Surgical Oncology

Introduction : Our Head & Neck Surgery Department is dedicated to provide specialized, individualized and compassionate care for patients with cancers affecting Head and Neck. We have an expert team of Surgeons, Radiation oncologists, Medical oncologists who work in close collaboration to provide the best treatment. The motto of our hospital and department is to enhance the cancer treatment through research and patient centred individualised treatment. We plan to integrate molecular markers, genetic profiling to customize treatment based on patients disease biology. The aim is to provide holistic care with focus on rehabilitation, psychosocial integration in society and improvement in quality of life.

Services offered: The key services include

• Dedicated OPDs for patients with joint clinics including surgical oncologists, radiation oncologists, medical oncologists, radiologists, and nuclear medicine departments.
• Minimally invasive surgeries using the da Vinci Xi surgical system, ensuring minimal scarring and early recovery.
• A specialized team of surgical oncologists for procedures such as oral commando surgery, thyroidectomy, and salivary gland surgery.
• Management begins with prehabilitation to prepare the patient for surgery, followed by the surgical process and post-treatment rehabilitation.
• Dedicated clinics for:
• Tobacco cessation
• Endocrine thyroid
• Skull base

Outpatient Clinics:
Monday - Friday
9:30 AM – 5:30 PM

Introduction :The Breast unit, at ACTREC manages patients with breast cancers at varous stages in collaboration with multi-disciplinary teams. The assessments, treatment planning and state of art surgical services are provided to patients for optimising clinical outcomes, cosmesis and function. The department carries out clinical work, educational programs and research activities.

Services offered:
OPD: Everyday between 9 am and 4 pm.
IPD

Imaging: Mammograms including contrast enhanced mammograms, ultrasonography, MRI, PET CT and image guided biopsy services are provided. Currently Contrast enhance mammograms are offered at TMH for the ACTREC patients.

Biopsy: Biopsies include trucut biopsies and surgical open biopsy when indicated, to confirm accurate histopathological diagnosis. Facilities for image guided biopsies, whenever indicated are available in intervention radiology department.

Surgical procedures: A full range of breast conservation surgeries, and radical breast removals with or without axillary sampling procedures (sentinel node biopsiy and axillary sample) as well as axillry clearence are offered to our patients. Various type of breast reconstruction procedures (some of them in conjunction with the plastic surgery team) are also offered to our patients. We have recently introduced new ways of implant based breast reconstruction after mastectomy using biological mesh and are in a process of introducing robotic breast surgery.

Research Activity: The ACTREC surgical oncology department focuses on providing exceptional patient care while conducting clinical research. We work to discover new surgical techniques to improve outcomes for patients.

Vision: The vision is to deliver world-class patient care services in a comprehensive manner to every individual with an emphasis on Quality, Service excellence and Empathy. We are determined to deliver the healthcare that the citizens deserve. We continue to be the country's premier cancer centre and provide leadership in cancer care through:

• Service: Providing excellent service through evidence-based oncology practices
• Research: Conducting affordable, innovative, and relevant research
• Education: Educating students, trainees, professionals, employees, and the public about cancer

Introduction :

Introduction :The neurosurgical services offer surgical treatment for complex brain and spinal cord tumors. The surgical team comprises 3 full time faculty and 2 specialist fellows, supported by surgical residents and other clinical as well as research support staff. In addition, the service also has a full-fledged IONM team. The faculty include

• Dr Aliasgar Moiyadi
• Dr Prakash Shetty
• Dr Vikas Singh
• Dr Parthiban Velayutham (IONM lead)

Services offered:

• The service caters to complex brain and spinal cord tumor patients offering state-of-the art surgical therapy as well as integrated comprehensive care under the umbrella of the Neuro-oncology DMG. The unit caters to both centres (TMH and ACTREC) and seamlessly manages the two sites to ensure optimal care to the patients.
• We also have a strong Intraoperative Neurophysiology (IONM) team catering not only to Neurosurgical patients, but also to head and Neck and Plastic surgical specialties.
• The service also trains fellows and many short term trainees/ observers. We also run a one year certificate course in IONM technology training.

Outpatient Clinics: Days/Time

Monday : 2- 4 pm

Research activities:

• One of the avenues of research is basic and translational work including biology of tumors (especially gliomas, meningiomas, and medulloblastomas) and we have active collaborations within (CRI) and outside (IIT-B) ACTREC.
• Another area of interest is intraoperative imaging techniques and advanced brain mapping.
• We also have a strong collaboration with BARC for developing an indigenous Neurosurgical robotic guidance system. The Neurosurgical Robotic lab at ACTREC is involved in the development and validation of this system.
• We are also running an academic PhD research programme under HBNI Health Sciences Scheme.
• As part of promoting the research activities, we are also conducting a periodic instructional course on Master class in Neurosurgical Oncology and IONM course in Neurosurgical Oncology every year.

Introduction :The Gynecological Oncology Service at Advanced Centre for Treatment, Research and Education in Cancer (ACTREC) is dedicated to the treatment of malignancies of the female reproductive tract. It shares a rich history and legacy being an integral part of Tata Memorial Centre. The Department is involved in high quality, protocol driven and evidence-based patient care. The services provided consist of dedicated gynecological oncological surgeons who work in collaboration with other specialists such as medical oncologists, radiation oncologists, radiologists and pathologists who are all specialized in gynecological oncology, to truly provide world class multi-disciplinary care to all sections of society. The department is also involved in training the next generation of gynecological oncologists in India through its much sought after MCh program.

Service Offered:

All types of gynecological oncological procedures are performed in the department, including preventive, diagnostic and therapeutic procedures. Pap smears, HPV DNA testing, Colposcopy, LEEP/LLETZ, office Pipelle endometrial biopsy, diagnostic and operative hysteroscopy to name a few. Advanced and radical surgeries such as cytoreductive surgeries, radical hysterectomy, pelvic exenteration and HIPEC(hyperthermic intraperitoneal chemotherapy) are performed regularly. Minimally invasive surgery, including laparoscopic and robotic surgery is frequently performed for gynecological cancers, where it is appropriate and feasible.

Outpatient clinics:
General OPD:
Tuesday and Thursday: 9.00 am – 5. 30pm

Private OPD:
Tuesday and Thursday: 9.00 am – 5. 30pm

Research/Important surgical publications:

• A Phase III Randomized Controlled Trial of Hyperthermic or Normothermic Intraperitoneal Chemotherapy versus No Intraperitoneal Chemotherapy during Interval Debulking Surgery in Patients with Advanced Epithelial Ovarian Cancer - HIPEC or NIPEC versus None: (ROHINI-N)
• Diagnostic performance of sentinel lymphnode mapping algorithm in early stage endometrial cancer

Published clinically impactful surgical studies:

• Gupta S, Maheshwari A, Parab P, Mahantshetty U, Hawaldar R, Sastri Chopra S, Kerkar R, Engineer R, Tongaonkar H, Ghosh J, Gulia S, Kumar N, Shylasree TS, Gawade R, Kembhavi Y, Gaikar M, Menon S, Thakur M, Shrivastava S, Badwe R. Neoadjuvant Chemotherapy Followed by Radical Surgery Versus Concomitant Chemotherapy and Radiotherapy in Patients With Stage IB2, IIA, or IIB Squamous Cervical Cancer: A Randomized Controlled Trial. J Clin Oncol. 2018 Jun 1;36(16):1548-1555. doi: 10.1200/JCO.2017.75.9985. Epub 2018 Feb 12. PMID: 29432076.
• Gulia S, Kannan S, Ghosh J, et al Secondary cytoreduction in platinum sensitive relapsed ovarian cancer: an individual patient level meta-analysis International Journal of Gynecologic Cancer Published Online First: 11 August 2023. doi: 10.1136/ijgc-2023-004342

Future vision:

The department aims to improve patient care further by employing state of the art technologies and inculcating best practices from around the world. The department aims to build a robust advanced gynaecologic oncological and minimally invasive surgery program, that benefits both patients and trainees. The department also aims to complete accrual and publish results of current ongoing important clinical trials and hopes to conduct clinically relevant and impactful research in the future. The department strives to improve the quality of the residency program, by focusing on skill acquisition and research methodology.

Introduction :

Introduction :

Introduction :The Bone & Soft tissue unit, Department of Surgical Oncology at ACTREC treats patients with a wide variety of malignant (bone sarcomas) and benign bone tumors, soft tissue sarcomas and skin cancers of limbs. The surgical team of musculoskeletal oncology in collaboration with multi-disciplinary teams provide assessments, treatment planning and state of art surgical services to patients for optimising clinical outcomes and function. The department carries out clinical work, educational programs and research activities. The department is supported by

Service OfferedOPD: Friday 02:00 to 04:00 pm
IPD

Biopsy Biopsies include trucut biopsies and surgical open biopsy when indicated, to confirm accurate histopathological diagnosis. Facilities for image guided biopsies, whenever indicated are available in intervention radiology department.

Surgical procedures The bone and soft tissue unit treats a diverse group of bone & soft tissue sarcomas, as well as benign soft tissue and bone tumours and skin cancers of limbs. Our unparalleled experience in the multidisciplinary management of bone & soft tissue sarcomas and skin cancers and expertise in surgery allows us to develop and implement individualised treatment plans that provide the best long-term outcomes for each patient. Our surgeons specialise in complex, multi-team resections that incorporate surgeons from across the surgery division.

Surgical procedures for sarcomas include limb salvage surgery and amputation in rare cases. Limb Salvage Surgeries (LSS) means resecting these tumours while preserving the limbs. This implies resecting the tumours with wide margins in soft tissue sarcomas, and resecting the bone along with cuff of normal soft tissue for bone sarcomas. LSS has become the standard of care for patients with these tumours in last 2-3 decades. This was possible due to advances in diagnostic radiology, pathology, chemotherapy and radiation therapy, improvement in the surgical techniques, availability of microvascular tissue transfers and availability of modular mega-prosthesis. We also manage melanomas and squamous carcinomas of limbs and offers treatment like wide excisions, lymph node dissections and reconstruction of defects by our plastic surgery team.

Research Activity The ACTREC surgical oncology department focuses on providing exceptional patient care while conducting clinical research. We work to discover new surgical techniques to improve outcomes for patients.

Vision The vision is to deliver world-class patient care services in a comprehensive manner to every individual with an emphasis on Quality, Service excellence and Empathy. We are determined to deliver the healthcare that the citizens deserve. We continue to be the country's premier cancer centre and provide leadership in cancer care through:

• Service: Providing excellent service through evidence-based oncology practices
• Research: Conducting affordable, innovative, and relevant research
• Education: Educating students, trainees, professionals, employees, and the public about cancer.

Introduction :At the Department of Plastic and Reconstructive Microsurgery, ACTREC, Tata Memorial Center, we are committed to providing advanced surgical solutions to improve the quality of life for our patients. Our expert team specialises in complex procedures for breast cancer, head and neck cancer, and sarcoma reconstruction, as well as comprehensive lymphedema management, secondary reconstruction, functional extremity restoration and facial reanima-tion procedures.

Breast Reconstruction
Reshaping the confidence
Breast reconstruction is a critical component of care for individuals undergoing resection in breast cancer management. Our team offers personalized treatment plans to help restore both appearance and function. We offer services including:

• Oncoplastic Surgery: Combining cancer surgery with plastic surgical techniques for optimal cosmetic outcomes.
• Autologous Tissue Reconstruction: Using your tissue from areas such as the abdo-men or back to reconstruct the breast.
• Implant-Based Reconstruction: Utilizing silicone or saline implants to rebuild the breast.
• LYMPHA(Lymphatic microsurgical preventive healing approach), lymphedema management with LVA (Lymphovenous anastomoses and VLNT (Vascularized lymph node trans-fers).

Our multidisciplinary approach ensures that each patient receives the best possible care tai-lored to their unique needs. We are commited to enhance the awareness for breast reconstruc-tion across India.

Head and Neck Reconstruction
Restoring function After Complex and large resections
Head and neck reconstructions are essential for patients who have undergone surgery for can-cer or traumatic injuries. Our specialists are adept in:

• Microvascular Free Flap Reconstruction: Using tissue from other parts of the body to reconstruct the head and neck area.
• Facial Reanimation Surgery: Restoring facial movements and expressions following nerve damage.
• Oral and Maxillofacial Reconstruction: Repairing defects and restoring function to the mouth, jaw, and facial structures.

Our goal is to restore functionality and aesthetics, helping patients regain their quality of life.

Sarcoma Reconstruction
Save the limbs
Sarcoma reconstruction involves advanced techniques to address defects resulting from the treatment of bone and soft tisssue sarcomas, which are rare cancers of the connective tissues. Our services include:

• Limb Salvage Surgery: Preserving the limb while removing the tumor and recon-structing the affected area.
• Complex Wound Closure: Utilizing local, regional, or free flaps to close large or complicated wounds.
• Rehabilitation and Follow-up Care: Ensuring optimal recovery and functionality post-surgery.

Our approach integrates surgical expertise with ongoing support to maximize recovery and quality of life.

Lymphedema Management
Innovative Solutions for Swelling Relief
Lymphedema is a condition characterized by swelling due to lymphatic system issues, often occurring after cancer treatments. We provide a range of management strategies, including:

• Complex Decongestive Therapy (CDT): Combining manual lymph drainage, com-pression therapy, and exercise.
• Surgical Interventions: Procedures like lymphatic venous anastomosis (LVA) or vas-cularized lymph node transfer to address severe cases.
• Education and Lifestyle Adjustments: Guiding patients on self-care practices to manage and reduce symptoms.

Our team works closely with patients to develop a tailored plan that addresses their specific needs and improves their quality of life.

Anatomy and Microsurgery Lab
Nurturing the hands
We have an anatomy/ microsurgery lab where we train microsurgery residents across India, regularly through workshops and conferences. The residents are trained on dry models(rubber gloves, silicone) and wet models(veins, rats) for microvascular surgeries.

Outpatient Clinics
Our outpatient clinics are designed to provide ongoing care and support to our patients. Ser-vices available include:

• Initial Consultations for diagnosis and treatment planning.
• Follow-up Appointments to monitor recovery and manage any complications.
• Pre-Operative and Post-Operative Care to ensure comprehensive treatment throughout the surgical process.

Days/Time
Our outpatient clinics are in the Shanti Sadan building. OPDs are open during the following hours:

• Tuesday: Private OPD (212) and General OPD (9A): 09:30 AM to 5:30 PM
• Friday: Private OPD (212) and General OPD (9A): 09:30 AM to 5:30 PM

Research Activity
At ACTREC, we are at the forefront of research in plastic, reconstructive, and microsurgery. Our research activities focus on:

• Innovative Surgical Techniques: Developing and refining new methods for recon-structive procedures.
• Patient Outcomes: Studying long-term outcomes and quality of life improvements following surgery.
• Lymphedema Therapies: Exploring advanced treatments and management strategies for lymphedema.

Vision
Our vision is to lead plastic and reconstructive microsurgery in oncology globally, with a spe-cific focus on India and the LMICs across the realms of service, training, education and re-search. We envision a future, where every patient receives the highest standard of care and the opportunity for a restored quality of life. Moving forward, our department is committed to:

• Expanding Services: Introducing new reconstructive techniques and therapies to ad-dress emerging needs.
• Enhancing Patient Care: Focusing on personalized care plans and improving patient outcomes through ongoing research and innovation. We are committed to starting ro-botic services in our department.
• Training and Education: Developing future leaders in the field through advanced training programs and continuing education opportunities. We are about to start an in-ternational fellowship at our centre.