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Our Clinical Services

Surgical Services

The Division of Surgical Oncology provides surgical care for many kinds of solid tumours. The signature surgical oncology services are Breast, Gastrointestinal Tract and Sarcoma, Hepatobiliary. Head & Neck and Thoracic Surgical Oncology.  Below is the introduction of various areas/ services:

Advanced Gastrointestinal and Sarcoma Surgical Oncology (AGISSO)
AGISSO specializes in Gastrointestinal Tumours, Pelvic and Peritoneal Cancers and Sarcomas. Through a multi-disciplinary and collaborative approach, surgical oncologists in this department provide holistic care to patients who suffer from these complex conditions. In addition, we perform diagnostic and therapeutic endoscopies and biopsies of suspected tumours.

Gastrointestinal and Peritoneal-based Tumours
Colorectal and gastric cancers are commonly seen in our patient population. They may be early staged and easily resectable, but may also be advanced, metastasizing to the liver, lung and peritoneum. Our department has offered cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) since 2001 and currently, has the most known extensive experience in Asia in CRS and HIPEC for patients with peritoneal-based tumours. Our multidisciplinary clinics offer a one-stop service for the evaluation and surgical management of these patients.

Advanced Pelvic Tumours
The pelvis is a small cavity in which many vital organs and structures are located. Due to its dependent location, many recurrent tumours of the abdomen and pelvis occur within the pelvis. Surgery for these patients is complicated, often involving multi-organ resection and should be undertaken by experienced surgeons. Our multidisciplinary clinics offer a one-stop service for the evaluation and surgical management of these patients, employing the expertise of a team of sub-specialists including gynae-oncologists and urologists for the benefit of the individual patient.

Sarcomas and Melanomas
Soft tissue sarcomas are a group of rare cancers that affect the soft tissues of the body. There are more than 70 different subtypes of soft tissue sarcomas and sarcoma-like growths. The more common sarcomas include liposarcomas, gastrointestinal stromal tumors (GIST) and leiyomyosarcomas. The mainstay of treatment is surgery with clear margins. Our department provides the surgical expertise in a coordinated multidisciplinary approach to the management of these tumours.

Melanomas are the most common malignant skin tumours. They often arise in the skin, but are also found in the eyes and mucous membranes. Surgery offers the best chance of cure and depending on the stage, often involves wide excision of the melanoma and sentinel lymph node biopsy or regional lymph node clearance. In advanced cases, isolated limb perfusion for limb salvage and surgery to relieve symptoms from metastases may be required. 

Multidisciplinary Team Approach to Complex Tumours
The management of advanced and complex tumours is not routine to most surgeons. It requires a holistic approach and individualized care for each patient. To this end, surgeons in the advanced cancer team work closely to achieve the best outcomes for our patients. All cases of malignant tumors are discussed at multidisciplinary tumour boards comprising of surgical oncologists, medical oncologists, radiation oncologists, radiologists, nuclear medicine physicians and other allied health staff to ensure the appropriate treatment decisions are made.

Gastrointestinal Tumours and Sarcoma (Advanced Cancer Surgery) Clinics
Referral Criteria:
Suspicious lumps
Enlarged lymph nodes
Cancers of the gastrointestinal tract (oesophagus, stomach, small bowel, colon and rectum) presenting with:
• Change in bowel habits
• Peri-rectal bleeding/ black stools
• Difficulty in swallowing
• Loss of weight and/or appetite
• 
Peritoneal-based tumours
Sarcomas
Melanomas

Breast
The SingHealth Duke-NUS Breast Centre offers a comprehensive range of advanced surgical options, in particular – oncoplastic and reconstruction breast surgery, sentinel node lymph biopsy, minimally invasive surgery (eg: mammotome biopsy) and intraoperative radiotherapy for patients undergoing breast-conserving surgery.
Treatment is individualized for each patient, and every case of breast cancer is discussed at a weekly multidisciplinary conference to ensure the best treatment options are recommended.
Patients have access to warm, supportive care from the team of experts focused on breast cancer throughout their duration of treatment.

Head & Neck
The SingHealth-Duke-NUS Head and Neck Centre provide holistic care for patients with tumours of the head and neck region through a multi-disciplinary collaborative approach. A wide array of services, ranging from open resection surgery to minimally invasive robotic surgery, is available to patients who require them. To this end, the Centre comprises of head and neck surgeons, otorhinolaryngologists (ENT), plastics and reconstructive surgeons and allied health staff all working in unison to achieve the best outcome for patients.

Hepatobiliary
The HPB Surgical Oncology Service at NCCS operates within the Comprehensive Liver Cancer Clinic (CLCC) which is a one-stop multi-disciplinary program. The clinic brings together all the different specialists relevant to the management of HPB cancers to work around the patient. This facilitates multi-disciplinary discussion and care. For the patient, it also avoids multiple appointments with various specialists at different locations.
Surgical resection remains the modality of treatment that offers potential cure for HPB cancers that are amendable.  Currently available therapies also offer the opportunity of down-staging locally advanced HPB cancers to receive potentially curative surgical resection.

The specialists practicing at the CLCC include HPB surgeons, medical oncologists, radiation oncologist, interventional radiologist and nuclear medicine physicians.

We are dedicated to the diagnosis and treatment of:
1. Primary liver cancer (hepatocellular, peripheral cholangiocarcinoma)
2. Colon / rectal cancer that has spread to the liver
3. Neuroendocrine / carcinoid tumours and GIST that have spread to the liver
4. Gallbladder cancer
5. Bile duct cancer (central and distal cholangiocarcinoma)
6. Pancreatic cancers


Conditions Managed by HPB Surgical Oncology Service
• All suspected or proven tumours in the liver, gallbladder, biliary tree and pancreas:
– without or without previous treatments now seeking consultation regarding possible surgical, regional  or systemic therapy
– already been given a treatment plan or already treated but seeking a multi-disciplinary second opinion

• secondary liver tumour with a known or suspected primary tumour elsewhere
– e.g. colorectal, neuro-endocrine/carcinoid, GIST

 
Thoracic
Thoracic Surgery is a surgical specialty devoted to the treatment and diagnosis of pulmonary and other thoracic conditions. The main emphasis is on thoracic lesions which are suspected neoplasms.

Diseases treated include pulmonary, oesophageal, mediastinal, pericardial and pleural lesions, chest wall and sternum, both benign and malignant conditions.

The depth and breadth of our thoracic services means that patients have access to the leading-edge surgical and non-surgical techniques. This includes the minimally invasive surgeries, known as Video-assisted Thoracoscopic Surgery (VATS) that allow for quicker recovery. This type of surgery uses small incisions rather than one large incision. This minimally invasive approach provides excellent exposure of the lung.  It reduces surgical trauma, minimizes postoperative pain, allows earlier patient mobilization and hence decreases hospitalization. This resulted in overall better quality of life. The application of VATS in thoracic surgery has become a standard of care and has almost become a routine approach for most conditions, both benign and malignant conditions. Most lung cancer surgeries, for example lobectomy, are done via VATS.

It had been shown that, for most cancers, patients have fewer complications if they have surgery at a hospital that performs large numbers of these operations and performed by surgeons with expertise in the procedure.
 
We also work with oncologists, radiation oncologists, pathologists, and radiologists to provide a multidisciplinary comprehensive approach to therapy.  We have a unified approach to cancer care, with teams of doctors who work together to guide each patient through diagnosis, treatment and recovery.