Surgical Oncology

Brief Introduction of Specialty

Surgical oncology is a highly specialised field within medicine that is dedicated to the surgical management of cancerous tumours. This discipline goes beyond the mere removal of tumours; it encompasses a comprehensive approach to cancer treatment that starts from the moment a patient is assessed and diagnosed.

The role of a surgical oncologist begins with the clinical evaluation of the patient, which involves a thorough assessment of the patient’s medical history, physical examination, and diagnostic imaging to understand the extent and nature of the tumour. This is followed by performing diagnostic biopsies, which are essential for determining the type of cancer, its grade, and its stage. These steps are crucial for formulating an individualised treatment plan to guide the surgical intervention.

Surgical removal of tumours is at the heart of curative treatment in surgical oncology. Depending on the type and stage of cancer, the surgical oncologist may perform various types of surgeries, ranging from minimally invasive procedures to more extensive surgeries that may involve removing the tumour along with surrounding tissues or organs to ensure complete eradication of cancer. The objective is to achieve clear margins—meaning no cancer cells are left at the edges of the removed tissue—which is critical for preventing recurrence.

In addition to curative surgeries, surgical oncologists also perform palliative surgical procedures. These procedures are designed not to cure cancer but to alleviate symptoms and improve the quality of life for patients who may have advanced or inoperable tumours. Palliative surgeries may involve relieving obstructions, controlling pain, or managing other complications caused by the tumour.

What makes surgical oncology distinct is the deep integration of surgical expertise with a profound understanding of oncology—the study of cancer. Surgical oncologists must be well-versed not only in the technical aspects of surgery but also in the biology of cancer, including how it spreads (metastasis), how it responds to different treatments, and the impact of various therapies on the patient’s overall health. This knowledge allows them to make informed decisions about the timing, extent, and type of surgery that will provide the best possible outcomes for the patient.

Furthermore, surgical oncologists are integral members of multidisciplinary tumour boards, which are teams of specialists from various fields of oncology, including medical oncologists, radiation oncologists, pathologists, and radiologists. In these collaborative settings, surgical oncologists provide expert input on the surgical aspects of cancer management. They help determine whether surgery is the best option, what type of surgery should be performed, and how it fits into the broader treatment plan that may also include chemotherapy, radiation therapy, or targeted therapies.

Year of Establishment

Department of Surgical Oncology was established in April 2021 at Shri Guru Ram Rai Institute of Medical Sciences and Shri Mahant Indiresh Hospital, Dehradun.

Number of Experts/Specialties

The department of Surgical Oncology currently has three full-time faculty members and five junior residents.

Teaching Program & Intake

National Medical Commission has approved 4 MCh Surgical Oncology Seats from the Academic year 2024-25.

Approximate number of cases treated per year

• Average OPD/Year
• Average IPD
• Average number of Minor Surgeries per year
• Average Number of Major Surgery per year

Advancement in Diagnostics and procedures in the Department

The Department of Surgical Oncology has the latest advanced instruments to handle a wide range of complex diagnostic and therapeutic surgical procedures. These include Cytoreductive Surgery (CRS) with Hyperthermic Intraperitoneal Chemotherapy (HIPEC), minimally invasive cancer surgeries (such as laparoscopic, thoracoscopic, and endoscopic techniques), breast reconstruction procedures like oncoplasty, free flaps, and implant-based reconstruction, multi-visceral resections, and complex radical surgeries involving the pelvis, urogenital system, intestines, and lung cancers. The use of modern energy devices, electrical saws, and stapling devices ensures that these challenging cancer surgeries are performed safely and efficiently.

The department also routinely carries out high-end diagnostic and therapeutic procedures like Upper GI Endoscopy, Colonoscopy, and Bronchoscopy. Moreover, all the latest molecular biomarkers required for targeted therapy and immunotherapy are available to patients at affordable rates.

Applying the Latest in research

Latest technological advancements in the management of cancer, such as Sentinel Lymph node biopsy in Breast cancer, cervical cancer, and endometrium cancer, application of Indocyanine green for assessment of vascularity and surgical margins, application of microsurgical techniques for Free flaps and vascular grafts for major oncological reconstruction and placement of limb implants for limb salvage surgeries in advance cancers of the limb.

Collaborative and Multidisciplinary cases

Cancer treatment is a collaborative effort. Every cancer patient is thoroughly evaluated in a Multidisciplinary Tumor Board, which includes Surgical Oncologists, Radiation Oncologists, Onco-anesthetists, and specialists from other fields. This team-based approach ensures that each patient receives a personalized treatment plan tailored to their specific needs, offering the best possible pathway for cancer care.

Important Tests and Procedures

All tests related to cancer diagnosis and treatment are available under one roof at our hospital. These tests include blood biochemistry, Upper Gastrointestinal Endoscopy, Bronchoscopy, Colonoscopy, Laryngoscopy, Histopathology, Malignant Cytology, Immunohistochemistry, Molecular Tests, Genetic Tests, and advanced imaging such as 3 Tesla MRI.

Specialty Clinics

Department of Surgical Oncology conducts specialty clinics as follows:

Special Clinical Cases treated successfully

• Advanced Ovarian Cancer Treated with Cytoreductive Surgery and HIPEC
  A 61-year-old female from Uttarkashi presented to Surgical Oncology Department with advanced Recurrent Ovarian cancer. She was evaluated, and after thorough investigations, she was given six cycles of neoadjuvant chemotherapy. She then underwent Cytoreductive surgery for the removal of visible disease and HIPEC for killing the remaining cancer cells. HIPEC is an advanced procedure in which a combination of high-dose chemotherapy and high temperature is used directly in the abdominal cavity to kill cancer cells. The Procedure involves advanced machine which continuously pumps heated chemotherapy-containing fluid into the abdominal cavity for 1.5 hours. The case of successfully operated by team of Surgical Oncologists and Onco-anesthetists at Shri Mahant Indiresh Hospital.
• Complex Surgical Oncology: Peutz-Jeghers Syndrome with Locally Advanced Hepatic Flexure Colon Cancer

  Peutz-Jeghers Syndrome (PJS) is a rare genetic disorder characterised by the growth of benign (non-cancerous) polyps throughout the gastrointestinal (GI) tract. These polyps can cause abdominal pain, bleeding and obstruction. People with PJS also have an increased risk of developing various cancers, including cancers of the stomach, intestines, pancreas, lungs, breast, ovaries and cervix. At the Department of Surgical Oncology, Shri Mahant Indiresh Hospital, we recently encountered a challenging and complex case involving a patient clinically diagnosed with Peutz-Jeghers Syndrome. The patient presented late in the disease course with adenocarcinoma of the hepatic flexure and severe locoregional spread, including infiltration into hepatic segments 5 and 6, the adjacent body wall, and colonic fistulisation extending to the lumbar body wall, adjacent diaphragmatic wall and 12th rib. Due to the absence of obstruction, our team administered four cycles of neoadjuvant chemotherapy to facilitate prehabilitation and improve the patient’s performance status. He underwent a staging laparoscopy to exclude miliary metastasis and peritoneal involvement, followed by a formal midline exploratory laparotomy and extended right hemicolectomy. This included an en-bloc resection of liver segments 5, 6 and part of segment 4. Entire Surgical Team’s expertise was crucial for precise anatomical preoperative planning, particularly to avoid injury to the duodenum despite dense adhesions. Major liver resection was done using a pseudo liver hanging technique in the constrained space between the tumour, segment 6, diaphragm, and Gerota’s fascia. The final histopathological report revealed ypT4bN0M0 (lymph node yield-30, all margins negative). The patient is currently undergoing adjuvant chemotherapy with close surveillance for Peutz-Jeghers Syndrome.

Team of Doctors

Dr. Pankaj Garg

MBBS, MS, MCh

Department Surgical Oncology Book Appointment

DR. AJEET KUMAR RAMAMANI TIWARI

MBBS, MS, MCH

Department Surgical Oncology Book Appointment

DR. PALLVI KAUL

MBBS, MS, MCH

Department Surgical Oncology Book Appointment