India ready for robotic surgeries to treat head, neck cancer: US surgeon 

New Delhi, Dec 24 (IANS) India has significant talent and expertise in traditional head and neck surgical procedures and the country is poised to take a giant leap with robot-assisted surgeries for head and neck patients in the days to come, a leading US robotic surgeon has said.

Dr. Chris Holsinger, 48, who leads Stanford Cancer Centre’s Head and Neck Oncology practice, has been interacting closely with leading Indian head and neck oncologists since 2008.

“I would love to work with more hospitals in India and do collaborative work for providing succour to head and neck cancer patients,” Holsinger told IANS in an e-mail interview.

According to the Indian Council of Medical Research (ICMR), over 200,000 head and neck cancers are reported in the country each year. Of these, nearly three-fourths relate to cancer of the oral cavity, throat and voice box.

“The Stanford Medical Center is working with leading oncologists with Indian healthcare providers like (Delhi’s) Rajiv Gandhi Cancer Institute and Research Centre (RGCIRC) and (Mumbai’s) Tata Memorial Cancer Hospital for a study of Human Papilloma Virus (HPV) negative patients. About 80 percent of Indian cancer patients test negative for HPV,” Holsinger said.

HPV negative is a more aggressive head and neck cancer and may be hard to treat with standard approaches of radiation therapy and concurrent chemotherapy.

“But in the US, the incidence of this disease is too rare. I believe this consortium of Indian robotic head and neck surgeons that gathered in Delhi can pave the way to launch this study and (we hope) to improve outcomes for patients with this disease,” Holsinger stressed.

When it comes to radiotherapy vs robotic surgery, he sees both treatment choices as complementary rather than competitive.

“In the US, we see better results for patients when a multi-disciplinary approach is used. In other words, both the surgeon and the radiation oncologists must be strong but flexible advocates for their patients,” he elaborated.

Consumption of tobacco in various forms – smoking, chewing of paan (betel leaf) and gutka – is a major contributor to head and neck cancer, especially oral cancer.

“Using tobacco and also consuming alcohol only further increase that risk. There are many genes now known to be associated with head and neck cancers but only rare inherited syndromes are associated with the disease,” said Holsinger, who was in New Delhi last week to attend a workshop.

“I was able to observe Dr Surender Dabas (of RGCIRC) perform two surgical procedures for removal of two head and neck cancers. Afterwards, the team at RGCIRC organised a lively workshop with over 125 attendees,” Holsinger said.

“This kind of collaboration allows the multidisciplinary team to provide a more personalized treatment depending on the stage of cancer and the affected head and neck organs as well as the patient’s preferences and his or her speech and swallowing function at the time of diagnosis.”

Use of computer-assisted surgery (via a surgical robot) to remove cancerous tissues or tumours in the head and neck areas helps the surgeon see the affected areas far more clearly – which is not possible in open surgery.

“A surgical robot helps in accessing the head and neck area through the oral cavity (mouth) thus reducing trauma, pain and blood loss. Best of all, minimally invasive surgical procedures do not leave any scars on the face or neck and recovery is much quicker,” the surgeon said.

Dr. Dabas had spent nearly two months with Dr. Holsinger at Houston’s M.D. Anderson Cancer Center some years ago.

Dr. Dabas told IANS: “Head and neck cancers represent the fifth most common type and cause of cancer-related deaths worldwide. In India, head and neck cancers account for nearly one-third of all cancer tumours. Poor oral hygiene escalates the chances of contracting oral cancer manifold.”

Any visible lesions, ulcers, difficulty in swallowing food, change in voice and pain in the ear present themselves as early signs of cancer.

Oral and pharyngeal carcinoma represents a significant public health problem worldwide, with more than 400,000 new cases per year.

India and the US, as also western Europe, have the highest incidences of oropharyngeal cancer worldwide, ranging from seven-17 cases per 100,000 people.

“In the US, we are seeing an epidemic of these cancers, especially in the oropharynx, due to an association with the HPV, which may be rising in India as well,” Dr. Holsinger stated.

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