GI Oncosurgery and Liver Transplantation Services

Gastrointestinal Oncosurgery is a subspecialty, which deals with the surgical management of cancer of esophagus, stomach, small bowel, colon, rectum, anal canal, gall bladder & biliary tract, pancreas and liver. Rajiv Gandhi Cancer Institute and Research Centre is the first institute in Delhi NCR to have a specialized unit of gastrointestinal surgeons with special interest in GI cancers for the management of these cancers. Multidisciplinary team involved in the management of GI and HPB (hepatopancreatobiliary) cancers consists of gastrointestinal surgeon, medical oncologist, radiation oncologist, intervention radiologist, gastroenterologist, hepatologist, nuclear medicine experts, GI pathologist and a stoma therapist. All complex cases are discussed in multi-disciplinary GI and HPB tumor board which is conducted weekly.

For the last one decade this multi-disciplinary team has been providing state of art evidence-based cancer care, at par with international standards, for GI and HPB malignancies. As a result, RGCIRC is one of the highest volume centers for GI and HPB cancer surgeries in India. The department has also pioneered in starting minimally invasive surgery for GI/HPB malignancies especially laparoscopic/robotic resection of colorectal cancers, robotic esophagectomies and robotic liver resections.

Spectrum of Services

• Surgery for esophagus and GE junction cancers
  • Ivor Lewis esophagectomy
  • McKeown’s Esophagectomy
  • Laparoscopic esophagectomy
  • Robot assisted minimally invasive esophagectomy
  • Total gastrectomy
• Surgery for Gastric cancers
  • D2 subtotal /Total gastrectomy
  • Laparoscopic D2 subtotal/total gastrectomy
  • Robotic gastrectomy
• Surgery  for gall bladder cancer
  • Radical cholecystectomy
  • Multivisceral resections including major liver resection.
• Surgery for pancreatic cancers
  • Pancreatoduodenectomy
  • Distal pancreatosplenectomy.
  • Laparoscopic pancreatic resection
• Surgery for liver cancers
  • Hepatectomy
  • Radiofrequency and microwave ablation.
  • TACE/TARE for liver tumors
  • Liver transplant
  • Liver resection for colorectal, neuroendocrine and non- colorectal/non -neuroendocrine liver metastases.
  • Robotic liver resection.
  • Deceased donor and living donor liver transplantation for chronic liver disease and liver cancers.
• Surgery for small bowel tumors
• Surgery for colorectal cancers
  • Right/left hemicolectomy
  • Anterior resection/low anterior resection
  • Abdominoperineal excision/extra levator abdominoperineal excision.
  • Sphincter saving resections
  • Laparoscopic colorectal resections
  • Robotic colorectal resections.
• CRS & HIPEC for appendiceal, peritoneal, colorectal and gastric cancers with peritoneal metastases.
• Multivisceral resection for retroperitoneal tumors.

Areas of special interest

Liver cancer

The department offers a specialized Liver clinic for the patients of liver tumors such as hepatocellular carcinoma, metastatic tumor, intrahepatic cholangiocarcinoma and neuroendocrine tumors. Ours is the first center in India to have facility of ICG test and mebrofenin scan – quantitative liver function tests, which helps in selecting patients for safe liver surgery. We have a state of art Interventional radiology department providing all facilities like PTBD (percutaneous transhepatic biliary drainage) and PVE (portal vein embolization). Department offers whole spectrum of non- surgical treatments available for liver tumors including radiofrequency ablation, intra-operative ultrasound, TACE (Trans arterial chemoembolization), TARE (Trans arterial radioembolization) and SBRT for liver tumors. We are also performing deceased donor liver transplant (DDLT) and Living donor liver transplant (LDLT) for chronic liver disease and hepatocellular carcinoma.

Gall bladder cancer

Northern India is one of the areas with highest prevalence of gall bladder cancer in the world. As a result, RGCIRC caters to a large number of gall bladder cancer cases. We have adopted many recent advances in the treatment of gall bladder cancer like use of PET scan in preoperative evaluation, neoadjuvant therapy, anatomical segment IVb/5 resection using Intra operative ultrasound and aggressive surgical management for locally advanced gall bladder cancer (preoperative biliary drainage, portal vein embolization and major hepatectomy or multivisceral resection).

Pancreatic cancer

Management of locally advanced pancreatic cancers with the use of neoadjuvant chemotherapy or chemoradiotherapy and vascular resections.

Colorectal cancer

Our department is offering comprehensive care for patients with stage 4 colorectal cancers with liver/lung or peritoneal metastases including neoadjuvant therapy, staged resections, intra operative radiofrequency or microwave ablation of liver metastases, metastatectomy for lung lesions and HIPEC. We also offer sphincter saving procedures for low rectal tumors and extralevator abdominoperineal resection (ELAPE) with reconstruction using biological mesh or pelvic exenteration procedures for locally advanced rectal tumors.

Peritoneal surface malignancies

We are the first center in India to have a dedicated HIPEC machine in 2012 and to start CRS(cytoreductive surgery) and  HIPEC (Hyperthermic intra-peritoneal chemotherapy) for gastrointestinal malignancies. Recently department has also started PIPAC (Pressurized intraperitoneal aerosolized chemotherapy) for peritoneal carcinomatosis.

Robotic surgery

Our department is offering robotic surgery for GI and HPB malignancies since 2012  including robotic esophagectomy, robotic gastrectomy, robotic colorectal resections and robotic liver resections. Our department is one of the highest volume Centre in the country for robotic esophagectomies.

Teaching and Training

The department has been actively involved in teaching and training of DNB trainees as a part of the DNB surgical Oncology course of the institute. The GI and HPB Oncosurgery department also offers, Indian Medical Association accredited one year fellowship in GI and HPB Oncosurgery and have trained many national and international surgeons in the intricate field of GI and HPB Oncosurgery. Our faculty has been participating in various capacities at national and international medical conferences.

Research and publications

The department is also actively involved in research on various aspects of GI and HPB malignancies ranging from basic science to clinical studies. We have been part of many multicentric national and international trials The department is credited with a large number national and international publications in reputed medical journals.

Recent publications

1. Primary GIST of the liver masquerading as primary intra-abdominal tumour: a rare extra-gastrointestinal stromal tumour (EGIST) of the liver. Louis AR, Singh S, Gupta SK, Sharma A. J Gastrointest Cancer. 2014 Sep;45(3):392-4.
2. Lifestyle and Sporadic Colorectal Cancer in India. Sinha R, Doval DC, Hussain S, Kumar K, Singh S, Basir SF, Bharadwaj M. Asian Pac J Cancer Prev. 2015;16(17):7683-8.
3. Effective Downsizing of a Gastroesophageal GIST Using Neoadjuvant Imatinib Mesylate: a Case Report. Asif S, Gupta N, Gupta G, Mehta A, Singh S. J Gastrointest Cancer. 2016.
4. The Initial Indian Experience with Cytoreductive Surgery and HIPEC in the Treatment of Peritoneal Metastases.Bhatt A, Mehta S, Seshadri RA, Sethna K, Zaveri S, Rajan F, Mahajan V, Singh S, Raj EH, Sugarbaker PH. Indian J Surg Oncol. 2016 Jun;7(2):160-5.
5. Role of CRS and HIPEC in appendiceal and colorectal malignancies: Indian experience. Gupta N, Asif S, Gandhi J, Rajpurohit S, Singh S. Indian J Gastroenterol. 2017 Mar;36(2):126-130.
6. Lymph node micrometastasis in gallbladder cancer. Shah SH, Gupta N, Gupta G, Mehta A, Singh S. Indian J Gastroenterol. 2017 Aug 7. doi: 10.1007/s12664-017-0775.
7. Clinical Impact of Mismatch Repair Protein Testing on Outcome of Early Staged Colorectal Carcinomas. Gandhi JS, Goswami M, Sharma A, Tanwar P, Gupta G, Gupta N, Pasricha S, Mehta A, Singh S, Agarwal M, Gupta N. J Gastrointest Cancer. 2017 Jun 5. doi: 10.1007/s12029-017-9954-5.
8. Setting up of the Indian HIPEC Registry: A Registry for Indian Patients with Peritoneal Surface Malignancies. Bhatt A, Mehta S, Ramakrishnan As, Pande P, Rajan F, Rangole A, Saklani A, Sethna K, Singh S, Zaveri S, Gopinath KS. Indian J Surg Oncol. 2017 Dec;8(4):527-532.
9. Oxaliplatin-Induced Multiple Focal Nodular Hyperplasia Masquerading as Colorectal Liver Metastasis-Case Report and Review of Literature. Jain C, Syed A, Gupta N, Kambhoj M, Rao A, Singh S. J Gastrointest Cancer. 2020 Jun;51(2):628-630. doi: 10.1007/s12029-019-00307-9.
10. 18-FDG PET-CT should be included in preoperative staging of gall bladder cancer. Goel S, Aggarwal A, Iqbal A, Gupta M, Rao A, Singh S. Eur J Surg Oncol. 2020 Sep;46(9):1711-1716
11. Iqbal SA, Goel S, Aggarwal A, Gupta N, Gupta M, Durga G, Talwar V, Singh S. Use of ¹⁸F Fluorodeoxyglucose Positron Emission Tomography Computed Tomography in Assessing Response to Neoadjuvant Chemoradiation and Its Impact on Survival in Esophageal Squamous Cell Carcinoma. J Gastrointest Cancer. 2020 Oct 31. doi: 10.1007/s12029-020-00543-4. Epub ahead of print. PMID: 33128717.
12. Singh S, Goel S, Iqbal A. Anatomical segment 4b/5 resection for gall bladder cancer using intraoperative ultrasound. J Visc Surg. 2021 Jun;158(3):253-257. doi: 10.1016/j.jviscsurg.2021.04.003. Epub 2021 Apr 23. PMID: 33896696.

FEATURED DOCTORS

MBBS, MS (General Surgery), DNB (General Surgery), Fellow (Liver Transplantation & Hepatobiliary Surgery)

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Dr. Shivendra Singh GI Onco Surgery & Liver Transplant

MBBS, MS, DNB

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Dr. Shaifali Goel GI Onco Surgery & Liver Transplant

MBBS, MS, MCh (Surgical Gastroenterology)

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Dr. Abhishek Aggarwal GI Onco Surgery & Liver Transplant