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CONCEPT OF ONCOSURGERY - THE CONTROVERSY AND OUR EXPERIENCE

Dr. R. K. Karwasra.. MS, FIAMS [ONCOLOGY], FICS Consultant Oncosurgen PGIMS, Rohtak (Haryana)
Several factors have led to a recent increase in the development of surgical oncology as a separate section in the large hospitals worldwide. The enthusiasm derives from the recognisation that modern oncologic management requires level of expertise in cancer surgery, chemotherapy and radiation therapy that are not common to most general surgeons who are experiencing a declining intellectual role in modern cancer treatments and research. But in our country controversy still exists whether surgical oncology should be developed as a separate speciality area or not, as many surgeons have resisted this concept because of the fear of fragmenting the field of general surgery, inspite of the fact that more than 90% of the cancers are solid tumour where surgeon plays the important role. To resolve this controversy, we have retrospectively analysed the cancer patients who attended and operated at our surgical oncology services between 1996-98 at PGIMS, Rohtak.
OBSERVATIONS :
* The speciality services in Surgical Oncology was started at PGIMS, Rohtak in 1996 by the author after his specialisation in this speciality (1994-96) from Tata Memorial Hospital, Bombay. Before this he was working as general surgeon at this institute since 1988 and was on faculty position.
o Total 913 patients attended the cancer surgery clinic between 1996-98 and 237 major oncologic procedures were performed in 194 patients during last 2 years.
Following were the reasons for not operating the pa-tients who attended the clinic: a. Advanced stage / because of metastasis or recurrence of the disease.
b. Long waiting list-patients lost to date.
c. Opted alternative unproven therapy.
ANALYSIS OF PATIENTS OPERATED AT SURGICAL ONCOLOGY SERVICES
Cancer patients Pre Operative Staging* Type of Surgery
Region Total Cases I II III IV Curative resection Paliative surgery
Head & Neck 65
(33.3%)		 6 14 25 20 65 Nil
Thoracic 26
(10.4%)		 ~ 5 15 0 20 Nil
G.I. 43
(22.2%)		 " 6 24 13 30 13
G.U 27
(14%)		 2 7 18 - 27 Nil
Breast 23
(11.8%)		 2 13 8 ~ 23 Nil
B.S.S 16
(8.3%)		 2 3 11 - 18 Nil
Total 194 12
(2.5%)		 48
(20%)		 10
(56%)		 33
(21%)		 181
(89%)		 13
(11%)
* 29 patients had recurrent or residual disease after R.T. or surgery by other surgeons.
Following major oncological procedures performed :

HEAD AND NECK CANCERS
1. Intraoral wide excision 3
2. Hemiglossectomies 2
3. Hemlmandibulectemies (3+7) 10
4. Composite resections - commandoes 7
5. Maxillectomies 5
6. Radical neck dissctions (18+7) 25.
7. Laryngectomies 2
8. Laryngopharyngectomies 2
9. Parapharyngeal tumour excisions 2
10. Wide excision of lip and face tumours with reconstruction 4
11. Parotidectomies 7
12. Total thyroidectomies 11
13. Excision of STS neck 1
Total 74

THORACIC CANCERS
1. Oesophagectomies (15+2) 17
2. Pneumenectomies 3
3. Mediastinal tumour excision 2
4. Total 22

G.I. CANCERS
1. Radical gastrectomies 4
2. colectomies 5
3. Anteriorresections 9
4. Abdomino perineal resections 3
5. Liver resections 2
6. Bile duct tumour excisions 2
7. Whipple procedures 5
8. Palliative bypass 13
  Total

G.U. CANCERS
1. Radical nephrectomies 4
2. Radical cystectomies 2
3. Amputation of penis 4
4. Groin node dissections (GND) 3
5. Retroperitoneal lymph node dissections (RPLND) 2
6. TUR bladder tumours 2
7. Werthiems radical hysterectomies 4
8. TAHBSO with cytoreductions for ovarian cancers 6
Total 31
Continued