Best Commando Surgery in Delhi, India

Commando surgery is a complex surgical procedure typically used to treat advanced or aggressive cancers, particularly in the head and neck region. The term "commando" refers to the extensive nature of the surgery, which involves removing a significant amount of tissue, including bone, muscle, and nerve structures, in addition to the primary tumour.

During the procedure, the surgeon makes incisions in the affected area and carefully removes the tumour and surrounding tissue to remove all cancerous cells. The surgery aims to achieve negative margins, meaning no cancerous tissue is visible at the edges of the removed tissue. In certain cases, reconstructive surgery may be necessary to restore form and function to the area after removing the tumour.

While commando surgery is a highly effective treatment option for certain cancers, it is also a complex and invasive procedure with significant risks, including bleeding, infection, nerve damage, and loss of function. Patients who undergo commando surgery require a prolonged hospital stay and a long period of recovery and rehabilitation.

Overall, commando surgery is an essential tool in the fight against advanced or aggressive cancers. Still, it is typically reserved for cases where other treatments have not been successful, and the benefits and risks for each patient should be considered carefully.

Why is Commando surgery done?

• Advanced Cancer: When cancer reaches a point where traditional treatments are ineffective in eradicating the malignant tissue, commando surgery is frequently considered.
• Success Rate: By removing as much cancerous tissue as possible, commando surgery aims to maximise the likelihood of a favourable outcome.
• Deep Tissue Involvement: Commando surgery is frequently performed when cancers have spread deeply into bone or tissue and cannot be treated using other techniques.
• Alternative to Amputation: Commando surgery can sometimes be used as an alternative to amputation by removing the cancerous tissue while leaving the affected limb or organ intact.
• Combination with Other Therapies: To improve the likelihood of a successful outcome, commando surgery may be combined with therapies like radiation therapy or chemotherapy.

Procedure 

Preparation of patient before surgery:

Before undergoing the procedure, the patient is expected to follow and share certain information with the doctor. These are as follows:

• Inform the doctor about the routine medications for various ailments, if any, and a detailed medical history of those conditions as well.
• Avoid ibuprofen, aspirin, or any other blood thinners at least one week before undergoing the procedure as it interferes with the blood clotting mechanisms and causes excessive bleeding after, resulting in delayed healing.
• It is advised not to consume anything after midnight prior to the day of surgery.

Procedure Details

• Anaesthesia: The patient is first given a general anaesthetic to make sure they are unconscious and pain-free during the procedure.
• Incision: To expose the cancerous tissue and associated tissues, a sizable incision is made in the neck and/or jaw.
• Dissection: The surgeon carefully separates the tissue from the nearby blood arteries, nerves, and other structures.
• Removal of the tumour: The surgeon next takes out the cancerous tissue, along with any lymph nodes that may have been impacted.
• Reconstruction: Depending on the extent of surgery, the surgeon may carry out reconstruction using tissue from other parts of the body in order to repair any flaws or damage brought on by the removal of the malignant tissue.

After gently closing the wound, the patient is brought to the recovery area.

Post-operative care

After surgery, a majority of the patients find it challenging to swallow because of swelling in the internal part of the oral cavity. A temporary tube meant for feeding is inserted into the patient either through the nose or mouth prior to the surgery. An adequate amount of food and liquids are given to the patient through this tube. It helps the patient heal by providing healthy nutrition.

After the surgery, the speech also gets impaired among the patients. It will gradually improve over a period of time and with the help of a speech therapist.

In certain cases, the patient may require post-operative radiotherapy sessions to ensure complete healing.

Complications

The following complications are commonly seen among patients undergoing commando surgery:

• Bleeding
• Infection
• Pain owing to the complexity of the procedure
• Skin hypersensitivity around the surgical site because of neuroma
• Numbness and weakness due to the pressure of the swollen tissues on the nerves
• Fistulas.

Precautions

These include:

• Avoid sleeping on the side of the incisions.
• Avoid indulging in any vigorous activity like exercising and operating heavy machinery like cars.
• Avoid alcohol intake and smoking.
• While lying in bed, the head side of the bed of the patient has to be elevated up to 30 degrees for a few days to make the patient comfortable. 

When to call the doctor

• Consult the doctor for any swelling or pus formation at the incision site.
• Problems with the flap or graft.
• If fevers do not resolve even after taking medications.
• In case of neurological complications.

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