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.
The department offers sub-specialist surgical services for cancers of the lower gastro-intestinal tract (colorectal) 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.
Our surgeons at SKMCH&RC, Peshawar are trained exclusively in the sub-speciality of colorectal surgery. Colorectal surgery 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 colon and 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 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:
Removal of all part of the colon
Removal of the right part of the colon
Removal of the left part of the colon
Removal of the last part of the colon
We have been at the forefront of providing keyhole rectal surgery to our cancer patients with excellent results. The benefits of laparoscopic surgery include less scars, pain, early recovery, less adhesions, 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:
Removal of the upper part of the rectum
Removal of most of the rectum
Removal of all of the rectum while preserving the sphincters and avoiding a permanent stoma
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.
Shaukat Khanum Peshawar Cancer Hospital and Research Centre offers key hole (laparoscopic) operations for stomach and oesophagus cancers and non-cancer diseases.
List of procedures offered for upper GI cancers:
List of procedures offered for non-cancer diseases:
SKMCH&RC, Peshawar has a fully established, dedicated hepatobiliary and pancreatic surgery service with surgeons trained specifically in this speciality. HPB sub-speciality 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, gastroenterologist, surgeons and other allied specialties. Since 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.
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 procedure 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.
Removal of the head of the pancreas
Removal of the tail of the pancreas
Removal of the cancer while preserving the rest of the pancreas
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 upto 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:
The left or right side of the liver is removed
A small part of the liver is removed
The gallbladder along with attached liver is removed
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.
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)
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.
This procedure is offered for appropriate patients with prolapse of the rectum. The rectum is fixed in position to avoid it from prolapsing outside.
Symptomatic hernias can be treated surgically at SKMCH&RC. Both the traditional open and the modern laparoscopic approaches are offered to appropriate patients.
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.
AT SKMCH&RC, Peshawar, we believe in following a holistic approach for all patients. All patients are discussed at out 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.
Prior to surgery, all patients get assessed by the department of anaesthesia with input from the medical specialties and allied health professionals (physiotherapist/nutritionist) as appropriate to ensure adequate optimisation of patients prior to the surgery.
We have state-of-the-art theatre suites featuring stainless steel modular wall systems with integrated controls and wall mounted 3D laparoscopic operating system which is a first of its kind in the province. The theatre suites are equipped with HVAC and Laminar air flow systems with HEPA filters to ensure reduction of contamination of wounds.
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 and maintenance of standards.
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.
The Department of Surgical Oncology is offering Hospital-wide fellowship programmes based at SKMCH&RC, Peshawar.
The training opportunities at SKMCH&RC include:
Our training programmes features 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.
