Interview: Dr. Sandeep Nayak, Surgical Oncologist, MACS Clinic & Professor, Kidwai Memorial Institute of Oncology, Bangalore
‘Laparoscopy extends to treat all cancers with fewer complications. It is effective and safe. ’
Meet Dr. Sandeep Nayak, a leading Surgical Oncologist in Bangalore who is also a teacher and a researcher in advanced cancer surgical treatments like laparoscopic and robotic cancer surgeries. Actively involved in cancer awareness drives, a light-hearted multi-faceted person and one of the pioneers in laparoscopic cancer surgery in India, Dr. Nayak shared with Nishat Paiker of MedGurus.ORG as how laparoscopy and robotic surgeries are used in all types of cancers to ease the pain and reduce the recovery time in cancer patients.
When and what inspired you to pursue surgical oncology?
Dr. Nayak: When I started my surgical career, oncology was still a developing field and laparoscopy was in its infant state. As a surgical student I saw the amount of precision needed in deciding about and performing onco-surgery, all to relieve the patient off the suffering and cure the patient.
Share a bit about various trainings you went through for cancer surgical treatments?
Dr. Nayak: Onco-surgery is a super-specialisation of general surgery. After completion of my general surgical training at Govt medical college Calicut, Kerala, I joined Kasturba Medical College, Manipal as a teaching faculty. Within few months of that I was selected for my post-doctoral training course in surgical oncology at CNCI, Kolkata. After completing my training, I did a fellowship in laparoscopic and robotic onco-surgery. I have dedicated myself to the development of the field of laparoscopic and robotic onco-surgery from that time.
You are more focused to laparoscopic surgery. What interest you most in it?
Dr. Nayak: Minimal access cancer surgery is the term that would describe both laparoscopic and robotic cancer surgery. This involves using small wounds to perform these major surgeries using advanced technology.
Most of the cancer surgeries are supra-major surgeries and most of our patients are in their sixth decade of life and above. The presence of the disease itself is a pain enough while undergoing an open surgery exceeds it. The amount of pain related to the surgical wound is a deterrent for many patients. However, with laparoscopic or robotic surgery, the pain is very minimal, the loss of blood is small and recovery is quicker. This reduces the stay in the hospital and patients return back to their normal lives quicker compared to open surgery.
My interest also extends to distribution of knowledge about laparoscopic and robotic cancer surgery. I have spent considerable time in the development of online textbook of laparoscopic cancer surgery for patients called ‘macsforcancer’. This site discusses all the cancers and their treatments in common words so that anybody can understand it.
How laparoscopic surgery or minimally invasive technique has changed the picture of cancer related surgeries?
Dr. Nayak: When laparoscopic surgery was introduced in the 80’s the technology was very young. It was meant only for simple surgeries like cholecystectomy (removal of gall bladder) or appendicectomy (removal appendix). However, over the years there has been a tremendous improvement in technology and techniques. This has made laparoscopic cancer surgery possible. In the last 10 years many a research has gone on to examine the outcomes of laparoscopic cancer surgery and compare it with open surgery. Recently robotics has entered into surgery to make the work easier for the surgeon. These techniques and technologies have been compared with the results of open surgery. These researches have given sufficient evidence that in good hands the results of open, laparoscopic and robotic surgery are same. With several advantages with the newer technology patients undergoing laparoscopic and robotic surgery are a happier lot.
Which other type of surgeries can be performed through laparoscopy?
Dr. Nayak: Today laparoscopic and robotic surgery has entered all the areas of surgery. Among cancer surgeries, the cancers within the chest, abdomen and pelvis are commonly treated laparoscopically or robotically. However, it interested me to extend the scope of minimal access surgery to superficial organs like thyroid, breast and oral cancer (neck node removal). I have already published my work on neck node surgery for oral cancer and the rest of the result is due for publication. So, today at my center we consider laparoscopic and robotic surgery for almost all types of cancers.
Is laparoscopic elective method of surgery or only doctors decide which mode (open or laparoscopic) is best for a patient based on medical conditions?
Dr. Nayak: Most of those cancers that are treated by open surgery can be treated using laparoscopy or robotic surgery. However, there are times when some cases may not be suitable for the advanced technique and open surgery might have to be performed. It will depend on 3 factors, surgeon’s ability to perform the given surgery, patients condition and stage of the disease. However, quite often it the patients who chooses the types of surgery that is performed.
Recently I saw a 21-year old girl about to be married in a month or two with thyroid cancer. Thyroid cancers are curable. However, an open surgery would have left an unacceptable in front of the neck. She approached me for scarless endoscopic thyroidectomy. She went hope absolutely no scar in the neck. The same can be done for non-cancerous thyroid nodules.
Another time there was a 65 year old gentleman with a stomach cancer who avoided getting surgery for the fear of open surgery. He was frail and also had a defect in the blood vessel inside his abdomen. Many surgeons had told him that he may not survive the surgery as there could be heavy bleeding during surgery. He came to me, he was happy to get the surgery done after knowing the surgery would be performed laparoscopically. He underwent surgery without even getting a blood transfusion and is leading a happy life.
There are many happy patients like this which gives me a great satisfaction.
What is the success rate for laparoscopic surgeries?
Dr. Nayak: The success rate of cancer surgery is measured by cure or long-term survival of the patient. We also come to know of the result of the surgery when the cancer tissue that is removed is examined under microscope by the pathologist. The microscopy report gives us the idea about the stage of the cancer and quality of surgery. Today there is enough evidence that the results of laparoscopic or robotic surgery are comparable to open surgery with many additional benefits for the patient.
What are the risk factors associated to laparoscopy?
Dr. Nayak: Laparoscopy or robotic cancer surgery is as safe as or safer than open surgery when performed by an experienced surgeon.
What kind of post-surgery care required for patients undergoing laparoscopy?
Dr. Nayak: The care that is required after surgery depends on the scale of the surgery that is performed and not on the approach (open or laparoscopy or robotic). Bigger the surgery greater is the ICU admission and care that is required. However, the requirement of pain killers and blood transfusion is reduced to less the half after laparoscopic and robotic surgery. The hospital stay is also reduced similarly.
What sort of challenges you face while performing cancer surgeries?
Dr. Nayak: Each patient is different. Each of them comes with different challenges. Some cases may be a surgical challenge to remove and others may be challenging to manage after surgery. Today for me greater challenge is to train more surgeons in performing minimal access cancer surgeries and increasing the awareness about the same. Many doctors are unaware of the fact that these newer techniques are available. Hospitals need to gear-up with the technology accordingly.
Share some of the most critical cases you have handled till date and are proud of.
Dr. Nayak: There are many more happy stories to share. There was this patient with esophageal (food pipe) cancer in her late 60’s not so fit for open surgery. She was sent to me by a colleague as last hope. Esophageal cancer surgery is a supra major surgery and the complications are high. Luckily laparoscopy has reduced these complications and more patients are able to undergo these surgeries today. This lady underwent the surgery and went home without much trouble.
I do get patients who have lost hope and I am happy to give them hope. I like to see a smile on their face as they go out.
What are other advanced surgical procedures? Which of them are available in Indian hospitals?
Dr. Nayak: Today, advanced laparoscopic equipments are available in many hospitals. We can perform all the advanced surgeries in India. But the number of trained surgeons are lacking compared to the population. I am training a lot of cancer surgeons in performing laparoscopic cancer surgery. These trained surgeons can go back and perform these surgeries at their centers.
Are these advanced surgical techniques expensive?
Dr. Nayak: The cost of laparoscopic cancer surgery is marginally higher than open surgical costs. These additional costs are related to the equipments. Robotic surgery is costlier than laparoscopic surgery due to cost of the robotic instruments itself. The quicker recovery and back to normalcy compensates for the increased cost. I have had patients who have joined their work within a week after surgery.
You have vast experience in laparoscopy, trainings, and awareness. How do you see developments in India in terms of advanced surgical processes like laparoscopy, robotic surgery etc.?
Dr. Nayak: Today, the laparoscopic equipment is available in most of the hospitals. Robotic surgery is also making its entry into India. Presently robotic surgery is available in two centers in Bangalore. Along with more number of trained surgeons required to perform these advanced surgeries and lack of public awareness is also an issue. Even many doctors don’t know about these newer developments and think that open surgery is better for patients. Most people don’t know that cancer surgeries can be done laparoscopically or robotically with same effectiveness. However, with our efforts I think this will improve.
If asked, how would you rate hospitals in India in terms of treatment, patient care facilities, and use of advanced medical technologies for treating cancer patients?
Dr. Nayak: India has all the technology that developed world has. We provide some of the best and advanced treatment facilities. However, it is not proportionate to our population and geographically not well distributed.
What is your opinion about the Patient Awareness & Guidance initiatives by GMA?
Dr. Nayak: These initiatives are useful for people to understand what is available to them in the form of treatment and help them in making the right choices. This is a welcome step.