With newer advances in cancer care leading to much improved outcomes over the last few decades, cancer care has transformed significantly. The surgeon, traditionally the only person dealing with cancers, is now expected to have a better understanding of the cancer process, collaborate actively within a multidisciplinary team of cancer specialists, and strive to achieve improved cancer outcomes rather than simply performing operations. Surgical Oncology has evolved into a recognized discipline which is essential to multidisciplinary cancer care.
The Surgical Oncology service at Patel Hospital started in 2016 with induction of a full time surgical oncologist. From the outset, this service aimed to streamline multidisciplinary care of cancer patients at Patel Hospital.
Multidisciplinary Team Meetings:
Multidisciplinary care and decision making is a pillar of cancer care. The surgical oncology service is actively involved in improving the quality of discussion and decision making for cancer patients in the tumor board meetings in collaboration with colleagues from general surgery, head and neck surgery gastroenterology, plastic surgery, medical oncology from within the hospital as well as radiation oncologists and pathologists from other institutions. In addition, the service represents Patel Hospital in various tumor boards held in different institutions across the city.
There are two areas of specialized multidisciplinary care that the service has been instrumental in; the peritoneal virtual multidisciplinary team comprising international experts as well as multidisciplinary soft tissue sarcoma clinic. These two services represent the specialized areas of service in which expertise is not available to the community.
The main bulk of patients managed by the surgical oncology service at Patel Hospital have gastrointestinal cancers. These include patients with cancers of the esophagus, stomach, intestines and pancreas. Many patients with advanced disease require chemotherapy or radiation in addition to surgery as part of their treatment. The Surgical Oncology service collaborates actively within a multidisciplinary team to discuss each patient and determine the most appropriate treatment strategy. Laparoscopic surgery is routinely involved in the surgical management of these patients.
Many times, cancers come back after treatment. This is not always an untreatable condition but requires expertise in evaluation and management of this complex problem. The surgical oncology service evaluates and selects patients for management after extensive discussion in multidisciplinary team meetings.
Peritoneal Surface Malignancies:
One of the highlights of achievements of surgical oncology at Patel Hospital is development of services for patients with peritoneal cancer. Peritoneal cancer is a debilitating condition that traditionally has been associated with dismal outcomes without treatment. Cytoreductive Surgery and Hyperthermic IntraPeritoneal Chemotherapy (CRS + HIPEC) is an aggressive surgical procedure that has been shown to achieve durable control of this disease in selected patients. Surgical Oncology service at Patel Hospital has been actively involved in the management of patients with peritoneal cancer. This includes a standardized evaluation process followed by discussion in a virtual peritoneal multidisciplinary team meeting comprising experts from other institutions as well as international experts. Patients considered suitable for CRS and HIPEC undergo this aggressive procedure and are managed postoperatively in collaboration with other teams in the hospital. The service has received more than 100 referrals over the last 2 years and hopes to develop international recognition based on collaboration and networking with international experts.
Soft Tissue Sarcomas:
There is a lack of expertise in management of soft tissue sarcomas available to our community. The Surgical Oncology service has strived hard to obtain expertise in the management of soft tissue sarcomas in collaboration with international experts. This has included our lead surgeon Dr Raza Sayyed completing Sarcoma, Melanoma and Rare Tumours Fellowship at the Royal Marsden Hospital, London, UK, which is the leading international expert center for sarcomas. Regular online meetings for discussion of patients with soft tissue sarcoma and their management allow us to achieve multidisciplinary decision making and management of these patients. The service deals with Soft Tissue Sarcomas of the limbs, trunk, groin, Retroperitoneal, pelvic and mesenteric sarcomas, as well as gastrointestinal stromal tumors (GIST).
Advanced Pelvic Malignancies:
The management of advanced pelvic malignancies is very challenging and involves collaboration between Radiation oncologists, medical oncologists and surgical oncologists. Locally advanced rectal cancers and recurrent rectal cancers, as well as advanced gynecological malignancies involving multiple organs requires multiple modalities of treatments, including pelvic exenterative surgery. Surgical Oncology Service collaborates within the multidisciplinary team of experts to manage these complex problems in the most appropriate method.
Cancer is not always curable in every situation. It is however very important to control symptoms and keep the patients comfortable even when we cannot cure the cancer. As there is no dedicated palliative care service for our patients, the surgical oncology service in collaboration with internal medicine, interventional radiology and pain management services strives to provide palliative care to these patients with advanced cancers.
Melanomas and other rare tumours:
Our lead surgical oncologist, Dr Raza Sayyed has completed a fellowship in Sarcoma, Melanoma and Rare Tumours at the Royal Marsden Hospital, London. The Surgical Oncology service is well equipped to deal with melanomas of the skin, visceral melanomas, multidisciplinary management of metastatic melanomas, as well as management of other rare tumours like neuroendocrine tumours and Merkel cell carcinomas.
The outcomes for cancer care are much worse in patients who are physically debilitated and undernourished. The surgical oncology service has initiated a prehabilitation program for patients undergoing complex surgical interventions to better prepare them for major surgery as well as improve their outcomes following treatment. This involves a close collaboration between a team looking at nutrition, physiotherapy, and nursing aspects both before and after the surgery.
Research and Publications:
The surgical oncology service recognizes its role in performing research and projecting the problems and outcomes of our population on a wider scale. We have been presenting our work in numerous national and international conferences in the form of oral and poster presentations as well as publication in indexed journals. The service feels proud to represent Patel Hospital internationally on various forums.
Collaboration is key to advancing in research, and the surgical oncology service actively collaborates in multiple international collaborative research projects, which has improved the research profile of the institution significantly.
The Surgical Oncology service has humble beginnings, however our track record over the last six years provides a testament to our aspirations to be at par with international standards. There is still a long way to go for us to achieve our aim of making the service as well as Patel Hospital into an internationally recognized center for comprehensive cancer care.