SURGICAL ONCOLOGY
Commonly known as ‘Cancer Surgery” is performed by trained Surgical Oncologist or known as ‘Cancer Surgeons’. Oldest specialty to cure Cancer still remains most important factor for cure, control and palliate Cancer. With the advances in the technologies the specialty has become more modern and less morbid..
Dawn of the 21st century also came with recommended standard treatment options and explosion of knowledge. Upgrading instruments and skills is now a permanent fixture in almost all specialties including surgical Oncology. Surgery is now not only with known outcomes but with minimal pain. The unexpected complications and discovery of some unknown factors are part of the historical archives. Minimal invasive surgery, small surgeries, cosmetically acceptable outcomes, minimal pain, early recovery and increased possibility of cure are hall marks of the recent ‘Cancer Surgery’.
At Ruby Hall, the constant quest to stay with time and sometimes racing ahead of the times is a norm. Team of two senior oncosurgeons with 5 associate consultants, 5 post graduate junior consultants, and three junior colleagues form the strong team.
Ruby hall remains one of the leading Cancer surgical care provider in India now for more than a decade. Modernisation and upgradation of the surgical skills also reflect in yearly oraganised national and international conferences. ‘Recent Advances in Cancer’ is a yearly event organized for last ten years.
More than 30 percent Cancer occurs in oral cavity and throat. Tobacco in different forms and abuse of alcohol is main reason for the increasing incidence in India.
Ruby Hall Clinic, being tertiary care institute and prominent Cancer institute in India, gets large number of oral Cancers. Most of the patients are male and young. Tongue Cancer and oral buccal Cancer is most common in this category. Most of these patients are in curative category but require extensive treatment in the form of surgery, radiotherapy and chemotherapy.
Ruby Hall Clinic is pioneer in aesthetic surgical methods, cosmetically acceptable results with minimal functional morbidity. Free tissue transfer one of the most important aspect in this surgery is common in Ruby Hall. Oral defects resulting in inability to open mouth and facial disfigurement is avoided by free fibular bone flap molded in the shape of the excised segment of jaw bone and implanted with micro-vascular anastomosis. A further research to insert dental implants in this transferred bone is going on. Image guided radiotherapy resulting fewer complications is giving very good results.
Annually more than 500 patients undergo this surgery at Ruby Hall and remain free of disease. Post treatment rehabilitation in the form of physiotherapy, diet modification advise, dysphagia and speech clinics are available at Ruby Hall.
Breast Cancer is one of the few Cancers which is showing a trend of decline from its peak world over. In India story is different, due to rapid urbanization and multiple socioeconomic factors the incidence of breast Cancer has jumped to number one position Cancer in women in India, surpassing cervical Cancer.
Although more than 80 percent patients diagnosed with breast Cancer are cured with modern treatment. Ruby Hall clinic started the endevour of excellence in treatment of breast Cancer quite early. One of the first Centre to offer breast conservation surgery in india and amongst very few to offer sentinel node biopsy in 2004.
Comprehensive set up of state of the art pathology Department, radiology Department to diagnose early tumours with minimal invasive needle biopsies and treating small non palpable breast Cancer has been a long strenuous journey. Aesthetic results with oncomammoplasty is standard practice at Ruby hall clinic.
Free tissue transfer, DIEP Flap, TRAM flap, pedicled flap are done by team of expert senior plastic surgeon trained in USA and UK.
Scientific research and finding new treatment avenues and making the life better for breast Cancer patients is been a constant effort for many years. Ruby Hall organizes bi-annual international conference to get the experts in the field together to deliberate the best treatment options and is aptly labeled as ‘Recent Trends in Breast Cancer’. Multiple scientific papers are published in international and national journals on novel methods of treatment for breast Cancer. Maharashtra Medical University fellowship affiliated to state government in breast Cancer is started for training young surgeon in this complex field.
Breast conservation surgery has long been established as a safe option for the treatment of Breast Cancer. However,a routine Breast conservation surgery becomes an inadequate procedure if the tumour size is slightly larger in relation to the breast size (larger tumour : breast size ratio). Breast Oncoplasty involves application of plastic surgery techniques while conserving the breast, in order to improve the cosmetic outcomes. It helps in maintaining the size, shape and symmetry of both the breasts while allowing slightly larger volumes of resection. Apart from being safe oncologically, oncoplasty techniques impart aesthetically better results, enhancing quality of life. Three main steps involved in oncoplasty are – resection of primary tumour with adequate margins, remoulding / reshaping of the breasts and symmetrization (either by reduction or by repositioning of the nipple) of the opposite normal breast, if required. Thus, it also helps in improving the appearance of both the breasts. All the procedures happen in one sitting and require hospital stay for 2-3 days. Most of the women can get back to work in 7-10 days.
Introduction:
The Centre for advanced GI Oncology at the Kamalnayan Bajaj Cancer Centre,Ruby Hall Clinic is one of the largest and most experienced Centers in India.The specialised Centre for Gastrointestinal Cancers was established with a focus on evidence based medicine and to provide patients with the best in medical care.
Multidisciplinary Patient Care is the hallmark of treatment at this state of art Centre. Each patient has a medical team dedicated to his or her care. This team includes experienced gastrointestinal (GI) Cancer specialists — gastroenterologists, endoscopists, diagnostic and interventional radiologists, pathologists, GI Oncology surgeons, medical oncologists, radiation oncologists, nurse practitioners and Oncology nurses — all of whom exclusively treat patients with GI Cancers.
Our team of diagnostic radiologists is nationally recognized for its expertise in using the most advanced imaging tools to safely and rapidly diagnose and stage GI Cancers or to detect changes in tumors.
Services:
- Surgery
- Gastroenterology
- Imaging
- Radiation Oncology
- Medical Oncology
- Stoma Clinic
Surgery:
Our achievements: High volume Centre for hepatopancreatobiliary surgery – Centre of excellence for pancreatic surgery in western India.
Pioneers in 3D laparoscopy – Aesculab state of the art laparoscopic system for advanced minimally invasive surgery in GI Cancers.
Among the few Centres in Western India to offer HIPEC therapy for selected Cancers.
Our Motto:
Excellence in Surgical Care: Our GI Cancer surgeons have pioneered many now-standard procedures as well as minimally invasive surgical techniques that ensure rapid recovery and nerve preservation helping patients retain normal organ function.Our operating rooms include some specially designed to facilitate complex procedures, allowing GI surgeons to work side-by-side with multiple surgical subspecialists.
High Volume Leads to Better Outcomes: Studies have demonstrated that high-volume experience results in improved outcomes for patients. As a high-volume GI Cancer surgery Centre, we are one of the leaders in western India in procedures to treat pancreatic Cancer. We also are among national leaders for a number of complex procedures to treat GI Cancers,and we have developed expertise in all the sub-specialities.
Colorectal surgery-
- Pouch procedures for Ulcerative colitis
- Sphincter saving procedures for rectal Cancers
- Laparoscopic resections
- Colonic and bowel resections
Foregut surgery –
- Radical gastric resections including spleen preserving surgery.
- Thoracoscopic radical esophagectomy
- Total esophageal replacements including coloplasty and free jejunal transpositions
Hepatobiliary surgery –
- Pancreatoduodenectomy and laparoscopic pancreatic resections
- Liver resections and complex hilar surgery
- Gall bladder resections
- Shunt surgery and devascularisation procedures
Other high-volume complex procedures include:
- HIPEC therapy for mucinous malignancies including colorectal metastasis
- Multiorgan and vascular resections for sarcomas
Gastroenterology:
- Interventional endoscopic procedures like EMR and ESD for early Cancers.
- EUS – endoscopic ultrasound- a highly specialized and sensitive test developed at the Digestive Healthcare Centre to image and biopsy the pancreas, esophagus, stomach and rectum.
- Endoscopic and EUS guided stents for palliation and as a bridge to surgery.
- Few Centres which offer POEM as an option for foregut motility disorders.
- Capsule endoscopy for diagnostic evaluation of occult lesions in the bowel.
Pathology-
Our pathologists – each of whom specializes in a specific tumor type – evaluate, diagnose and stage all biopsied tumors, usually within 24 to 36 hours. This translates into rapid and accurate diagnosis and staging of the Cancer and leads to faster, more precise treatment for patients.
- IHC and molecular markers for targetted treatment
- Collaboration with genetic counselors and state of the art labs for familial Cancer screening and management.
- Gene mapping for more effective treatment.
Imaging:
- 256 slice CT scan,3 Tesla MRI and the country’s first inline PET scan
- Nuclear imaging Centre with facilities for Dotatate scans,radioiodine ablation
- Interventional team with facilities for
TIPS
- Radio and chemoembolisation of liver tumours
- Radiofrequency ablation
- Vascular and biliary interventions
Radiation Oncology:
Pioneering Radiation Therapy -Our radiation oncologists use the most advanced therapies to treat GI Cancers, many of which are unique or available at few other hospitals.
- 3D-treatment planning and gated radiotherapy, which pinpoints a tumor’s exact location, precisely targeting radiation while minimizing damage to healthy tissue
- Intraoperative radiation therapy, which delivers a precise dose of radiation into the tumor during surgery, sparing surrounding healthy tissue .
- Intensity-modulated radiation therapy/Image guided radiation therapy, which delivers precise radiation doses to a tumor or specific areas.SBRT or steriotactic radiation treatment with the highest volume experience for the same.
Medical Oncology:
Our medical Oncology team is a vital part of our treatment protocols and have a vast experience in administration of novel treatment options including targeted therapy. Indwelling venous access devices ,ports and continuous infusion therapy in a stae of the art day care Centre is available.
Stoma Clinic:
Many patients undergo ostomy surgery that alters their normal passage of elimination. Abdominal stomas are being constructed with increasing frequency in the treatment of various malignant, congenital, inflammatory and traumatic conditions.
The deprivation of normal control and alteration in physical appearance can have profound psychological impact.
The Enterostomal Therapist (ET) provides direct patient care to person with abdominal stomas, fistulas, draining wounds and incontinence, as an educator, consultant and researcher. With additional knowledge, specific skills and desirable attitudes an ET can be the turning point in the life of an ostomate especially when he is under severe strain and depression. An ET patient can resume his normal activities and regain his self esteem.
The life of the ostomate has been vastly improved by technical advancement in surgical techniques, prosthetic devices combined with the development in specialized stoma-care with the five phases of ostomy rehabilitation.
- Pre-operative phase (psychological preparation)
- Recuperative phase (post operative care, fixing of stoma appliance)
- Transition phase :Hospital discharge planning and psychological preparation to adjust with stoma.
- Post-hospital phase (follow up care for evaluation of stoma and suggestion of proper appliances, self care, nutritional guidance)
A fully developed unit with the services of a team of surgeons , pulmonologists and support staff has made the unit a standout performer in the Department.Aggressive management of esophageal and lung Cancers has been able to reduce morbidity associated with these procedures.
- Thoracoscopic interventions
- Minimally invasive esophagectomy
- Mediastinal tumours excision
- Conservative lung surgery
We are one of the few Centres in the country to have dedicated surgeons specially trained in orthopaedic Oncology.Comprehensive care involving the surgeons , medical oncologists and rehabilitation team has been the fulcrum running the service.
- Limb conservation surgery
- Megaprosthesis custom built devices
- Complex sacral and pelvic tumour excisions
Incidence of Cancer in women is less compared to men, probably due to less risky life.
Style compared to men. Irony is in spite of less women getting affected by Cancer the mortality is almost similar to men. Inaccessibility of health services, male dominated society and careless attitude by men and women towards health of women is the main cause.
Commonest gynaecologic Cancer in women is cervical Cancer and well recognized prevention is Pap smear. Other commonest Cancer in women is breast Cancer and has more incidence than cervix in urban areas. Information on breast Cancer is given separately. Ovarian Cancer and endometrial Cancer are other two very common Cancers in women.
Early diagnosis and surgery followed by radiotherapy or chemotherapy is mainstay of the treatment. Most of these Cancers require a proper oncological surgery and staging of the disease. Minimal invasive or laparoscopic surgery for cervical Cancer reduces surgical pain and is preferred over open surgery. Similar unnecessary or wrong laparoscopic surgery can harm patient. Ovarian Cancer surgery is generally done by open surgical technique due to fear of spreading the tumour cells by laparoscopic surgery.
HIPEC or heated intraperitoneal chemotherapy during surgery is one of the most promising techniques for improving result of the surgery after complete removal of tumour. Also called as complete cyto-reductive surgery.
Ruby hall surgical Oncology team is pioneer in most of these techniques due to efficient surgical team and good infrastructure. Results of last ten years of these surgeries show improved quality of life and overall survival in these Cancers.