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Indian Journal of Surgery, Vol. 65, No. 6, November-December, 2003, pp. 521 Letter to Editor Conservatism in oncosurgery Ankur Kothari, Komal A Kothari A/7, Reva Park Society, Near Jain Derasar, Manjalapur, Baroda - 390011, India. E-mail: drankurkothari@hotmail.com Code Number: is03117 Sir, Kindly accept my heartiest congratulations for bringing out the special issue of Indian Journal of Surgery on "Conservatism in Oncosurgery". This issue is a timely publication, for today we are witnessing a paradigm shift1 from what was taught and practised previously, i.e. from "Radicality in Oncosurgery" to "Conservatism in Oncosurgery". Conservatism in oncosurgery will require the fulfilment of a few basic necessities before teaching, propagating and practising it widely. 1. Public education and awareness - the public should be made aware of early diagnosis of cancer. They should be explained the benefits of early diagnosis and the means to achieve early diagnosis. 2. Availability of modern diagnostic and therapeutic technology - CT scan, MRI, EUS, staplers etc., should become widely available along with the trained personnel, at affordable rates. 3. Availability of chemotherapy and radiotherapy - chemotherapy and radiotherapy form the backbone of conservative oncosurgery, and they should be easily available with persons having sound knowledge of imparting the same. 4. Trained surgeons - teaching and practice in medical colleges should be based on sound principles of Oncosurgery. Only those personnel trained in Oncosurgery should attempt Conservative Oncosurgery. 5. Patient feasibility - the patient should be able to understand the need for regular follow-up and conservative oncosurgery should be offered only if the patient consents for the same. 6. Good record-keeping - good record-keeping is required for detection of early recurrences and also to compare the results of Conservatism with those of Radicality. There is little doubt that conservative oncosurgery is an important tool in the armamentarium of oncosurgeons, but a few questions need to be answered: - Even 55 years after gaining independence, 70% of our population lives in rural areas,2 which still believes that cancers are incurable. Shouldn't we first educate this body of people regarding cancer and its treatment? - Even in many urban areas CT, MRI, EUS, etc. are affordable only to the upper strata of the society. How can conservative oncosurgery be offered to those who may have to think twice before even getting an ultrasonography done? - Even today, chemotherapy and radiotherapy and the trained personnel to provide them are available in only a few hospitals. How can one offer conservative oncosurgery without the availability of these adjunctive modalities? - The students and residents in medical colleges are still taught principles of radical oncosurgery. Shouldn't the teaching be updated so that the young surgeons imbibe the principles of conservatism? - The majority of the rural and even most of the urban population may not be able to afford the thorough follow-up and investigations required following conservative oncosurgery. They would prefer radicality against conservatism when it comes to cost-effectiveness. What can be the solution for this group of patients? This letter should not be perceived as a campaign against conservatism in oncosurgery. I truly believe and feel that conservative oncosurgery has an important role to play today and it will increase by leaps and bounds in the future. However, at the same time, the other side of the coin should be kept in mind and due care practised. References 1. Desai PB. The shifting paradigm in Oncology - redefining the Surgeon's role. Ind J Surg 2003;65:317-9. 2. Antia NH. Rural surgery in India. Ind J Surg 2003;65:66-7. © 2003 Indian Journal of Surgery. Also available online at http://www.indianjsurg.com |
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