Two-day surgery could help patients with advanced cancer

Complex surgery planned over two days could expand options for patients with the most advanced pelvic cancers, according to a new study.

Surgeons in Southampton are using a planned two-day surgical approach for patients with the most advanced and complex pelvic cancers.

A new study suggests this technique could expand access to potentially curative surgery.

Published in the journal Colorectal Disease, it is the first to report on this approach. Major cancer surgery is deliberately carried out over two consecutive days, rather than as a single extremely long operation.

Treating advanced pelvic cancer

In the UK, around 4,000 people each year are diagnosed with advanced pelvic cancers. These include cancers of the bowel and other organs deep within the pelvis.

For many of these patients, standard treatments such as chemotherapy or radiotherapy are no longer effective. This leaves major surgery as the only potential route to long-term survival.

This type of surgery can involve removing multiple organs and surrounding tissue to clear the cancer.

Trialling a two-day approach

As cancers become more advanced and involve structures such as bones, nerves or major blood vessels, operations can last well over 15 hours. This pushes the limits of what is safe or practical to complete in one day.

To address this challenge, the Complex Cancer and Exenteration Team at University Hospital Southampton (UHS) developed a planned two-day approach.

The main tumour is removed on the first day. This is followed by reconstruction and remaining surgery on the second day, after a planned overnight stay in intensive care.

The study compared 27 patients who underwent the two-day approach with 38 patients who had very long single-day operations.

Some operations in the two-day group involved up to 28 hours operating time. There were no deaths within 90 days of surgery in either group. Surgeons were able to remove all visible cancer in most cases - 82% in the two-day group and 76% in the single-day group.

Quality-of-life scores and levels of decision regret were similar between the two approaches. This suggests that spreading surgery over two days does not negatively affect patients’ experiences, despite the complexity of the procedures.

Expanding options for patients

Charles West is a Colorectal Surgery Research Fellow at UHS and the University of Southampton.

He said: “Some pelvic cancers are so extensive that trying to complete all of the surgery in one very long day can create significant risks and challenges.

“This study shows that a planned two-day approach can be delivered safely for carefully selected patients, and may allow more people to be considered for potentially curative surgery.”

PLANETS Cancer Charity part-funded the research, alongside Bowel Research UK and Penguins Against Cancer. The charity welcomed the findings.

Neil Pearce is co-founder and chairman of PLANETS Cancer Charity.

He said: “Thousands of people in the UK are diagnosed with advanced pelvic cancers each year and, for many of them, surgery offers the only chance of long-term survival.

“This study provides important early evidence that a planned two-day approach can be safe and acceptable for patients, and may help expand treatment options for those facing the most complex disease.”

The authors emphasise that this remains highly specialised surgery, suitable only for carefully selected patients in expert centres. However, they say the findings provide an important foundation for further research and collaboration.