I’ve been working with laser oncosurgery for the last 12 years and we have done a huge amount of work in laser oncosurgery. Laser oncosurgery is, I would say, the next gold standard for cancer patients because we have always been looking for a treatment option in which you can destroy the cancer without operating. For two reasons – one, for the patient because patients do not want mutilation. Whenever I’m talking I’m talking about breast and oral cancer so ladies don’t want their breast removed and none of the patients want half of their face removed. So if you can have an option where you can keep all these things intact and use the present oncology principles or the oncology [??] which, by the way, are just fantastic at work. All they need is a minimum tumour load to act. But unfortunately what happens is that when we are doing conventional surgery there are two things which happen. One is the surgery spreads the cancer so we keep on chasing that spread all around the body. Two is in oral cancer it causes a huge amount of problems which, in the long term are not reversible. Right from mouth closure to gingivitis to feeding problems, speech problems. Frankly it leads to a huge amount of depression in the patients. So it’s more like a punishment rather than a treatment, and that goes for breast cancer too. So if you’re taking somebody’s breast off and expect them to go and forget about it, everything is fine, it doesn’t work that way.

So there are a lot of medical problems, there is a lot of depression, there are a lot of divorces happening because of breast cancer surgery. That is where laser comes in because laser can destroy the tumour and this is done under sonographic control so we know exactly how far the tumour is. Then we follow up the patients, if there is any small recurrence it can still be lasered, which is another one- or two-minute job. So, all in all, there’s no cutting involved and there’s no mark, in fact. What I always tell people, the future of surgery is no surgery whether we like it, we don’t like it, it’s all around us. Cancer was immune to it for a very long time but now laser has caught up with that.

How does laser oncosurgery differ from conventional cancer treatment?

Conventional cancer treatment is basically based on skill sets of the surgeon. So it involves a lot of operating theatre time, a lot of cutting. So you are cutting, cutting, cutting everywhere and trying to remove the cancer. Laser does away with all that. So the timing is probably just about half an hour to 45 minutes. You do the whole procedure under sonography control, you can actually see the tumour on sonography. The procedure is done percutaneously and you can put the laser inside the tumour and then it depends on the laser skillsets to ablate or burn or fulgurate, whichever word you prefer, to destroy the tumour.

That is something you can make out on sonography itself and the sonologist has to be skilled in that. So there has to be a retraining of all the surgeons in laser and the results that we have seen, quite frankly, are outstanding.

In what treatment situations can it be helpful?

Laser is currently being used in selected situations in brain cancer, oral cancer, yes, you can use it in throat cancer, you can use it in thyroid cancer. We have used a lot of it in thyroid cancer. There are a lot of papers on that, on the subject also. Breast cancer, you can use it in recurrent cases inside the chest, if there are periphery lesions of the lung you can ablate them, burn them, rather than trying to open up the chest. The body absorbs the dead material on its own. Lower down you can get it in liver, a lot of work is being done in ablation techniques of liver, plus prostate, a lot of work being done in prostate as well.

Having said that, it is catching up now. Laser is catching up in oncology and we are very definite and we are very sure in the next ten years laser is going to be the new platinum standard.

How accurate is laser surgery in comparison to conventional surgery?

First of all, we all have to realise that we feel that 100% of the cancer should be out. Practically it is not possible so whatever is being removed is a part of cancer which is what we call in layman’s terms swelling. So when we remove the swelling we try to remove a margin around it. So that margin is either a pathological margin which is very small, maybe 5mm, 3mm, or it may be a clinical margin which will be about 1.5cm. But in many cancers, in most of the cancers actually, the tumour will have seedlings outside the margin level. This is the primary reason why chemotherapy is given. Chemotherapy should not be used for treatment of the swelling or the tumour, you understand. Chemotherapy is used for the cells which are around the tumour so that will remain. But now the chemotherapy has a much better effect because the tumour load is 99% gone. That is the primary reason why you’re doing surgery in the first place. If surgery could remove 100% of the cancer then why would you give chemotherapy radiotherapy.

So laser also does the same thing. Laser would remove, under radiological control, maybe 99% of the… 95-99%, it all depends on the size of tumours. Then the rest of the treatment is conventionally by chemotherapy but, having said that, there is a difference. Now we don’t need very high doses of chemotherapy. So specifically in our practice we use almost 50% of the dose of normal chemotherapy. So most of our patients tolerate it quite well and, in fact, we tell them to eat well and we give all the other instructions like no sugar, you can’t go back to your tobacco or whatever other issues. We have seen patients gaining even 10kg in six months on chemotherapy. On chemotherapy.

So we had to rework the whole of oncology around the patient. Right now most of the oncology that we are doing is around the doctor, the hospital, the departments. No, you have to rework it around the patient. So even in chemotherapy we don’t have a standard dose. For example, if the patient is a 75-year-old person we would not do it with a BMI dose, we would cut down the dose by another 50% so that he’s able to tolerate it, rather than having him end up in ICU and things like that.

How can this be a beneficial treatment option in LMICs?

In two ways. First of all it does not need major hospitals to do this. The equipment which you require is available off the counter. So you can have a laser machine, that’s not a problem. The sonography machine is not a problem. The skillsets of the sonologists are always available. The operating theatre is not a problem because you don’t need a very major operating theatre  because the timing itself is just about one hour for most of the surgeries. There’s hardly any blood loss so you don’t need blood banks standing by for an operation. And the recovery time is 24 hours so you can do it in smaller hospitals, you can do it in smaller places which don’t have a huge $100 million hospital behind them. The best part is that you don’t need oncosurgery skillsets so you can have it with an ordinary ENT surgeon or even a general surgeon which, as anybody knows, general surgeons will be much more in number than an oncosurgeon. They will be available in many more facilities, which an oncosurgeon needs a [??], now you can have it in a hospital which is just about 20 beds. You get a much better response because, for example, in places which are in developed countries, so by the time the patient comes to the main centre he has already gone from stage 1 to stage 4. Stage 4, as you know, in conventional surgery is really not curable. We can do a lot of it in laser, that’s a different issue, but it’s always better to catch it early.

There’s hardly any expense involved. So most of the treatment can be done in maybe less than… I would say if you want to bring it down you can bring it down to less than $800. That includes surgery and chemotherapy.

What can be done or is being done to make this treatment an option in India?

We are trying our level best to educate people. We have been fairly successful because of the internet. So the patients are demanding now from their surgeons that we want to do laser. There is a problem of stepping over the boundary and taking a leap of faith. So we invite everybody to come and have a look at our centre in Bombay, whichever part of the world you are from. Come and see the patients. Even if you attend about two sessions in our OPD you realise that this is what you want in your country rather than… And this is what the patients want at the end of the day.

So we were always looking for a treatment which would be more patient-centric and a better treatment in terms of overall survival, OS as they call it in oncology terms. So better OS and a better quality of life. So we call it better quantity of life and better quality of life. So both these things are available now with new laser technology.

What is your e-poster at WCC about?

We’ve got an abstract for a presentation for patients which we did in the last around ten years. The results we are showing on photographs, with photographs. I feel it’s very apparent that once you see the before and after pictures with the timeframe that this is a new revolution and I invite everybody to be a part of it for the betterment of the patients.

I always say now, because I’ve been a surgeon, I have not taken up a knife in the last ten years. At the end we would like just to say that the fight with cancer starts now.

What is being done to streamline this treatment in India and globally?

I’m here at the World Cancer Congress, so that’s one part. I’m inviting a lot of people, we’ve got these posters, we’ve got these folders. We are inviting people because I’ve realised 99% of cancer professionals are not even aware that this wonderful treatment is already in. It is US FDA approved, so the US FDA knows about it, it’s part of the NCCN guidelines, though not as in guidelines but they have mentioned it in the NCCN guidelines.

 I am trying my level best with the Ministry of Health in India to take this forward. We have got our YouTube channel, Orchid Center For Laser Surgery. We get enquiries from all over the world.

Is there anything else you would like to add?

I feel a lot of people should look for alternatives in the field of laser in whichever cancer. There are only so many people who are doing laser for cancer all over the world and that is a very precious community. I would advise most of the surgeons to actually look at it very, very seriously because this is going to be the future so whether you like it or not we do close to 30-40 operations every month in our centre and that is without any advertisement or anything, it’s just word of mouth. So about 50% of the cases we are now getting after now 5-7 years is just word of mouth, that we’ve done his uncle or some relative and he is cancer free at the end of three years. So he’s obviously recommended laser.

It’s a technology which anybody can master in very less time. We are here to hand hold any surgeon who wants to go through this and upgrade himself. Yes, sadly, there is an issue that we all love surgery and we have huge egos as surgeons. But I think those egos have to be left aside when you consider the future. The future of surgery, again, is no surgery. It’s in gastroenterology, we gave up gastroenterology a long while back to medical guys. Cardiac bypass surgeries have been taken over by angioplasty. So these are all examples of no surgery. Oncosurgery is also going to be part of that. It’s all around us, we just need to be aware of it and look at it seriously and upgrade ourselves.