Surgical oncologists do not understand what tumours are: they remove the tumour and 'clean out' the lymph nodes, which he regards as wrong.
Original statement
عليا بقى بتوع جراحه الاورام جراحه الاورام ده يا عيني ما يفهمش يعني ايه اورام هو بيخش يشيل الورم هو مالوش دعوه بيه وبي بينقي الليمف نودز بينقي الغدد الليمفاويه الغدد الليمفاويه دلوقتي انت بتنقيها
verbatim according to source. Translation by the project; the Arabic wording is authoritative.
Translation
Surgical oncologists do not understand what tumours are: they remove the tumour and 'clean out' the lymph nodes, which he regards as wrong.
Origin
- Source status
- Video transcript (own words)
- Attribution
- Elawady (machine transcript)
- Video
- Dr Diaa Al Awady د ضياء العوضي is live! السيليوليت (Open source)
- Published
- 11 October 2025
- Timestamp
- 0:05:12 (location in the original video’s automatic YouTube caption track; confirms where the words occur, not who speaks)
- Attribution uncertainty
- Transcript is YouTube CC or machine-generated (no timestamps); wording may contain speech-recognition errors. Speaker attribution within live streams/podcasts is not marked in the transcript; the excerpt was judged to be Elawady's own speech from context. Recurrence = number of archive transcripts matching the keyword pattern ['الغدد الليمفاويه|الليمف', 'تشيل|بينقي|استئصال|يشيل'] (approximate; includes re-uploads/clips; 5 distinct text passages).
- Claimed mechanism
Not stated in this excerpt.
- Claimed health effect
Not specified.
- Population concerned
Cancer patients undergoing surgery.
- Geographic restriction by Elawady
none found; he does not limit this statement to a country or to a production system
Diverging source versions
- Source status
- Video transcript (own words)
- Attribution
- Elawady (machine transcript)
- Video
- Dr Diaa Al Awady د ضياء العوضي is live! لايف مفاجيء (Open source)
- Published
- 5 August 2025
- Timestamp
- not available (transcript has no timings)
- Attribution uncertainty
- Further video in which the same statement recurs; no excerpt recorded. Archive transcript without timestamps.
Scientific assessment
Mostly false – Essential parts of the statement are not supported by the evidence or are strongly exaggerated.
Certainty of evidence: moderate – Further research may still affect the assessment.
1. What was claimed?
Surgical oncologists do not understand what tumours are; they remove the tumour and 'clean out' the lymph nodes, which he regards as wrong.
2. What is demonstrably correct?
Part of his criticism matches what oncology itself learned from trials: removing all axillary nodes did not improve survival compared with less extensive surgery over 25 years (I-INTB-05); in women with 1-2 positive sentinel nodes, skipping full axillary dissection was non-inferior for 10-year survival (86.3% vs 83.6%) (I-INTB-06); in melanoma, completion lymph-node dissection did not improve melanoma-specific survival and caused lymphoedema in 24.1% vs 6.3% (I-INTB-07). Arm lymphoedema affects about one in five breast-cancer survivors and is about four times more common after axillary dissection (I-INTB-08). The German INSEMA trial (5502 women) showed that in small, clinically node-negative breast cancers even sentinel-node biopsy can be omitted without worse 5-year disease-free survival (91.9% vs 91.7%), with less arm swelling (I-SRC-106).
3. What is wrong or exaggerated?
The claim that surgical oncologists 'do not understand' tumours is a personal judgement, not a finding. The de-escalation of lymph-node surgery came from oncologists' own randomised trials. In all these trials the tumour itself was removed, and sentinel-node biopsy remained because nodal status gives prognostic information (I-INTB-07). Using alternative-only care instead of standard treatment for curable cancers was associated with higher death rates (I-CHM-03). In the US SEER registry, the 0.64% of breast-cancer patients who refused recommended surgery had about a 2.4-fold higher risk of death (observational; I-SRC-107). UK NICE guidance follows the trials: sentinel-node biopsy rather than full clearance, and further surgery when the tumour reaches the margin so that it is completely removed.
4. What remains unclear?
How much lymph-node surgery is optimal differs by cancer type; this assessment used breast cancer and melanoma trials.
5. Which studies support it?
I-INTB-05, I-INTB-06, I-INTB-07, I-INTB-08, I-SRC-106 (support less lymph-node surgery).
6. Which studies contradict it?
I-CHM-03, I-SRC-107 (against refusing cancer surgery or treatment).
7. What applies to Germany and Europe?
European practice follows these trials (sentinel-node biopsy, less axillary dissection).
8. What is known about Egypt?
The same evidence applies; access to sentinel-node techniques may vary.
9. What practical conclusion is appropriate?
Less lymph-node surgery is appropriate for many patients, and this is decided by oncology teams using trial evidence. It is not a reason to refuse tumour surgery.
Assessment details
- Rationale for certainty of evidence
RCTs show that routine extensive lymph-node dissection does not improve survival in breast cancer and melanoma (I-INTB-05, I-INTB-06, I-INTB-07) and causes lymphoedema (I-INTB-08), which supports part of his criticism. The broader message - that surgical oncologists do not understand tumours and that removing tumours and nodes is wrong - is not supported; these trials all kept tumour removal and sentinel-node staging.
- Source quality
Machine transcript of a live stream; wording may contain recognition errors; meaning checked in context.
- Regional transferability
High; the same trial evidence underlies EU and Egyptian practice.
- Individual exceptions
The need for lymph-node surgery depends on tumour type, stage and node findings.
- Regional scope of the claim
- general (biological/medical)
- Last reviewed
- 26 October 2026 provisional
Scientific evidence in detail
Overinterpreted – A real finding exists, but the claim draws more from it than the data allow (e.g. association taken as cause, animal data applied to humans, small effect presented as large).
Research question: In solid cancers, does removing the tumour and (where indicated) staging or removing lymph nodes improve outcomes compared with less or no surgery?
Research question in detail (PICO)
- Population
- Patients with operable solid cancers (evidence mainly breast cancer and melanoma)
- Intervention or exposure
- Tumour resection with lymph-node staging/dissection
- Comparison
- Less extensive or no lymph-node surgery; no surgery
- Geographic scope
- universal biology
- Outcomes
- Overall/disease-free survival
- Regional recurrence
- Lymphoedema
Study results as reported by the authors. Our assessment follows below.
What speaks for the claim?
Skipping armpit lymph-node surgery in small breast cancers
Reimer T et al.. N Engl J Med 2025 · PMID 39665649 · DOI 10.1056/NEJMoa2412063 Randomised controlled trialabstract checkednewly addedINSEMA RCT: omission of sentinel-node biopsy in cT1-2 cN0 breast cancer with breast-conserving surgery.
- Actual result
- 5-y iDFS 91.9% vs 91.7%; HR 0.91 (0.73-1.14); less lymphoedema.
- Methodological quality
- high (large RCT)
- Relevance
- direct for less node surgery
- Limitations
- Tumour removed in both arms.
Fewer lymph nodes removed, same survival
Giuliano AE et al.. JAMA 2017 · PMID 28898379 · DOI 10.1001/jama.2017.11470 Randomised controlled trialfull text, structured risk-of-bias assessmentZ0011 RCT: no axillary dissection with 1-2 positive sentinel nodes.
- Actual result
- 10-year survival 86.3% vs 83.6% (non-inferior).
- Methodological quality
- high
- Relevance
- direct for less node surgery
- Limitations
- Selected patients.
Full lymph-node removal in melanoma did not extend life
Faries MB et al.. N Engl J Med 2017 · PMID 28591523 · DOI 10.1056/NEJMoa1613210 Randomised controlled trialfull text, structured risk-of-bias assessmentMSLT-II RCT in melanoma.
- Actual result
- Completion dissection did not improve melanoma-specific survival; lymphoedema 24.1% vs 6.3%.
- Methodological quality
- high
- Relevance
- direct
- Limitations
- Sentinel biopsy retained.
What speaks against the claim?
Refusing breast-cancer surgery
Gaitanidis A et al.. Clin Breast Cancer 2018 · PMID 28784267 · DOI 10.1016/j.clbc.2017.07.010 Cohort studyabstract checkednewly addedSEER: refusal of recommended breast-cancer surgery.
- Actual result
- 0.64% refused; about 2.42-fold mortality risk.
- Methodological quality
- low (confounded)
- Relevance
- direct for refusing tumour surgery
- Limitations
- No CI in abstract.
Patients who used only alternative medicine for curable cancer died more often
Johnson SB et al.. J Natl Cancer Inst 2018 · PMID 28922780 · DOI 10.1093/jnci/djx145 Cohort studyabstract checkedAlternative medicine instead of standard care.
- Actual result
- Alternative medicine alone vs conventional treatment: death HR 2.50 (1.88-3.27); breast cancer HR 5.68 (3.22-10.04).
- Methodological quality
- low-moderate
- Relevance
- direct for replacing treatment
- Limitations
- Observational; small alternative-medicine group.
What does the overall evidence say?
Editorial assessment based on the studies above – not itself a study result.
Which position is better supported?
Tumour removal remains essential; lymph-node surgery has been de-escalated by oncologists' own trials and is decided individually.
Why some studies weigh more
Large RCTs support less node surgery but all retained tumour removal; observational data on refusing surgery are confounded but consistent.
Is a causal relationship established? Yes, established RCTs establish that less node surgery is safe in defined groups; tumour removal is part of every trial arm.
Remaining uncertainty
Optimal extent of node surgery differs by cancer type and stage.
Justified conclusion
He is partly right that routine extensive lymph-node removal is often unnecessary, but this insight comes from surgical oncology itself; the claim that surgeons do not understand tumours and that removing tumours is wrong is not supported.
Why do studies seem to disagree?
Trials supporting less node surgery (I-SRC-106, I-INTB-06/07) and data against refusing surgery (I-SRC-107) do not conflict: they address node surgery versus tumour surgery.
Does this depend on the country?
- General biological effects
- Universal.
- Eating habits
- Not applicable.
- Origin of the food
- Not applicable.
- Contaminants
- Not applicable.
- National production conditions
- Not applicable.
- Legal rules
- NICE NG101 (UK) follows these trials.
- Actual monitoring data
- Not applicable; access to sentinel-node techniques in Egypt may vary.
A regional difference that changes the conclusion is not supported by robust data.
Statistical re-check
- HR CI symmetry and non-inferiority margin; absolute difference – HR 0.91 (0.73-1.14) symmetric; upper bound below 1.271; iDFS difference +0.2 points recalculated
- Proportion refusing; CI of mortality effect – 3389/531,700 = 0.64% (matches); mortality HR 2.42 given without CI - cannot be checked recalculated
Certainty of the overall evidence (GRADE, simplified)
- Main outcome
- Survival after omitting tumour surgery
- Starting level
- low (observational studies)
- Reasons for downgrading
- risk of bias: confounded observational data
- Reasons for upgrading
- large effect (about twofold mortality)
- Result
- low
Simplified assessment by a single reviewer, following the GRADE approach; not a formal GRADE panel. GRADE rates the body of evidence for one outcome, not individual studies.
Clinical guidelines and official statements checked
- NICE: NG101 Early and locally advanced breast cancer: diagnosis and management (last updated 14 April 2025) (2025) · Original publication
Use sentinel-lymph-node biopsy rather than axillary clearance to stage the axilla when ultrasound/biopsy is negative; do not offer further axillary treatment for micrometastases or isolated tumour cells; offer further surgery when tumour is at the margin (0 mm) to ensure the tumour is fully removed. - ESMO: Early breast cancer: ESMO Clinical Practice Guideline (2024) · Original publication could not be retrieved; content not used
Search strategy
Documented literature searches for this review (search strings in the original database syntax).
| Database | Date | Search | Looking for | Hits | Included |
|---|---|---|---|---|---|
| PubMed | 26 October 2026 | (omission OR omitting) sentinel lymph node biopsy breast cancer randomized trial (INSEMA OR SOUND) | supporting evidence | 21 | |
| Europe PMC | 26 October 2026 | (lymphadenectomy OR "lymph node dissection") AND (randomized OR randomised) AND (survival) AND (gastric OR colorectal OR melanoma OR breast OR endometrial) AND ("meta-analysis") AND PUB_YEAR:[2018 TO 2026] | both directions | 4484 | |
| PubMed | 26 October 2026 | (refusal OR refused OR declined) surgery breast cancer survival National Cancer Database | contradicting evidence | 62 | |
| PubMed | 26 October 2026 | early breast cancer ESMO clinical practice guideline diagnosis treatment follow-up 2024 | guidelines | 3 | |
| NICE / ESMO / Annals of Oncology websites | 26 October 2026 | NICE NG101 recommendations; ESMO early breast cancer guideline 2024 (ESMO page and Ann Oncol full text returned 403/no content) | guidelines | 3 |
How deeply was this checked?
7 linked studies: 2 checked in full text (2 of them with a structured risk-of-bias assessment), 5 on the basis of the abstract, 0 bibliographically only. No formal assessment with two independent reviewers and no independent human expert review has taken place yet.
Last scientific review: 26 October 2026
History of the verdict
- 25 October 2026 · Phase 1 · Initial assessment: Mostly false (moderate)
- 26 October 2026 · Phase 4 (systematic evidence review) · Re-examined with extended evidence; verdict unchanged: Mostly false (moderate)
INSEMA strengthens the correct part (less node surgery); SEER refusal data and NICE support the safety note. Verdict and certainty unchanged.
New sources: I-SRC-106 I-SRC-107
In plain language
Dr. Elawady said cancer surgeons do not understand tumours and wrongly 'clean out' lymph nodes. Large trials have indeed shown that removing many lymph nodes often does not help survival and can cause lasting arm or leg swelling. Because of these trials, surgeons now remove fewer lymph nodes. But the same trials still removed the tumour, and checking a few 'sentinel' nodes is still useful. Refusing cancer surgery is dangerous.
Studies on this claim
Studies supporting the claim (0)
No studies in this group.
Studies contradicting or limiting the claim (2)
-
Patients who used only alternative medicine for curable cancer died more often
Johnson SB et al.. J Natl Cancer Inst 2018 · PMID 28922780 · DOI 10.1093/jnci/djx145Cohort studyindependent cross-checkabstract checked★ key studyRisk of death was 2.5 times higher overall and 5.7 times higher for breast cancer.
Does the study support the specific claim? No · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Compare AM-only vs conventional treatment.
- How was the study done?
Matched registry cohort.
- How many people, animals or samples were studied?
840 matched patients.
- What was actually found?
HR 2.50 for death.
- How large was the observed effect?
HR 5.68 breast cancer.
- What do the results mean in everyday life?
Replacing cancer treatment with alternatives is dangerous.
- What are the study's limitations?
Observational.
- What does it say about Elawady's specific claim?
Contradicts refusing therapy.
- Do the results apply to Germany and Europe?
Moderate.
- What can explicitly not be concluded from this study?
Effects of complementary approaches used alongside treatment.
-
Refusing breast-cancer surgery
Gaitanidis A et al.. Clin Breast Cancer 2018 · PMID 28784267 · DOI 10.1016/j.clbc.2017.07.010Cohort studyindependent cross-checkabstract checkedPatients who refused recommended surgery had a 2.4 times higher risk of death; the groups also differed in other ways.
Refusing recommended breast-cancer surgery associated with about 2.4-fold mortality (confounded).
Does the study support the specific claim? No · Methodological quality: low · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Study surgery refusal
- How was the study done?
Registry cohort
- How many people, animals or samples were studied?
531,700 patients
- What was actually found?
Refusal rare but linked to higher mortality
- How large was the observed effect?
2.42 times higher mortality risk
- What do the results mean in everyday life?
Refusing surgery is risky
- What are the study's limitations?
Observational, confounded
- What does it say about Elawady's specific claim?
Contradicts distrust of tumour surgery
- Do the results apply to Germany and Europe?
Direction applicable
- What can explicitly not be concluded from this study?
Exact causal effect
No study in this group is marked as key.
Studies with mixed or unclear results (5)
-
Removing all armpit lymph nodes did not improve survival
Fisher B et al.. N Engl J Med 2002 · PMID 12192016 · DOI 10.1056/NEJMoa020128Randomised controlled trialindependent cross-checkabstract checked★ key studyOver 25 years, women without routine axillary dissection survived as long as those with radical mastectomy.
Supports less lymph-node surgery; all arms removed the tumour.
Does the study support the specific claim? Partly · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Compare radical vs less extensive breast surgery
- How was the study done?
RCT
- How many people, animals or samples were studied?
1665 women
- What was actually found?
No survival difference
- How large was the observed effect?
HR 1.03-1.08, CIs include 1
- What do the results mean in everyday life?
Taking out more lymph nodes did not make women live longer; the breast tumour was still removed in all groups.
- What are the study's limitations?
Old trial; abstract only
- What does it say about Elawady's specific claim?
Partly supports his criticism of lymph-node 'cleaning'; contradicts rejecting tumour removal.
- Do the results apply to Germany and Europe?
High
- What can explicitly not be concluded from this study?
Cannot conclude that tumour surgery is unnecessary.
-
Fewer lymph nodes removed, same survival
Giuliano AE et al.. JAMA 2017 · PMID 28898379 · DOI 10.1001/jama.2017.11470Randomised controlled trialindependent cross-checkfull text, structured risk-of-bias assessment★ key studyIn women with 1-2 positive sentinel nodes, skipping full axillary dissection did not worsen 10-year survival.
Supports less lymph-node surgery, not abandoning tumour surgery.
Does the study support the specific claim? Partly · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Test whether full lymph-node dissection is needed
- How was the study done?
RCT
- How many people, animals or samples were studied?
891 women randomised (856 analysed)
- What was actually found?
Survival non-inferior without dissection
- How large was the observed effect?
86.3% vs 83.6% at 10 years
- What do the results mean in everyday life?
Oncologists now remove fewer lymph nodes because trials showed it is safe in selected patients.
- What are the study's limitations?
Specific population; trial closed early with fewer patients and deaths than planned
- What does it say about Elawady's specific claim?
Partly supports his point on lymph nodes; contradicts his claim that surgeons 'do not understand'.
- Do the results apply to Germany and Europe?
High
- What can explicitly not be concluded from this study?
Cannot conclude that tumour removal, sentinel-node staging or lymph-node surgery in other situations (mastectomy, more positive nodes, palpable nodes) is unnecessary
-
Full lymph-node removal in melanoma did not extend life
Faries MB et al.. N Engl J Med 2017 · PMID 28591523 · DOI 10.1056/NEJMoa1613210Randomised controlled trialindependent cross-checkfull text, structured risk-of-bias assessmentCompletion dissection did not improve melanoma-specific survival but caused more lymphoedema.
Supports less lymph-node surgery; nodal staging still valuable.
Does the study support the specific claim? Partly · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Test completion lymph-node dissection
- How was the study done?
RCT
- How many people, animals or samples were studied?
1939 randomised patients (1755 per protocol)
- What was actually found?
No survival benefit; more lymphoedema
- How large was the observed effect?
86% vs 86% 3-year survival; lymphoedema 24.1% vs 6.3%
- What do the results mean in everyday life?
Removing more lymph nodes is not always better; doctors changed practice after this trial.
- What are the study's limitations?
Follow-up only about 3.5 years; per-protocol emphasis; requires regular ultrasound surveillance
- What does it say about Elawady's specific claim?
Partly supports his criticism of lymph-node removal.
- Do the results apply to Germany and Europe?
High
- What can explicitly not be concluded from this study?
Cannot conclude that sentinel-node biopsy or tumour removal is unnecessary; observation was safe only with intensive ultrasound follow-up
-
Arm swelling after breast-cancer lymph-node surgery
DiSipio T et al.. Lancet Oncol 2013 · PMID 23540561 · DOI 10.1016/S1470-2045(13)70076-7Meta-analysisindependent cross-checkabstract checkedAbout 1 in 5 survivors develop arm lymphoedema; risk is about four times higher after full axillary dissection.
Supports harm of lymph-node removal.
Does the study support the specific claim? Partly · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Estimate lymphoedema incidence
- How was the study done?
Meta-analysis
- How many people, animals or samples were studied?
72 studies
- What was actually found?
16.6% overall; 19.9% after dissection vs 5.6% after sentinel biopsy
- How large was the observed effect?
about 4-fold
- What do the results mean in everyday life?
Removing many lymph nodes often causes lasting arm swelling.
- What are the study's limitations?
Heterogeneous studies; abstract only
- What does it say about Elawady's specific claim?
Supports his concern about lymph-node removal as a harm.
- Do the results apply to Germany and Europe?
High
- What can explicitly not be concluded from this study?
Cannot conclude that lymph-node surgery never benefits patients.
-
Skipping armpit lymph-node surgery in small breast cancers
Reimer T et al.. N Engl J Med 2025 · PMID 39665649 · DOI 10.1056/NEJMoa2412063Randomised controlled trialindependent cross-checkabstract checked★ key studyWomen with small breast cancers who had no lymph-node surgery did as well over 6 years as those who had a sentinel-node biopsy, with less arm swelling.
Supports reducing lymph-node surgery in selected patients; tumour removal was part of treatment in both arms.
Does the study support the specific claim? Partly · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Test omitting lymph-node surgery
- How was the study done?
Randomised trial
- How many people, animals or samples were studied?
5502 women
- What was actually found?
No worse survival without node surgery; fewer arm problems
- How large was the observed effect?
5-y iDFS 91.9% vs 91.7%; HR 0.91
- What do the results mean in everyday life?
Less lymph-node surgery is often possible
- What are the study's limitations?
Mostly small tumours
- What does it say about Elawady's specific claim?
Supports less node surgery but tumour was always removed
- Do the results apply to Germany and Europe?
High
- What can explicitly not be concluded from this study?
Whether tumour surgery can be skipped (it cannot be concluded)
No study in this group is marked as key.
Regional context
Germany / EU
European practice follows these trials (sentinel-node biopsy, less axillary dissection).
Egypt
The same evidence applies; access to sentinel-node techniques may vary.
What applies in my country?
General scientific assessment
Mostly false Routine extensive lymph-node removal has been scaled back on the basis of trials, but removing the tumour remains an essential part of cancer treatment.
This statement concerns biological or medical relationships. The scientific assessment above applies regardless of the country; country-specific food data do not change it.
References
- Use of Alternative Medicine for Cancer and Its Impact on Survival.. Johnson SB et al.. J Natl Cancer Inst 2018 · PMID 28922780 · DOI 10.1093/jnci/djx145
- Refusal of Cancer-Directed Surgery by Breast Cancer Patients: Risk Factors and Survival Outcomes.. Gaitanidis A et al.. Clin Breast Cancer 2018 · PMID 28784267 · DOI 10.1016/j.clbc.2017.07.010
- Twenty-five-year follow-up of a randomized trial comparing radical mastectomy, total mastectomy, and total mastectomy followed by irradiation.. Fisher B et al.. N Engl J Med 2002 · PMID 12192016 · DOI 10.1056/NEJMoa020128
- Effect of Axillary Dissection vs No Axillary Dissection on 10-Year Overall Survival Among Women With Invasive Breast Cancer and Sentinel Node Metastasis: The ACOSOG Z0011 (Alliance) Randomized Clinical Trial.. Giuliano AE et al.. JAMA 2017 · PMID 28898379 · DOI 10.1001/jama.2017.11470
- Completion Dissection or Observation for Sentinel-Node Metastasis in Melanoma.. Faries MB et al.. N Engl J Med 2017 · PMID 28591523 · DOI 10.1056/NEJMoa1613210
- Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis.. DiSipio T et al.. Lancet Oncol 2013 · PMID 23540561 · DOI 10.1016/S1470-2045(13)70076-7
- Axillary Surgery in Breast Cancer - Primary Results of the INSEMA Trial.. Reimer T et al.. N Engl J Med 2025 · PMID 39665649 · DOI 10.1056/NEJMoa2412063