Surgeries

Read about some of the surgeries we perform

Sphincter Saving Surgeries In Rectal Cancer-To Avoid A Permanent Stoma.

Dr Praveen performs the following sphincter saving procedures for rectal cancer

1. Ultra low anterior resection
2. Intersphincteric resection
3. TEMS- Trans-anal Endoscopic Microsurgery
4. TAMIS-Trans Anal Minimally Invasive Surgery

Cancer Surgeries Using Laparoscopy And Robotic Surgery.

Laparoscopic and robotic surgery have revolutionized the surgical field in recent times. Despite the initial hindrances both these approaches have been embraced by cancer surgeons all around the globe…

Cytoreductive Surgery And Hipec

Cytoreductive surgery and HIPEC has changed this perception. With this technique cure is possible in pseudomyxomas and appendicular malignancies and prolonged treatment free periods can be achieved in several types of cancers.

Digestive System Cancer

Cancers of the digestive system ( GI oncology) is a broad term covering cancers arising from different parts of the digestive system starting from esophagus to anal canal. Each segment of digestive system is unique in the type of cells it harbours, in the way it functions and the way it responds to treatment…

Other Surgeries

Chemoport and Hickmann catheters are inserted to gain long term access to large veins in the neck or thorax. This avoids multiple needle pricks to take blood samples, chemotherapy, blood transfusions,drug injections. The procedure can be done under local anesthesia or general anesthesia. The position of the catheter is checked several times using x-ray, ECG and sonography to ensure correct postioning and avoid complications.

  • See FAQ on chemoport insetion
  • See case studies on chemoport inserions

Surgeries for oral cavity cancer
Surgeries for oral cavity cancers entails removal of the affected area with a margin of normal tissue of 1-1.5cm around it to ensure complete removal of the tumor. This is called wide excision. There are various parts in the oral cavity i.e.tongue, floor of mouth, palate, mandible(lower jaw bone), upper alveolus(upper jaw bone), buccal mucosa( inner cheek). Based on the site affected the name of the surgery changes. Sometimes there are more than one area is involved by the tumour.
Surgery name Affected part
Posterior segmental mandibulectomy Removal of the back portion of jaw bone
Hemimandibulectomy Removal of half of jaw bone
Tongue wide excision Tongue
Buccal mucosa wide excision Inner side of the cheek
Upper alveloectomy Upper jaw bone and hard palate
Maxillextomy Cheek bone
Bite resection Upper+low jaw+cheek
Composite resection More than one part
Reconstruction after oral cavity surgery:

All the oral cavity surgeries create a defect. These defects lead to various degrees of impairment in speech, swallowing and appearance. These defects need to be closed attain optimal results. Sometimes when the defects are small they can be closed primarily with good results. But most of the times a tissue from elsewhere in the body is brought in to fill the defect.

The best form of such reconstruction is with a “FREE FLAP”.

Free flap means the tissue is harvested from either your arm or leg along with its blood vessels. These blood vessels are connected to the native blood vessels of the neck so that the tissue survives. Such a technique gives us the freedom to harvest flaps of different sizes,composition and shapres from different sites to fit the defects.

Other form of reconstruction is “PEDICLED FLAPS” where the harvested tissue derives blood supply from its original site.

Eg:

1. PMMC flap –Pectoralis Major Myocutaneous flap
2. DP flap- Deltopectoral flap

Neck dissection:

Oral cavity cancers spread to lymph nodes in the neck. Hence removal of these nodes is also necessary during surgery. This procedure is called neck dissection. Depending on the extent of surgery ,various names have been given to neck dissections.

Eg:

1. Radical neck dissection

2. Modified radical neck dissection

3. Selective neck dissections

4. Supra Omohyoid neck dissections.

  • See FAQ on head neck cancers
  • See case studies on head and neck cancers

Parotid gland is a salivary gland which is situated behind the law bone under the ear. It secrets saliva. While oral cavity cancers are commonly squamous cell cancers caused by some form of tobacco use, tumors of the parotid gland are different. Some examples of the tumours are –pleomorphic adenoma, wathin’s tumour, mucoepidermoid carcinoma, acinic cell carcinoma, adenoid cystic carcinoma. To treat these tumours parotid gland has to be removed either partially or completely depending on what part is affected. Parotid gland is divided into 2 parts –superficial and deep. When only superficial part needs to be removed it is called superficial parotidectomy. When both parts need to be removed it is called total parotidectomy. Incertain instances removal of only a part of superficial lobe is adequate. Then it is called adequate parotidectoomy.

Type of Parotid Tumor Type of Surgery
Pleomorphic adenoma Superficail parotidectomy/adequate parotidectomy
Warthin’s tumour Adequate parotidectomy
Low grade mucoepidermoid Superficial parotidectomy
High Grade mucoepidermoid Total Parotidectomy
Adenoid cystic tumour Total Parotidectomy

Depending on the aggressiveness of the tumour parotid tumours also require neck dissections but mostly not as extensive as oral cancers.

Cancers that affect thyroid are PTC (Papillary thryroid cancer),FTC(Follicular thyroid cancer), Anaplastic thyroid cancers, Medullary thyroid cancers.The last two are quite rare.

2 types of thyroid surgeries are done to address these cancers. Hemithyroidectomy- removal of half of thyroid gland

Total thyroidectomy- removal of the complete thyroid gland

There are several factors that need to be considered before deciding the type of surgery.

In certain cases of thyroid cancers, neck node dissection is also required, which is called central compartment clearance.

  • Read FAQ on thyroid cancer
  • Read case studies on thyroid cancer

In the present times most of the laryngeal cancers ( cancers of voice box and areas above and below it) are treated by chemoradiation. Surgery for laryngeal cancer is needed

a. When there is recurrence or residual cancer after radiation

b. When the cancer is advanced and larynx has become nonfunctional and leading to breathing difficulty and repeated aspirations

The surgery where the voice box is removed to treat cancer is called Total Laryngectomy. Neck dissection is also performed at the same time. After this surgery patient will be unable to speak naturally. However voice prosthesis are available that can be implanted during surgery after which patient can produce good quality voice with training.

  • Read FAQ on Larynx cancer
  • Read case studies on larynx cancer

Due to the advances in research and reconstructive techniques variety of options are available for breast cancer surgeries.

In early stages of breast cancer- complete removal of the breast is rarely needed. Removal of the tumour with surrounding normal tissue for complete clearance also gives equivalent results. This is called breast conserving surgery. Sometimes when the the tumour is relatively large compared to breast size , simple removal of the tumor leads to significant changes in the shape and appearance of the breast which are aesthetically undesirable. In such situations tissue in the remaining breast needs to be redistributed (called oncoplasty) or new tissue from other sites ( eg.from the back- latsimuss dorsi flap) needs to be brought in to achieve good cosmesis.

In advanced cases the complete removal of the breast is needed. It is called radical mastectomy.

  • Read FAQ on breast cancer
  • Read case studies on breast cancer

Chest wall tumours are relatively rare tumours. The surgery for chest wall tumors involve removal a part of the chest wall including the ribs . Removal of the chest wall causes instability of the chest cavity leading to compromised breathing and circulation. Hence all the defects caused by these surgeries need rigid reconstruction using bone cement, titanium mesh or other novel materials.

For Esophageal cancer, near complete removal of the esophagus is necessary. The procedure is called total esophagectomy. Since esophagus travels from neck to abdomen through the chest, total esophagectomy requires surgery in all these parts. The part where esophagus is dissected in the chest can be achieved with the help of thoracoscopy or robotic surgery. This will reduce pain of large incision on the chest and helps in early recovery. After the removal of the esophagus the stomach is converted into a tube to replace it and it is joined in the neck with the remaining esophagus.

When esophageal cancer involves the lower part where it joins the stomach the surgery entails removal of the part of stomach and part of esophagus. This is called partial esophagogastrectomy. In this procedure the remaining stomach is joined to the remainded of the esophagus in the chest . This can be done with the help of robotic or thoracoscopy.

  • FAQ on esophageal cancer
  • Case studies on esophageal cancer

Surgery for the stomach cancer requires removal of the part or whole of stomach to achieve complete clearance.

Cancer in the lower part of stomachàremoval of lower 50-70% of stomach(distal gastrectomy)

Cancer in the upper part of stomachàremoval of the entire stomach (Total Gastrectomy)

Along with removal of the stomach the nodes that drain it also have to be cleared. This is called D2 lymphadenectomy.

While very early cases of stomach cancer can be operated laparsocpically or with robot, in advanced cases an open surgery is recommended to achieve good clearance.

Colon and rectum for the lower digestive tract.

Colon is divided into a)ascending colon (b)transverse colon (c) descending colon (d) sigmoid colon

In colon cancer the part of the colon involved is removed with 5cm of normal colon on either side of it along with its nodes to achieve good clearance. In colonic surgeries the fascial layer surrounding it has to be removed completely. It is called total mesocolic excision.

Most of the colonic cancers can be removed laparoscopically.

Part of colon involved Type of surgery recommended
Ascending colon (right colon) Right colectomy
Transverse colon Transverse colectomy/ extended right colectomy
Descending colon ( left colon) Left colectomy
Sigmoid colon Sigmoid colectomy

Rectum is the terminal portion of digestive tract above the anal canal. Its divided into (a)upper (b)mid (c) lower rectum. Most of the rectal cancers can be operated laparoscopically or with the help of robot.

In the cancer of Upper and mid rectum a permanent stoma can be avoided in almost all the cases. However in low rectal cancers whether a permanent stoma is needed depends on several factors like: anal sphincter tone, tumour spread, involvement of other structures.

Part of rectum affected Surgery offered
Upper rectum Anterior resection
Mid rectum Low anterior resection
Low rectum Ultra low anterior resection
Intersphincteric resection
Abdominoperineal resection( permanent stoma)

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