled some of his colleagues at New Jersey’s Monmouth Medical Center.

At internal meetings and in a press release, Chagares declared that he would perform a robotic mastectomy—a new and relatively untested minimally invasive surgical procedure. According to the press release, his first patient, Yvonne Zucco, 56, was being treated for stage IIa breast cancer.


Conversation with The Cancer Letter

MSK’s Kirstein: Robotic mastectomy not demonstrated to be safe for treatment or prevention of breast cancer

The Breast Surgical Service at Memorial Sloan Kettering Cancer Center has decided not to adopt—or study—robotic surgical devices in mastectomies, said Laurie Kirstein, a breast surgical oncologist at MSK.


Conversation with The Cancer Letter

MD Anderson’s Hunt and Selber: We will study immediate and long-term outcomes of robotic mastectomy in a prospective trial

Robotic mastectomy deserves to be studied, because the procedure may improve cancer-related outcomes, surgeons at MD Anderson Cancer Center say.

Both robotic and open procedures allow the surgeon to follow oncologic principles, said Jesse Selber, professor and director of clinical research at the Department of Plastic Surgery at MD Anderson.


Penn’s Brooks: Surgeons should study oncologic endpoints for years, not just 30-day outcomes

The University of Pennsylvania was planning a short-term trial for robotic mastectomies, but after an FDA advisory, investigators decided to revise that protocol to include assessment of cancer-related outcomes, said Ari Brooks, director of endocrine and oncologic surgery, director of the Integrated Breast Center at the University of Pennsylvania Health System, and professor of clinical surgery at Penn Medicine.


ISSUE 22 – MAY 31, 2019PDF

How a New Jersey hospital used a misguided study of robotic surgery to wage an ill-fated war on breast cancer

Using a da Vinci robot for breast cancer surgery? Is it safe? Effective?

You might want to know that, according to informed consent documents for a study that was approved by the IRB at Monmouth Medical Center, all issues stemming from robotic mastectomy have been sorted out.


Letter from the Editor

The path from a correction to an investigation of research conduct at Monmouth Medical Center

Our investigative story this week is an outgrowth of a correction.

Last summer, Monmouth Medical Center, a 500-bed hospital within the RWJBarnabas Health system, came to The Cancer Letter’s attention when a breast surgeon there used a da Vinci robot to perform robotic nipple-sparing mastectomies on two patients, a woman with invasive breast cancer and a man with abnormal growth in his breast.


Conversation with The Cancer Letter

Fotopoulos: Monmouth Medical Center told us to not follow up with robotic mastectomy patients

As the team lead by surgeon Stephen Chagares prepared a protocol for robotically-assisted mastectomy, the Institutional Review Board at Monmouth Medical Center provided guidance “every step of the way,” said Nicholas Fotopoulos, a research coordinator and an undergraduate at Princeton University in his sophomore year.


ISSUE 44 – NOV. 22, 2019PDF

Robotic mastectomy surgeon sues Monmouth, alleging defamation, antitrust violations

Stephen A. Chagares, a New Jersey general surgeon who recently set off a national debate by using a robotic surgical device to perform mastectomies, has filed a lawsuit claiming defamation and violation of federal and state antitrust laws on the part of Monmouth Medical Center.

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