Medical advances could soon spare patients surgery, say experts

Thousands of people every year could be spared surgery for cancer and worn-out joints thanks to better drugs, vaccination and advances in genomics, a report by medical experts predicts.

Developments in surgery could also make many operations less invasive and more effective, while more patients would have preventive procedures to stop an illness worsening.

The widespread take-up of the human papilloma virus vaccine, for instance, should mean that thousands of people will in future not develop cervical, oral and anal cancer, so not need surgery.

Similarly, expansion in the role of immunotherapy to treat cancer should mean that some people who get the disease will not need surgery because the drugs will have shrunk the tumours. Improved ways of delivering radiotherapy should also cut the number of cancer operations.

In addition, the potential of stem cells to treat osteoarthritis – using patient cells to repair damaged joints – is likely to lead to fewer hip and knee replacements.

The projections are contained in a report on the future of surgery by an independent commission of medical experts for the Royal College of Surgeons of England.

Several hundred thousand operations for cancer alone could become obsolete over the next 20 years, the commission concluded.

Genomics, the use of DNA to predict who is likely to develop a particular illness, would play the biggest role in making surgery unnecessary in an increasing number of cases, the commission found.

“Genomics will likely have the biggest impact as our ability to sequence genomes and identify patients carrying genetic mutations or inherited conditions that increase their risk of developing cancer improves,” said Richard Kerr, the commission chair. “This will likely reduce the number of cases of breast, colorectal and thyroid cancer requiring surgery.”

For example, “liquid DNA analysis” involving blood tests could lead to patients getting a quicker diagnosis and having preventive surgery earlier than at present. That could lead to tumours being removed soon after they are spotted rather than patients having an entire organ taken out.

A new generation of smaller surgical robots will play an expanding role in operations, the medical experts concluded after their year-long inquiry. That is expected to make surgery less demanding for patients and speed up recovery times. Robots will increasingly be used in gynaecological procedures as well as colorectal and cardiothoracic operations in the 2020s and 2030s.

Kerr said medicine was on the cusp of potentially “transformative changes in surgery that have the potential to dramatically improve patients’ care, helping them to live healthier lives for longer”.

Stephen Powis, NHS England’s medical director, said the NHS’s world-leading role in collecting data on patient health and the 100,000 Genomes Project meant it was “well-placed to incubate and exploit the full benefits of this future”.

Matt Hancock, the health and social care secretary, said: “Technology has the potential to revolutionise the NHS by equipping staff with life-saving tools, preventing diseases before they develop and empowering patients to take greater control of their own health. I am determined to nurture a culture of innovation in the NHS to allow cutting-edge technology to flourish and make our health service the very best it can be.”


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