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Changing Paradigm of Cancer Surgery

Jan 19 | 1:30 PM

In India, surgical oncology has advanced in its technological innovation and the availability of experienced surgeons, almost at par with the developed world. Oncosurgeons today perform a full range of cancer surgeries and reconstructive procedures with high precision and efficiency. Brands such as Fortis are leading the charge on this front. Join Dr. Anil Heroor, India’s premier cancer surgeon, as he takes a deeper look at the changing paradigm within the field!

[Music] good evening everyone netflix welcomes you to this session today on changing paradigm of cancer surgery we have with us dr anil hero he is an onco surgeon trained at tata memorial hospital he heads the advanced onco surgery unit at fortis hospitals mumbai after completing his mbbs he did his general surgical training from ltmg hospital scion and then he did a surgical oncology training at tata memorial hospital he has received the best paper award at two international conferences for his work on esophageal malignancies apart from this he has many publications including 17 international publications to his credit his area of expertise includes gastrointestinal cancers colon and rectal cancer breast cancer robotic and minimal access surgery cancer yeah thank you thank you charlie and thank you netflix and i must compliment as i was telling just now it's an excellent initiative very interesting and i'm sure it will go a long way in bringing a lot of knowledge and updating people across india and hope everyone takes advantage of this platform my topic today is upgrading surgeries and improving lives and it's a self self explanatory topic uh i was uh it always uh so basically surgery uh you know for a lot of people is just about you know just cutting up and stitching actually as somebody has very aptly said surgery is not only the art of using a knife it is the art of saving a life and what is exactly a life saved have you ever thought about it what do you mean by saving a life when we you know sort of pat our backs and think that we have saved lives is it merely to live is when a person just goes home from the hospital is it enough is it just adding a few more years especially in my kind of speciality that assumes a lot more importance that by we have added three more years to the person is he living a life which should be lived is it restoration of function is that important is it important to have that a person can go about his life normally he can integrate back to society so what exactly is a life saved and that is a question that we have been grappling since medicine began so in my opinion it is not just adding life years to life but also adding life to those years the life that the per patient lives after you have done your surgery after you have done your treatments should be something which is worth living and that is what is measured as quality of life a few years back we did a quality of life study in our own unit regarding our patients who had undergone colorectal surgery first thing is a lot of patients shy away from talking about quality of life and that is why unfortunately you know we as doctors do not really get yet an insight about what patients think uh we all know that you know patient will you know argue with the receptionist he will argue with the watchmen in the outside the hospital but when he comes in front of the doctor usually usually things are changing and things are changing fast i know that but usually people are a little reluctant to express frank opinions and especially when certain questions about quality of life comes it it becomes a little difficult for them to you know sort of talk very very freely with the doctor because they feel that they are commenting on the ability of a doctor and they don't want to really hurt the person sitting in front of them that is why we undertook this short survey which was you know uh you know which which which we did a tele survey through to all the patients whom we had operated for 10 years and gaze their quality of life on various parameters in europe you have this scale of quality of life called as an eortc questionnaire and each disease has a questionnaire of its own and it's a very nice way of measuring they are very particular about it so when you you ask for it in english then you say that if i'm going to ask the questions and say hindi then you have to translate it into hindi and then have another translator translate the hindi version back to english and match the version 1 and version 2. so you are pretty accurate and we found that our quality of life uh did fairly well on certain aspects especially when we were doing minimally access surgery and that is why we uh we i what i would like to discuss today is this aspect of minimally access surgery or laparoscopic surgery that is making such a change in cancer surgery today [Music] so basically where do we use most of minimal access surgeries nowadays it is used in lot of gi surgery since the cancer of the colon and rectum are something close to my heart i will speak with colon and rectum as the focus of minimal access surgery which is now improving the quality of life for a lot of patients now colon and rectal surgery if i were to just give a brief introduction is some is it is a disease which is rapidly exploding any idea or how about you know what is uh what was uh what was the incidence of colon and rectal cancer in japan and south korea at the turn of the century it was just about about in just about 20 years this this incidence jumped from 20 to actually 50. the same happened with korea any guesses on what happened in this country in these countries if you actually think about it the both these countries in that respective time period between 1940s and 1960s for japan and 80s to 2000s for south korea underwent major industrial changes the entire lifestyle changed the entire food habits changed and so did incidents of cancer and colorectal cancer which was such a low incidence cancer suddenly jumped up when when these changes occurred so uh a lot of times even though we think that cancer has no real cause we do not really know what happens in cancer we do not know what how how this comes about in reality this is quite integrated with the kind of life will live uh i would like to take ask you quickly if you can first put in the comments that how what is the percentage of cancers which is related to lifestyle any idea if you can put in the comments please do please do comment on that about how what do you think is the percentage of lifestyle you know being the cause of cancer we'll come to that a few slides later so in india if you almost think that somebody has said almost 40 60 percent perfect 60 is the answer that is that was a british study which said that 60 percent of cancers are actually related to lifestyle so if you think that cancer is not preventable think again and these graphs show exactly this is one of my favorite graphs because this graph shows exactly how lifestyle affects cancer in countries underwent change there were social revolutions there was there was an industrial revolution that happened lifestyles changed food habits changed and colorectal cancer increased so naturally in such a society we also as treating doctors have to ensure that they come back and enjoy the lifestyles that they have sacrificed so much for so then why minimal access how does minimal access fit into all this picture is it necessity sometimes you think is it progress is it something that you are doing you know actually which is a progress in surgery without really affecting the patient because a lot of therapies you know sometimes appear as if they are a progress for the industry they are a progress for the doctors but for the patient is it so that is something that a lot of people wonder so we have to examine that is it a gimmick so you know uh for for making my practice more attractive for saying that i am the best surgeon around i can i can do such a large surgery in such a small incision is it because of that do we want to do minimal access because of that and most importantly in these in days of cynicism is it industry driven medicine are we being pushed to do something that the industry wants us to do without us even knowing let us take a look at some facts as we go along so if you look at laparoscopic surgery for colon actually it immediately started after lab cholecystectomy you know those were the days of the wild west as far as laparoscopic surgery was concerned 1989 was lab cholecystectomy everybody got excited people thought that they can do a lot of things through small incisions in 1990 somebody attempted colonic cancer for the first time this was technically difficult it was challenging it was time consuming it led to a lot of problem in the sense that people started doing the same kind of surgeries that mean they tried to you know like they pull out a gallbladder through a small hole the same way they tried to pull out cancer through the small hole and what did it what happened because of that there was something that was called as port site metastasis which means that the cancer cells when the tumor was squeezed through that hole started implanting in those pores now you know in laparoscopic surgery they make those small holes in order to put instruments they are called as ports and these ports started getting infested with the cancer cells and leading to tumors there so the patient was fine there was no tumor anywhere else there was no tumor in the liver no tumor in the lungs but a large mass and believe me in those days in the in 2000s every one of us had at least one story to tell about a surgery being done laparoscopically and the patient being messed up and frankly honestly speaking that is what drove a surgeon like me to laparoscopic surgery because i wanted to know what really happens if you do laparoscopic surgery and whether the patient will really benefit or it is just something that is poor understanding of the of of this technique that is leading to such kind of problems patients on the other hand intuitively felt that laparoscopic procedures are more advantageous than open ones and that was a and that was a survey which was conducted by the new england journal of medicine in 2004 but of course you have this random surveys on the internet and for some some of them can tell you what kind of dress the staff should wear so even that has an opinion nowadays so we don't really rely on those kind of opinions to be uh now in laparoscopic surgery what is important is to have a very good equipment set up now if you need to have a good laparoscopic equipment uh what what is required is a good camera we are a good uh a good good energy source now what is an energy source you are seeing one in the screen right now actually they are a series of uh series of you know the photos which are over one another unfortunately we can't show you all of them but you need a good monitor you need a good it's not it's not about just having a 14 inch tv and doing laparoscopic surgery you need a good medical grade monitor you need good high definition cameras you need good energy sources now energy sources are something which are used to cut tissue when you are doing laparoscopic surgery now what happens when uh if you don't have them then the complex surgeries that we do for example say a laparoscopic surgery for cancer rectum uh where you need to burn a lot of tissue you don't need blood in the field now in laparoscopic surgery uh no surgery nobody likes bleeding to happen but especially in minimally access if there is blood in the field the vision of the surgeon immediately gets compromised and that is why you will see normally laparoscopic surgeries always have less blood loss than open surgeries so we need these good kind of equipments good instruments a good setup everything is a must because this is basically a technology based surgery and that is why you need all the all the supports that we are and from greatest incisions like this you know when we used to take incisions from top to bottom we are now moving on to something which is as small as you can see you can hardly see the incision here this was one of our cancer rectum patients a small fan and steel incision which is taken for a cesarean section even smaller than that for removing tumors of the rectum this was one of our gastrectomy patients you can see a small midline incision there now which has which was used to extract the tumor and suture it to back now now there are two main questions that i'm always asked how can you see such a large tumor through this small incision and more importantly is it oncologically safe now seeing is believing if i can have the videos on yes uh if yes i will help you video yes yes so you can see here that you can see very very clearly that's a cancer rectum you can see the rectum there and this is an ah in this is the ah this is the ultra season scalpel or this is called as an harmonic scalpel it uses ultrasound to cut and coagulate at the same time that is the nerve you can see you can see each structure i don't know how well you can appreciate it on the on the mobile but when you see it on a 32 or 14 screen things look so clear so clear that you can actually make out each strand that you are cutting and that is what makes this more better than even open surgery the second video please so that is again the nerve being dissected now some some people would say that this is the most important nerve in a man's body any idea this is a cancer rectum case that is the inferior mesenteric artery and that's a nerve being dissected around the inferium centric artery this is the nerve agent is now this is important for genito urinary function uh in in people it is responsible for both sexual function it can cause importance and retrograde ejaculation if cut in males it can cause dysparene in females it can cause a lot of urinary dysfunction when it is cut so these nerves have to be preserved and now there is there is evidence that in the robotic surgery and in laparoscopic surgery the sexual preservation of sexual function is much better than in open surgery these strands are not really visible when you go ahead these strands are not really visible when you actually go ahead and do do do open or open surgery whereas in laparoscopic surgery it is much more clearer so now in colon surgery or in gastrointestinal surgery it is not enough to just have to cut the two ends you have to join them back together and secondly one of the most important things for our patients is that will i be able to pass my stools in a normal way saving the anal sphincter is one of the most important questions as far as the patient is concerned a patient will want to die remember they will say that i will die rather than have a permanent colostomy back so what has made a change what is the paradigm shift that has occurred that is helping us to do this now let's see the joining of two ends can i have the video so here you see a rectal cancer we have put a stapler from below this stapler is coming through and these two ends are joining together being joined together now what staplers have done is that they have really reduced the incidence of a permanent colostomy when i was i was doing my training the incidence of aprs or abdominal perineal resections with permanent colostomy was nearly 30 to 40 percent of all rectal resections we used to do things were very simple back then our professors used to say if you can feel the rectum feel that rectal tumor with your finger on doing a pr the patient goes for apr and has a permanent colostomy if you can't feel it then you can think about doing an anterior resection now this is no longer true for tumors as low as even one centimeter or two centimeters we are now trying to save the sphincter by doing interspenderic resections or and colloidal anastomosis we are doing ultra low rectal resections thanks to laparoscopic and robotic surgery and the use of staplers and this is what has made a huge difference for the patient as far as spin the preservation is concerned then i go to the presentation now one the other other shift that is now slowly occurring and i am sure in the next five to ten years you are going to see a lot more of this is robotic surgery uh robotic surgery essentially is a slave and master system it is not something that you know what we watch in in cartoons it is not something that the robo is going to operate a lot of patients have this fear uh that that this is uh that it is going to be uh that that that we are we are going to have uh the robo operating and it is not going to be the surgeon who is operating that the surgeon is sitting somewhere else and the robo uh sort of killed the patient was one headline that i read about two to three years back doesn't happen the robo is a slave and master system unless somebody is moving the robo the robot doesn't move what it does what it brings to the table is a lot of stability there is a lot of stability in the system your tremors are filtered out it brings a lot of good vision because there is it's a immersive 3d vision that the robo gives you can see structures very well you can see them very clearly and thirdly most importantly the robotic arms have a flexibility and they have a seven degrees of freedom which means that they can move in seven degrees and they can actually rotate through the entire 360 degrees it is better than your wrist then when it happens so robotic surgery is something that is catching up cost is still a major concern as far as robotic surgeries is concerned we we actually are waiting for indigenous robots we are waiting for more companies to come up in the market so that this wonderful technology there will be more available and will be cheaper in uh when it when it comes now is it so simple is lab surgery so simple is making the jump so easy i think what is most important is that the surgeon should have good experience in open surgery we conduct a lot of training camps for surgeons who want to learn laparoscopic oncology and one of the criteria that we put is that you have to be operating at least at least one case of colonic cancer every month because if you are not even doing one case then it is a complete waste because you will never pick up the technique because there is something called as a learning curve for any procedure and that learning curve extends to about 20 to 25 cases for a simple right hemicolectomy if somebody does not have those volumes you cannot go ahead and learn lab surgery for in such a complex situation so you need good experience in open surgery you need technical skill and dexterity there has to be some comfort you cannot be a total you know uh total uh you know total this uh left to left thumbs when you are actually operating laparoscopic surgery because you need to be comfortable with this technology and what you require finally is patience patience and more patience because that is finally what is going to teach you laparoscopic surgery so we have come a long way now we have completed more than thousand cases of laparoscopic in our laparoscopic oncology series most of them have been colorectal cancer we have also done ripple surgery we have done a lot of gynecological malignancies with laparoscopy we have done we have published our data we have of quality of life as i said we have also published our data for use of staplers uh in comparison in comparison with uh uh in both laparoscopic and open surgery uh one can i have this video please one of the wonderful wonderful things about the about minimally accessing surgery is its use in thoracoscopic surgery now this is a lung surgery that we are doing i remember this patient he was a 71 year old normally to do an open lung surgery in a 71 year old is very difficult because of the long incision you have to crack open the ribs this causes so much pain and morbidity that they don't breathe they go on prolonged ventilation and then you know they land up with ventilator associated pneumonias and all the other complications which are there what thoracoscopy has really done it has improved the outcomes the short-term outcomes so well this patient incidentally was sitting up the next day doing his physiotherapy and went home on the fourth day absolutely fine and that is what the pleasure of doing thoracoscopic surgery is as far as lung cancer is concerned or esophageal cancer is concerned next next again another another area where it has really improved short-term outcomes is thymus surgery uh you we know of myasthenia gravis uh or thymomas which can cause myasthenia gravies that the treatment for thymomas is to do surgery previously the the the incision was a midline sternotomy as they do for cabg very morbid procedure especially in a patient who has been weakened by myasthenia gravis they used to go on ventilator post post operatively what thoracoscopy has done if you can put on the video please yes sir thank you yeah so here you are seeing the thymic surgery that is the beating heart that is there uh you can see that that's a thymoma that [Music] okay fine i don't think we're getting the video fine you can go back to the presentation so yeah that's that's the thymuma and uh we have to dissect over the large veins that are there if you can i didn't see there there is a uh the superior vena cava there that's the superior vena cava which is seen and that's the phrenic nerve so all these structures are seen very clearly and with the use of these instruments you can actually dissect on the vein without really causing any harm to uh to the to the vein per se even a thyroid can be uh you know sort of operated with endoscopic surgery though i'm not a very big fan but you know you know in a young girl you know this was a very young girl she was 19 year old unmarried parents were anxious for them you're not having a visible scar on the neck was important so you can see the scar was around the nipple and in the axilla and we could actually do a hemothyroidectomy for this patient through this scar which was obviously hidden very well uh even a ripple's procedure which is considered to be the ultimate procedure as far as oncology is concerned is something that can be done through laparoscopy we have had the experience of doing it both the laparoscopic as well as robotic and it is really really gives the patient a very very fast recovery as far as even this morbid procedure is concerned so uh all in all uh i would i would like to end by saying that uh minimally access surgery is something that has uh that is now here to stay uh evidence for minimally access surgery now is very strong there are numerous trials which show that minimally accessed surgery is as good as open surgery in colorectal cancer there is no doubt i think that now there was this large trial which showed that which was called as the color 2 which had 802 patients who were randomized showed that the results are absolutely the same similarly there were trials for gastrectomy similarly there were trials uh for esophagectomy we all of which showed a good uh results for minimally accessed surgery the only plot was a trial on cancer cervix but there were so many holes in that trial that obviously we need a better trial design in order to come to a conclusion whether minimally access surgery should be done for cervix or not uh thank you very much for giving me a patient here uh i'll now turn to some of the questions that have come in the in in this in the question box yes uh yeah so this is from dr kunal can you say something about lab surgery in crohn's yeah basically it is the same as in as in lab surgery for any lab colorectal surgery of course any inflammatory bowel disease whether it is crohn's or whether it is ulcerative colitis is extremely difficult is much more difficult than doing it for oncology because there is a lot of inflammation around ah that is why these patients sometimes bleed sometimes the vision is poor the bowels are dilated uh so challenging but can be done how many sessions of adjuvant chemotherapy are required for colon cancer pre-treated with surgery and radiotherapy so great three with no metastasis good surgical margin so basically i think that you need a complete report for it normally what happens is if a patient has been operated adjuvant chemotherapy is what is there there are various regimens one of which is call fox which has 12 cycles which are given at 15 day intervals and the other is capox which is 6 cycles given at three weekly intervals i think you are it depends on what kind of surgical report that the patient has um there were there was a recent paper which said that there are some patients who might even get away with three months of adjuvant chemotherapy as compared to six months of adjoining is lab a better option for oligometastatic lesions in different organs than the traditional method i have not really understood the question but if i have interpreted it right uh basically you are asking me if it is a good option for liver metastasis or any other metastases it depends on the location of the metastasis the expertise of the surgeon the comfort of the surgeon it does not make a difference as far as the disease is concerned see basically as my boss used to always say laparoscopic surgery is a means to the end it is not the end in itself having said top all of this about laparoscopic or minimally access surgery i would especially for the youngest younger students and the post graduates in the audience i would like to say that we give giving a safe outcome for your patient is more important than the means that you employ first do no harm is the basic principle of medicine you have to be uh you have to have crossed your learning curve and you have to be a very uh you have to have an expertise in doing laparoscopic surgery what is your opinion about leak rates in small bowel laparoscopy versus open there is no evidence that leak rates are more in laparoscopy or open it is absolutely the same i think those were the questions uh one question was by dr kunal when in one video you said this is the most important was it it was uh yeah it was it was uh it is basically the superior hypogastric plexus these are uh these are these are the uh these are this is the plexus which are uh which is which at the beginning is sympathetic is uh then there is a parasympathetic input it forms the inferior hypogastric nerve and then finally forms the inferior hypogastric plexus so there are three places where the nerve has to be preserved when we are doing rectal cancer surgery and that is much better seen in minimally access according to me all right okay so so till i think we can wait for a few minutes for questions so would you want us to play the video for the whipple's procedure the one which we yeah we can if we have time yes sir yes sir definitely [Music] so this is a vehicle's procedure and this was done for a periampillary carcinoma that's a deodorant that we have dissected you can see once when we flip the duodenum you are seeing the inferior vena cava there and we are actually dissecting between the aorta and the inferior vena cava [Music] that's the that's the inferior vena cava being seen we are dissecting between the aorta and the inferior vena cava this is the aorto cable nodes that are being removed so if you think that we are compromising as far as that's the auto cable nodes you can see ota and ivc if you think that we are compromising on the radicality and when we do minimally access surgery or completely wrong we actually have much better vision and we remove equal number of nodes whenever we do minimally access that's the superior ecentric vein and the pancreas being dissected out i hope you can see it well on your screens that's the superior centric vein [Music] that's the hepatic artery which has been dissected and that the gastrodiodenal branch [Music] which is clipped and cut then we resect the stomach by putting a stapler there's a little buffering of the video that's i apologize for the same that's the stomach and the duodenum being [Music] bisected off once we have done the pancreatic tunnel we go to the opposite side we dissect the first loop of jejunum [Music] [Music] that's the first loop of jejunum being dissected [Music] [Music] i think the video is getting a little stuck uh that's the pancreas being cut now the specimen being separated out the last structure which is actually cut is the common bile duct you can see the pancreas being cut with the harmonic scalpel [Music] that's the pancreatic duct nothing is stuck now buffering quite a lot so there's one question uh which which which is asking whether there is a laparoscopic intervention available advisable in ovarian cancer no it is not advisable in ovarian cancer there are certain uh no goes as far as laparoscopy in oncology is concerned ovarian cancer is one of them where if there is extend extensive peritoneal meds then we will not go and do laparoscopic surgery in fact if there is any suspicion of malignancy as far as ovarian cancer is concerned if you see a patient who has solid masses within an ovarian cyst then i would strongly suggest and the cyst is more than five centimeters in size i would strongly suggest that an open surgery should be done there should be no spillage because then you are going to upstage the tumor from stage one to stage three so that's a no go as far as laparoscopic intervention is concerned and how to proceed recurrent gps cancer now gps means uh i guess when you are say when you are saying mrnd then you mean to say that it is modified radical negative section and gbs means gingiva buccal sulcus so if that is uh that is the case then basically if it is resectable you need to do a ct scan and see if it is resectable if the nodes are not stuck to any major vessels if it is resectable then you have to go ahead and do a commando surgery which is a composite resection of the mandible along with the radical neck dissection and then do a reconstruction nowadays this reconstruction is done using a free fibula flap uh which is taking the fibula bone and using it to reconstruct the uh the bone or the mandible bone yes sir how to reduce foresight metastasis now port site metastasis is basically uh the reduction of port side metastasis nowadays is less than 0.04 percent that is because our understanding the fundamental understanding of uh laparoscopic surgery has improved we now know that as i said it is a means to the end and not an end in itself because now you are doing the same surgery for the same disease you are not doing something different so if you try and you know squeeze the tumor out through incisions then you are going to have a port side implant that is why we prefer to take an incision we use wound protectors where there is a commercially available wound protectors are there or you can use a plastic bag in order to isolate the wound from the tumor when you are removing it and that is how we have reduced portside metastasis as well as surgical site infections are minimally invasive surgeries used for neck dissection yes minimally invasive surgeries are used for neck dissection as well nowadays uh there are various techniques both robotic as well as endoscopic uh though again as i said i feel that it's a little uh taking it a little far too far but then there are people who do it very very well so there's one raise and i'll just accept the request yeah yeah will you please elaborate gbs gbs uh i didn't get gbs's is uh i just answered gbs is gingivo buccal sulcus or dbs gallbladder cancer gallbladder cancer so uh so basically uh what do you want to know about gallbladder cancer [Music] so basically gallbladder cancer is a is a topic by itself it's a it's an entire subject by itself uh just to put it briefly these are very aggressive malignancies uh these are very aggressive malignancies now when they occur in the now what happens a lot let me put it in this way as what things can be best avoided now whenever an ultrasound is done and you see a gallstone as well as you see and the sonologist says that there is a small pollen or there is a tumor which is there along with the gallbladder then i would strongly recommend that this kind of case should not be done by a general surgeon it should be it should be done by a surgical oncologist or at least a person who is well trained in hepatobiliary surgery you need to also have a frozen section ready uh even if laparoscopy is attempted at the first go then the specimen should be put into a bag and extracted without any contamination of the wound this is the most important thing when you are dealing with an operable gallbladder cancer if you find that there is a gallbladder cancer then it requires a resection of the liver liver bed that is a segment 4 5 as well as clearance of the lymph nodes which are along the along the bile duct more extensive resections can be done unfortunately gall bladder cancers usually present with jaundice we present in an advanced stage and at that point in time uh you know you have just have palliative chemotherapy and nothing else i would strongly urge everybody that after a polycystic tummy the specimen should be sent for histopathology examination a lot of times i find patients coming up and saying that that is because the doctor has not sent the gulfs to gallbladder for a histopathological examination uh anything that comes out of the body should go for an uh for a biopsy and we must we must and that's a double double underline for both you and me follow up on the histopathology report a lot of times people we had a patient of appendicitis operated six months later that guy came to us with a huge mass he was operated in the nursing home in the periphery was fine and six months later developed intestinal obstruction with a huge mass when he came to us he had recurrent malignancy there nobody had bothered to see the original report the report when it was traced clearly said adenocarcinoma of the appendix so we must follow up if there is one lesson about gallbladder cancer that i would like to really emphasize here is that please follow up on your histopathology reports for all the gallbladders that are getting operated [Music] okay yes i think we are done with the questions for today thank you so much sir it was a very nice session uh very very uh explained very nicely properly we have lots of emojis still coming on we have comments that it's a nice session and thank you i think we have one question what is core tip neutropenic colitis kindly highlight no i i really don't uh not got this question what is and we have it was a good session so so thank you so much for coming on our platform uh it was nice to have you here i'm sure our audience they are just constantly giving their feedback through the emojis we hope to see you again and thank you to the audience as well for attending this session

BEING ATTENDED BY

Dr. Murtuza Zozwala & 632 others

SPEAKERS

dr. Anil Heroor

Dr. Anil Heroor

Head of Department - Surgical Oncology, Fortis Hospitals, Mumbai

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dr. Anil Heroor

Dr. Anil Heroor

Head of Department - Surgical Oncology, Forti...

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