WebMD Health News
Louise Chang, MD
June 2, 2008 -- Sen. Edward Kennedy's brain surgery, done this morning at Duke University Medical Center in Durham, N.C. to treat Kennedy's brain cancer, was "successful," Kennedy's doctor says.
Here is the statement from Duke neurosurgeon Allan Friedman, MD: "I am pleased to report that Senator Kennedy's surgery was successful and accomplished our goals. Senator Kennedy was awake during the resection, and should therefore experience no permanent neurological affects from the surgery. The surgery lasted roughly three and a half hours and is just the first step in Senator Kennedy's treatment plan. After a brief recuperation, he will begin targeted radiation at Massachusetts General Hospital and chemotherapy treatment. I hope that everyone will join us in praying for Senator Kennedy to have an uneventful and robust recovery."
A resection removes the tumor, but experts say the type of tumor Kennedy has likely can't be totally removed by surgery.
Before the operation, Kennedy's office released a statement noting that Kennedy will spend about a week recovering at Duke University Medical Center. Kennedy will return to Massachusetts General Hospital, where his tumor was diagnosed, for radiation treatments and chemotherapy.
Kennedy, 76, has a type of brain tumor called a malignant glioma. Doctors at Massachusetts General Hospital announced Kennedy's brain cancer diagnosis on May 20. The next day, Kennedy was discharged from Massachusetts General Hospital.
Since then, brain cancer survivors who have dealt with similar types of brain cancer have encouraged Kennedy to remain hopeful.
In his presurgery statement, Kennedy said he is "deeply grateful" to everyone who has expressed support "as I tackle this new and unexpected health challenge." Kennedy also says he looks forward to returning to the U.S. Senate and "doing everything I can to help elect Barack Obama as our next president."
WebMD spoke with two experts about Kennedy's brain surgery while the operation was still under way.
Heros and Flamm aren't treating Kennedy.
What does "targeted surgery" involve?
Heros: Targeted surgery is kind of a nonspecific term. If the purpose of the surgery is to achieve a maximum resection [removing as much of the tumor as possible]; oftentimes the surgery is performed while the patient is awake, so they can monitor the speech and avoid impairing his ability to understand speech and speak. ... Also, they can examine him during the procedure to make sure they do not cause motor weakness.
We know that we cannot totally resect these tumors because of the rootlets of tumors invading or infiltrating the brain tissue. ... There is evidence that if the tumor can be maximally resected [removed as much as possible], that may increase the chance of longer survival and better result from treatment.
Flamm:I assume today's surgery was an attempt to remove a significant amount of the tumor. The purpose of doing this is to reduce the "tumor burden," which would make the radiation and chemotherapy more effective. ... Let's say it was in a more favorable place where you wouldn't be concerned about damaging [language-related] areas of the brain. Even if you said, "I think I got it all," you would still follow up with radiation and chemotherapy, because if you don't, the tumor will be back in a matter of months.
Dr. Heros, when Sen. Kennedy was diagnosed, you said that because of the tumor's location, surgery probably wouldn't be a major component of treatment. But he is having surgery. Does that tell you anything about his condition?
No. The decision to perform surgery is very dependent on the judgment of the neurosurgeon. One thing we don't want to do is to impair neurologic function that could limit quality-of-life issues for the sake of resecting more tumor tissue. This is very much a judgment made by the neurosurgeon.
What are some of the risks from the surgery?
Heros: The main risks that we would be concerned about would be -- since it is on the left side of the brain -- is for some loss of speech function. And that it could be ... the decreased ability to understand speech [or] speak words properly. It may include difficulty using numbers, reading, or writing. A risk may also include decreased vision to the right side of their visual field and motor weakness of their right face, arm, and leg.
Does his age make a difference in those risks?
Heros: I don't believe that the age makes the difference in the immediate risks. Sometimes age makes a difference in terms of recovery if deficits do occur. The main risk is, of course, the location of the tumor.
If there were complications, would they be immediately obvious?
Heros: The neurologic deficits should be immediately obvious. Of course, we always have to watch for secondary medical complications -- infection, making sure the surgical incision heals well, and there are some other medical complications that can occur after surgery that the physicians would monitor him for.
What's the recovery process like? Sen. Kennedy's statement indicates that he expects to be in the hospital for about a week.
Heros: The recovery time depends totally on what happens at the time of surgery, whether or not there are any neurologic deficits as well as the medical condition of the patient. Hopefully, we can look forward to hearing that Sen. Kennedy leaves the hospital within that amount of time.
Why do you think he chose to go to Duke and Dr. Friedman?
Heros: Oftentimes [patients] seek multiple opinions, and this decision to have surgery is a recommendation based on the judgment of the surgeon. There are several centers in the country that perform motor mapping awake surgery, and Duke is well known for this, as many other centers are.
Flamm: The people who met up at the MGH [Massachusetts General Hospital] were from the MGH, Duke, and UCSF [University of California at San Francisco]. They have big tumor programs at these places, as do other places. But I don't know what prompted that particular decision. ... There's nothing that one of these large university medical centers has that the others aren't aware of. It may be that he thought he'd get more privacy outside of Boston. I don't know. You can speculate on any reason. Maybe he liked Allan Friedman. He's a nice guy. But so are the people at the MGH.
Anything else you would want to add?
Heros: Now we need to wait and hear from Duke how the surgery went and look forward to Sen. Kennedy's recovery.
Flamm: I just wish him well. It's a devastating diagnosis.
SOURCES:Statement, Allan Friedman, MD, Duke University Medical Center.Statement, Sen. Edward M. Kennedy.WebMD Medical News: "Sen. Ted Kennedy Has Brain Cancer."WebMD Medical News: "Sen. Ted Kennedy Leaves Hospital."WebMD Feature: "The Faces of Brain Cancer."Deborah Heros, MD, associate professor of clinical neurology and neuro-oncology, University of Miami Leonard M. Miller School of Medicine.Eugene S. Flamm, MD, Jeffrey P. Bergstein Professor and chairman, department of neurosurgery, Montefiore Medical Center at Albert Einstein College of Medicine, New York.
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