Dr Debkumar Ray, Consultant General and Minimally Invasive Surgery, AMRI Hospital, Salt Lake – Kolkata talks about ways to treat GI cancers
Gastrointestinal (GI) cancers are common these days. Lot of environmental and dietary factors like smoking, tobacco and alcohol are few predisposing causes for GI cancers.
A lot of regional variations and genetic predispositions lead to the development of GI cancers as well. With the advent of modern diagnostic gadgets like CT scan, MRI, PET CT, nuclear scans, GI cancers can be diagnosed easily in modern medicine and at the same time if it is detected early it can be cured. In majority cases, surgery is the main stay therapy in conjunction with chemotherapy and radiotherapy, either before (neoadjuvant) or after (adjuvant) surgery. Cancer surgery these days can be done through key hole/ laparoscopic method.
What are the common GI cancers?
Cancer involving oesophagus, stomach, small and large intestine and also of solid organs like gall bladder , pancreas and liver.
Can a stomach cancer be operated via key hole/ laparoscopy?
Yes, but not fully. A majority of the dissections can be done through multiple incisions and modern gadgets, however, while removing the operated specimen, we need to make a small cut.
Tell about the key hole surgery for stomach cancers?
Key hole surgery minimises blood-loss, pain as a small incision is done.The intestines starts functioning soon as compared to open surgery. So effectively patients go home early with minimal pain.
Is it safe to do cancer surgery via key hole?
Yes. In the early 90’s there was a worry about port site cancer implantation but several research has shown no added risk. Due to the usage of HD camera system and modern gadgets like ultra-sonic scalpel, vessel sealing systems and other stapling devices for joining the intestine, it is safe in trained hands.
Can colon and rectal cancer be operated via key-hole surgery?
Yes, especially rectal cancer when it is positioned very low and we cannot save the anus (Abdominoperineal Resections or APR). In conventional surgery, we need to make a big midline abdominal incision but if we do it via laparoscopic method we can avoid the cut and its related pain /complications. So the hospital stay is reduced and it’s virtually pain free. For high rectal cancers we do anterior resections which again involves a big abdominal wound, but Lap Anterior Resections are much better in terms of post-operative pain and hospital stay.
For other colon cancers, right hemicolectomy and left hemicolectomy can be done through laparoscopic assistance and the main advantage is again less blood loss, minimal pain and virtually no wound complication.
Who should be doing this key hole cancer surgery? Can it be done in Kolkata?
Laparoscopic cancer surgery requires a lot of technical skills and a majority of so called ‘oncosurgeons’ are not trained in it. So for better results, it is better to visit trained laparoscopic surgeons who conducts both cancerous and non-cancerous gastrointestinal surgery on a regular basis.
The surgeries are done on a regular basis at our institution for the last four to five years.
Is key hole surgery for GI cancer more expensive than conventional open surgery?
Partly yes. It involves a lot of gadgets and staplers, but considering the reduced hospital stay and pain free quick relief, it is much more cost effective.