Surgical Oncology at SKMCH&RC, Peshawar

The Department of Surgical Oncology at SKMCH&RC, Peshawar offers comprehensive evaluation, diagnosis, treatment, and management services to adult cancer patients. Our surgeons work in close collaboration with medical and radiation oncologists and other allied specialties to ensure that a multidisciplinary approach is followed for each patient. Pain management specialists, dieticians and psychologists are also available at the Hospital round the clock to provide multi-dimensional care to our patients.

Our Expertise

The department offers sub-specialist surgical services for cancers of the lower gastro-intestinal tract (colorectal), upper gastro-intestinal tract, breast surgery, urology, plastic surgery and hepato-pancreatico-biliary (HPB) regions of the human body. Our surgeons are also able to provide extensive expertise in adult general surgical procedures for non-cancer diseases.

Colorectal Surgery

Our surgeons at SKMCH&RC, Peshawar are trained exclusively in the sub-specialty of colorectal surgery. Colorectal sub-specialty includes diseases of the large intestine, rectum and anal canal. The team has established itself regionally for expertise in minimally invasive (keyhole, laparoscopic) approaches to the gastro-intestinal tract as well as sphincter saving rectal surgery to avoid permanent stoma in selected cases. We offer Minimally Invasive 3D laparoscopic Surgery (MIS) for cancers of the colon and rectum.

Since the start of surgical services at SKMCH&RC, Peshawar, our dedicated and sub-specialty trained colorectal surgeons have safely performed multiple major laparoscopic surgeries involving the large colon, rectum and anal canal.

Laparoscopic Colectomy:

Laparoscopic colectomy is a surgical procedure to remove all or part of the colon via the keyhole approach. The colon is a large tube-like organ involved in digestion of food and is present towards the end of the digestive tract. Depending on the cancer location, extent of involvement and patient factors, there are various types of colectomies that can be undertaken at SKMCH&RC, Peshawar:

Laparoscopic Total colectomy Removal of all parts of the colon

Laparoscopic Right hemicolectomy Removal of the right part of the colon

Laparoscopic Left hemicolectomy Removal of the left part of the colon

Laparoscopic Sigmoid colectomy Removal of the last part of the colon

Laparoscopic Anterior Resection:

We have been at the forefront of providing keyhole rectal surgery for our cancer patients with excellent results. The benefits of laparoscopic surgery include less scars, pain, early recovery, less adhesion, and early progression to chemotherapy. The rectum is present towards the end of the colon and is involved in storage and evacuation of digested food. Various type of surgeries can be performed for cancer of the rectum, depending on the cancer location and other patient factors:

Various type of surgeries can be performed for cancer of the rectum, depending on the cancer location and other patient factors:

Laparoscopic High anterior resection: Removal of the upper part of the rectum

Laparoscopic Low anterior resection: Removal of most of the rectum

Laparoscopic Ultra-low (sphincter preserving) anterior resection: Removal of all of the rectum while preserving the sphincters and avoiding a permanent stoma.

Laparoscopic Abdomino-Perineal Resection (APR)

In this procedure, the whole rectum and anal canal is removed for cancers involving the lower end of the gastro-intestinal tract. The laparoscopic approach results in a much smaller perineal wound, leading to reduction of associated complications and earlier recovery. In selected cases such as locally advanced cancers, the Extra-levator Abdomino-Perineal Resection (ELAP) is also undertaken.

Breast Onco-plastic Surgery

Shaukat Khanum Peshawar Cancer Hospital and Research Centre offers extensive expertise in the management of breast cancers and non-cancer diseases of the breast. Our surgeons work in close collaborations with plastic & reconstructive surgeons as well as radiation-oncologists to ensure treatment is according to established guidelines.

List of procedures offered for breast & oncoplastic surgery:

Breast conserving surgery
Mastectomy
Axillary dissection
Breast reconstruction

Plastic & Reconstructive Surgery

Our dedicated plastic surgery trained consultants offer specialist services for skin related cancers as well as reconstructive surgical procedures.

Microvascular reconstructive surgery
Skin cancer and sarcoma resection
Free flaps for breast reconstruction

Uro-Oncology Surgery

The services offered by our dedicated Uro-oncologist include management of kidney cancers, prostate cancer and tumors of the urinary bladder. The procedures offered include

Nephrectomy
Cystoscopy for bladder tumors
Orchidectomy

Gynae-Oncology

The surgeons are trained in the management of cancers related to the ovary and uterus. The procedures offered include minimally invasive approaches with close input from the radiation-oncologist

Laparoscopic oophorectomy and hysterectomy
Laparoscopic pelvic lymph node dissection
Laparoscopic pelvic exenteration

Upper GI (Oesophago-Gastric) Surgery

Shaukat Khanum Peshawar Cancer Hospital and Research Centre offers keyhole (laparoscopic) operations for stomach and oesophagus cancers and non-cancer diseases by dedicated surgeons trained.

List of procedures offered for upper GI cancers:

Totally minimally invasive (Laparoscopic and VATs) oesophagectomy
Laparoscopic gastrectomy
McKeown (3 stage) oesophagectomy for mid oesophageal cancers
Ivor Lewis (2 stage) oesophagectomy for lower oesophageal cancers
Total gastrectomy for proximal and mid gastric cancers (D2)
Subtotal gastrectomy for distal gastric cancers

List of procedures offered for non-cancer diseases:

Laparoscopic cholecystectomy
Laparoscopic anti-reflux surgery
Laparoscopic repair of diaphragmatic hiatus hernia
Laparoscopic Heller’s myotomy for Achalasia
Laparoscopic sleeve gastrectomy
Laparoscopic inguinal hernia repair
Laparoscopic umbilical hernia repair
Laparoscopic incisional hernia repair

Hepato-Pancreatico-Biliary

SKMCH&RC, Peshawar has a fully established, dedicated hepatobiliary and pancreatic surgery service with surgeons trained specifically in this specialty. HPB sub-specialty deals with diseases of the liver, pancreas and gallbladder. The HPB team at SKM Peshawar has expertise in laparoscopic (keyhole, minimally invasive) approaches for the surgery of liver and pancreas. We offer laparoscopic liver resections for cancers of the liver, laparoscopic Whipple’s operation (pancreatico-duodenectomy) for cancer of the pancreas and distal pancreatectomy with spleen preservation.

All cases are discussed at the multi-disciplinary team (MDT) meeting which is attended by radiologists, oncologists, gastroenterologists, surgeons and other allied specialties. Since the start of surgical services at SKMCH&RC, Peshawar, our dedicated and sub-specialty trained HPB surgeons have safely performed multiple major laparoscopic surgeries involving the liver, spleen, gallbladder and pancreas.

Laparoscopic Pancreatic Surgery

Surgery of the pancreas is a complex operation requiring extensive training and a multi-disciplinary team effort. Studies have shown that outcomes from dedicated high volume hepato-biliary units are much better when compared to low volume non-hepatobiliary units. Our unit is considered a high-volume center by international standards, and we have extensive experience of performing such complex pancreatic procedures with good outcomes. We perform a totally laparoscopic (keyhole surgery) operation of the pancreas which results in smaller scars and better pain control compared to the classic open approach. Various types of pancreatic surgery are undertaken at SKMCH&RC, Peshawar, depending on cancer location and other patient factors.

Laparoscopic Pylorus Preserving Pancreatico-duodenectomy (Whipple’s operation): Removal of the head of the pancreas
Laparoscopic Distal Pancreatectomy: Removal of the tail of the pancreas
Laparoscopic Enucleation: Removal of cancer while preserving the rest of the pancreas

Laparoscopic Hepatectomy (liver resections)

Hepatectomy is a surgical procedure in which a cancerous part of the liver is removed. The liver can have cancer formed within it or come from somewhere else in the body. The amount of liver removed can be minor (small part of liver is removed) or major (the whole right or left side of liver is removed). The liver has a remarkable ability to regenerate and tends to grow back with time thus allowing surgeons to undertake removal of up to 60-70% of the liver. At SKMCH&RC, we perform various types of laparoscopic liver resections in appropriate patients depending on cancer and patient factors:

Laparoscopic Major Hepatectomy: The left or right side of the liver is removed.

Laparoscopic Minor Hepatectomy: A small part of the liver is removed.
Laparoscopic Radical

Laparoscopic Radical Cholecystectomy: The gallbladder along with attached liver is removed.

Laparoscopic Splenectomy

Splenectomy is a surgical procedure in which the spleen is removed. Performing this procedure via the keyhole approach leads to a quicker recovery, less pain and smaller scar length.

General Surgery

We offer general surgery procedures for non-cancer diseases. These procedures include laparoscopic cholecystectomy, hernia repair and surgery for peri-anal diseases (haemorrhoids, peri-anal fissures/fistulas)

Benign breast surgery:

Our dedicated breast surgical team can manage benign breast lumps with input from the plastics team to ensure good cosmesis in removal of benign breast lump with reconstruction where needed.

Cleft lip and palate repair:

Our plastic surgery team can provide a multi-disciplinary treatment in close collaboration with the pediatrics team for defects related to the lip and palate.

Laparoscopic day case cholecystectomy:

The infection of gallbladder secondary to stones can cause recurrent pain. We offer day case laparoscopic cholecystectomy at SKMCH&RC for appropriate patients. The patients come to the hospital on the morning of the operation and are discharged home on the same day as long as certain parameters of safety are met.

Laparoscopic Rectopexy:

This procedure is offered for appropriate patients with prolapse of the rectum. The rectum is fixed in position to avoid it from prolapsing outside.

Hernia repair:

Symptomatic hernias can be treated surgically at SKMCH&RC. Both the traditional open and the modern laparoscopic approaches are offered to appropriate patients.

Surgery for peri-anal disease:

Non-cancer diseases of the anal canal (pilonoidal sinus, peri-anal fistula and haemorrhoids) are also being treated at SKMCH&RC, Peshawar by trained colorectal surgeons.

Our Key Strengths

AT SKMCH&RC, Peshawar, we believe in following a holistic approach for all patients. All patients are discussed at our multi-disciplinary team meeting (MDT) to ensure appropriate treatment is being undertaken. We follow a culture of safety including complete compliance with the World Health Organization (W.H.O) peri-operative safety checklist to ensure safe surgery for our patients.

Pre-operative assessments

Prior to surgery, all patients get assessed by the department of anesthesia with input from the medical specialties and allied health professionals (physiotherapist/nutritionist) as appropriate to ensure adequate optimization of patients prior to the surgery.

Operation Room Suits

We have state-of-the-art theatre suites featuring stainless steel modular wall systems with integrated controls and a wall mounted 3D laparoscopic operating system which is the first of its kind in the province. The theatre suites are equipped with HVAC and Laminar air flow systems with HEPA filters to ensure a reduction in contamination of wounds.

Sterilization

We have advanced steam sterilizers and washer dryer systems in place to ensure sterility of our instruments. These facilities are regularly audited to ensure compliance with and maintenance of standards.

Intensive Care Unit

We have a state-of-the-art Intensive Care Unit with specialized equipment and monitoring facilities to allow 24-hour observation of our patients after complex surgical procedures. The surgeons and intensive care teams work in close collaboration to ensure optimum post-operative care for each patient based on their specific needs.

Training Opportunities

The Department of Surgical Oncology is offering Hospital-wide fellowship programmes based at SKMCH&RC, Peshawar.

The training opportunities at SKMCH&RC include:

Two-Year CPSP approved Fellowship Programme in Surgical Oncology
Medical officer training programme in surgical oncology (Hospital-wide training programme)

Our training programmes feature a strong academic focus with monthly journal clubs and evidence-based sessions. In addition, monthly morbidity and mortality meetings are conducted. Teaching sessions are conducted thrice a week. Our trainees are evaluated every 6 months to discuss their training needs. The fellows work in close collaboration with medical officers and a supervision-based training model is followed.

Cancer services

Non-Cancer Services