Key Takeaway:
Price controls—whether on alcohol, rent, or healthcare—consistently lead to shortages, declining quality, and corruption. For Indian healthcare to thrive and innovate, a transparent, profitable, and patient-focused free-market approach is essential.

Introduction: The Hidden Costs of Price Controls

Imagine needing a medical scan or a doctor’s appointment, only to wait weeks or even months for your turn. While price capping is often introduced with the best intentions—to make healthcare more affordable—history and global experience show that it can backfire, leading to scarcity, lower quality, and even corruption. As India debates price controls in healthcare, it’s crucial to understand what’s at stake.

Imagine walking into a store and finding empty shelves, or searching for an apartment only to discover none are available—or worse, the ones you find are in poor condition. These are not just hypothetical scenarios; they are the real-world consequences of government-imposed price caps. While the intention behind price controls is often to make essential goods and services more affordable, history shows that such policies usually backfire, harming the very people they aim to help.

Alcohol:
In the early 1970s, the United States government tried to control inflation by capping prices on a wide range of goods, including alcohol. The result? Shortages, black markets, and a surge in illegal sales. Instead of making alcohol more accessible, these controls led to lower quality and increased corruption .

Rent:
Cities like New York and San Francisco have long histories of rent control. While a lucky few enjoy below-market rents, most renters face a shrinking supply of available apartments, deteriorating building conditions, and higher prices elsewhere. Studies show that rent control reduces the quantity and quality of housing, and often benefits the well-connected rather than those most in need .

Healthcare:
Attempts to cap healthcare prices in the U.S. and elsewhere have led to hospital closures, reduced quality of care, and longer wait times. When hospitals can’t cover their costs, they cut services or close altogether, leaving patients with fewer options and lower standards of care .

Whenever governments artificially cap prices, they create scarcity—demand outstrips supply, and not everyone can get what they need. This scarcity opens the door to corruption and black markets, especially in essential sectors like healthcare.

Historical and Global Examples:

Key Finding:
When price controls create scarcity, those with connections or money find ways to jump the queue, while ordinary people are left waiting—or paying bribes for basic care.

Healthcare is unique—it’s both a vital service and a business. Hospitals invest heavily in advanced equipment, skilled staff, and innovative treatments like robotic surgery. These investments are only possible if hospitals can earn a fair return. If price caps are imposed:

• Capital Expenditure (Capex) Suffers: Hospitals may delay or cancel investments in new technology, leading to outdated care.
• Quality Declines: With squeezed margins, hospitals cut corners—less staff, older equipment, and longer wait times.
• Innovation Stalls: No one wants to lose money. If providing high-quality care isn’t profitable, new techniques and technologies simply won’t arrive.

Key Finding:
In a free market, prices reflect the true cost of quality care. Artificially low prices force providers to compromise on quality or exit the market altogether .

Despite their wealth, both the US and UK are grappling with long waiting times for routine healthcare—an outcome often linked to price controls and system constraints.

NHS (UK) Waiting Times (2024–2025)- Entirely government run.

• GP Appointments: 56% are same-day, but 2.2% wait 28+ days.
• Outpatient Appointments: Median wait is 13.3 weeks; only 59.8% seen within the 18-week target.
• Diagnostic Scans: Median wait is 2.4 weeks, but 18.4% wait over six weeks. For CT scans, 57% wait more than six weeks.

• New Patient Appointments: Average wait is 31 days in major cities; some specialties and cities are much longer.
• Diagnostic Scans: Waits of a week or more are common, especially for non-urgent cases and in areas with fewer providers.

Key Insight:
Even in advanced economies, price controls and system bottlenecks have led to long waits for basic and advanced healthcare services.

Today, India stands out for its relatively easy access to both basic and high-end healthcare. Patients can often see specialists or get advanced scans within days, not weeks or months. This is possible because the system, while imperfect, allows for market-driven pricing and investment.

Healthcare Access and Quality (HAQ) Index is calculated based on mortality rates from causes that should not be fatal if effective medical care is available.  While India’s overall healthcare quality lags behind the US and UK, access to care—especially for those who can pay—is often faster and more flexible. This is a direct result of allowing providers to set prices that reflect their costs and investments. Proce control will not make HAQ better- in fact, it will make it worser.

If price controls are imposed in India, the likely consequences are clear from global experience:

• Scarcity of Services: Hospitals may limit the number of patients or reduce investment in new technology, leading to longer waits.
• Decline in Quality: With squeezed margins, providers may cut corners, use older equipment, or reduce staff.
• Corruption and Black Markets: Scarcity creates opportunities for bribery and under-the-table payments, as seen in Venezuela and Eastern Europe.
• Loss of Talent: Skilled doctors and nurses may leave for better-paying jobs abroad, worsening shortages at home.
• Stifled Innovation: Without the ability to earn a fair return, hospitals will be less likely to invest in advanced treatments like robotic surgery.

Prediction:
If price capping is introduced, India could see the same long waits and corruption that plague other countries with strict price controls—erasing its current advantage in healthcare access.

India produces some of the world’s best doctors and nurses, yet thousands leave each year for better-paying jobs abroad. In 2023 alone, up to 100,000 Indian nurses migrated overseas, and nearly 75,000 Indian-trained doctors were working in Organisation for Economic Co-operation and Development  (OECD) countries . The main reason? Indian hospitals, constrained by low prices, simply can’t afford to pay competitive salaries.

This “brain drain” means India loses not just talent, but also the ability to innovate and provide world-class care at home.

Healthcare is a business—but it can be a clean, ethical, and patient-focused one. When providers are allowed to earn a fair profit, they can:

• Invest in new technology and advanced treatments (like robotic surgery)
• Attract and retain top medical talent
• Offer faster, higher-quality care to patients

Innovation in Action:
Techniques like robotic surgery, advanced imaging, and minimally invasive procedures are only possible when hospitals can invest in the latest equipment and training. These advancements mean:

• Faster recovery
• Reduced complications
• Better quality of life for patients

But these benefits depend on a system that rewards quality and innovation—not one that punishes success with artificial price caps.

Some countries have found ways to balance universal access with market-driven quality:

• Switzerland: Everyone must buy private health insurance, but insurers compete for customers. The result? High-quality care, short wait times, and universal coverage—though at a higher cost .
• Singapore: Citizens use mandatory health savings accounts and choose between public and private providers. The system is efficient, affordable, and delivers excellent outcomes .

These models show that when patients and providers are empowered by transparent, competitive markets, everyone benefits.

If India wants to retain its best healthcare talent, attract investment, and foster innovation, it must allow healthcare to operate as a clean, transparent business. This means:

• Encouraging Profitable, Ethical Practice: Hospitals should be rewarded for quality and innovation, not penalized by price caps.
• Supporting “Make in India” for Healthcare: Higher prices enable investment in research, new technology, and world-class care.
• Letting the Market Work: As the economy grows, what seems expensive today will become affordable tomorrow, just as mobile phones and air travel have become accessible to millions.

Key Takeaway:
Price controls may seem like a quick fix, but they undermine quality, drive away talent, and stifle innovation. A patient-focused, market-driven healthcare system is the best way to ensure access, quality, and progress for all.

History teaches us that price capping—no matter how well-intentioned—leads to shortages, lower quality, and corruption. In healthcare, these effects are especially damaging, as they directly impact lives. By embracing a transparent, ethical, and profitable healthcare market, India can retain its best talent, foster innovation, and deliver world-class care to its people. The future of Indian healthcare depends on letting quality and value—not artificial price limits—lead the way.

In recent years, advancements in artificial intelligence (AI) have revolutionized various industries, and healthcare is no exception. Particularly in cancer treatment, AI is being explored as a potential tool to enhance decision-making processes. A recent study published in BJS Open evaluated the concordance between therapeutic recommendations for colorectal cancer (a type of cancer that affects the colon or rectum) made by multidisciplinary teams (MDTs) and those generated by an AI model, ChatGPT. The findings shed light on the role AI might play in the future of cancer care, offering both opportunities and challenges.

When treating complex conditions like colorectal cancer, decisions are typically made by a multidisciplinary team (MDT). This team consists of specialists from various medical fields—such as surgeons, oncologists, radiologists, and pathologists—who collaborate to create tailored treatment plans for each patient. MDTs are considered the gold standard for cancer care because they integrate diverse expertise and take into account patient-specific factors like age, medical history, and overall health.

However, MDTs are not without challenges. They require significant time, resources, and coordination. Additionally, because they are human-led, decisions may sometimes be influenced by individual biases or subjective perspectives. As the number of cancer cases rises globally, the demand on MDTs continues to grow, leading researchers to explore innovative solutions like AI to support their work.

ChatGPT, a large language model, has shown promise in various fields, from education to customer service. In medicine, tools like ChatGPT are being developed to assist with diagnosing illnesses, suggesting treatments, and even supporting patient communication. In the study, researchers tested ChatGPT’s ability to recommend treatment plans for newly diagnosed colorectal cancer patients and compared its decisions to those of MDTs.

The results were intriguing. ChatGPT’s recommendations aligned with MDT decisions 72.5% of the time in pre-treatment discussions and 82.8% in post-treatment discussions. This level of concordance suggests that AI could play a supportive role in cancer treatment planning, particularly by providing an additional layer of insight or confirming existing decisions. Moreover, AI models like ChatGPT have the potential to reduce the workload on MDTs by processing large amounts of clinical data quickly.

1. Efficiency and Speed: AI can analyze complex clinical data quickly, potentially saving time during decision-making processes.
2. Consistency: Unlike humans, AI tools do not experience fatigue, distractions, or emotional biases, which can lead to more consistent decision-making.
3. Access to Guidelines: ChatGPT was programmed to follow the German S3 guidelines (a leading evidence-based framework for colorectal cancer treatment). This ensures its recommendations are grounded in established medical protocols.

Scalability: As the demand for MDTs increases, AI tools could help manage growing caseloads, especially in resource-limited settings where access to specialists may be constrained.

• Limited Context Understanding: ChatGPT relies on textual data to make recommendations and cannot interpret nuanced visual information from imaging tests like CT or MRI scans. This may lead to oversimplified or incomplete suggestions.
• Human Factors: Decisions in cancer care are not just about clinical data; they also consider factors like a patient’s psychological state, social circumstances, and functional health. AI lacks the ability to account for these human elements.
• Age and Complexity: The study found that discrepancies between ChatGPT and MDT recommendations were higher in older patients (above 77 years) and those with more complex health conditions. This highlights the importance of human oversight when using AI in clinical settings.
• Potential for Errors (Hallucinations): Although not observed in this study, AI models can sometimes generate incorrect or misleading information, known as “hallucinations.” Rigorous monitoring is essential to avoid such risks.

While AI is unlikely to replace MDTs anytime soon, it has the potential to complement their work. For instance, AI could serve as a “second opinion,” offering alternative perspectives or confirming decisions. It may also be used to triage patients, identify treatment options based on clinical guidelines, or streamline administrative tasks, freeing up time for healthcare professionals to focus on patient care.

However, the integration of AI into healthcare must be approached with caution. Ethical considerations, such as patient consent and data privacy, are critical. Additionally, standardized frameworks will be needed to ensure accountability and transparency in AI-assisted decision-making.

The study underscores the growing role of AI in healthcare and its potential to enhance cancer treatment decision-making. By working alongside human experts, AI tools like ChatGPT can help improve efficiency, reduce workload, and ensure evidence-based care. However, AI’s limitations highlight the irreplaceable value of human judgment, empathy, and experience in medicine.

As innovations in AI continue to evolve, the future of healthcare looks brighter. By combining the strengths of advanced technology with the expertise of dedicated healthcare teams, we can move closer to a world where every patient receives timely, personalized, and high-quality care. At MACS Clinic in Bangalore, under the leadership of experts like Dr. Sandeep Nayak, such advancements hold the promise of transforming cancer treatment, making it more accessible, efficient, and patient-focused.

When faced with advanced abdominal cancers that have spread to the lining of the abdomen (known as peritoneal carcinomatosis), treatment options can seem daunting. These cancers, often arising from colorectal, ovarian, or appendix tumors, are notoriously difficult to treat. However, a groundbreaking combination of surgical and chemotherapy techniques—Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC)—is offering new hope . And now, with the integration of Enhanced Recovery After Surgery (ERAS) protocols , patients are experiencing faster recoveries and better outcomes than ever before.

CRS and HIPEC are used to treat cancers that have spread to the peritoneum (the lining of the abdominal cavity). These cancers were once considered untreatable, with patients often receiving only palliative care to manage symptoms. However, CRS and HIPEC have changed the game.

• Cytoreductive Surgery (CRS): This is an extensive surgical procedure where all visible cancerous tumors are removed from the abdominal cavity. It may involve removing parts of affected organs, such as the intestines, spleen, or ovaries, depending on the cancer’s spread.
• Hyperthermic Intraperitoneal Chemotherapy (HIPEC): After the surgery, heated chemotherapy is delivered directly into the abdominal cavity . The heat enhances the effectiveness of the chemotherapy, allowing it to target any remaining microscopic cancer cells while minimizing side effects on the rest of the body.

This combination is typically recommended for patients with cancers like advanced ovarian cancer, pseudomyxoma peritonei (a rare tumor of the appendix), or colorectal cancer that has spread to the peritoneum. CRS and HIPEC are not suitable for everyone; careful patient selection is crucial. Factors such as the extent of cancer spread, overall health, and the absence of metastases in other organs (like the liver or lungs) determine eligibility.

CRS and HIPEC are life-saving but highly invasive procedures. Traditionally, recovery from such surgeries was slow and fraught with complications. Patients often faced:

• Prolonged Hospital Stays: Recovery could take weeks, with patients confined to hospital beds for extended periods.
• Delayed Return to Normal Activities: Weakness, pain, and complications like infections or intestinal blockages (ileus) often delayed recovery.
• High Risk of Complications: Traditional recovery methods, such as prolonged fasting and heavy reliance on narcotics for pain management, increased the risk of infections, respiratory issues, and other complications.

These challenges underscored the need for a more structured, patient-focused approach to recovery.

Enhanced Recovery After Surgery (ERAS) protocols are transforming the way patients recover from complex surgeries like CRS and HIPEC . ERAS is a set of evidence-based guidelines designed to reduce the physical stress of surgery, promote faster healing, and improve overall outcomes. These protocols address every phase of the surgical journey—before, during, and after the procedure.

1. Preoperative Preparation:

• Patients receive counseling to understand the procedure and set realistic recovery goals.
• Nutritional optimization and physical conditioning (prehabilitation) prepare the body for surgery.
• Smoking cessation and anemia correction are emphasized to reduce complications.
  2. Intraoperative Strategies:
• Advanced anesthesia techniques and careful fluid management minimize surgical stress.
• Maintaining normal body temperature and blood sugar levels during surgery helps improve outcomes.
  3. Postoperative Care:
• Early mobilization (getting patients out of bed and walking within hours of surgery) prevents complications like blood clots and pneumonia.
• Patients are encouraged to resume eating solid food as soon as possible, often within a day of surgery.
• Pain management focuses on reducing narcotic use, relying instead on multimodal approaches like epidurals or nerve blocks.

The integration of ERAS protocols into CRS and HIPEC has led to remarkable improvements in patient outcomes:

• Faster Recovery: Patients recover more quickly, with shorter hospital stays. For example, studies show that ERAS can reduce hospital stays from 10–11 days to as few as 7 days.
• Lower Complication Rates: By addressing factors like fluid overload and infection prevention, ERAS reduces the risk of complications such as surgical site infections or intestinal blockages.
• Improved Quality of Life: Patients experience less pain, regain strength faster, and return to their normal routines sooner.
• Better Long-Term Outcomes: Faster recovery allows patients to start additional treatments, such as chemotherapy, sooner, improving their chances of long-term survival.

While ERAS protocols offer significant benefits, their implementation is not without challenges. These include:

• Multidisciplinary Coordination: Successful implementation requires collaboration among surgeons, anesthetists, nurses, nutritionists, and physiotherapists.
• Patient Compliance: Patients must actively participate in their recovery, which can be challenging after such an extensive procedure.

Tailoring Protocols: Not all elements of ERAS are suitable for every patient. For example, patients with extensive disease may require modifications to the standard protocol.

The combination of CRS, HIPEC, and ERAS protocols represents a new frontier in cancer treatment. These advancements are not just about extending survival—they are about improving the quality of life for patients facing some of the most challenging cancers. By reducing recovery times, minimizing complications, and empowering patients to take an active role in their healing, these protocols are setting new standards for care.

At MACS Clinic, Bangalore, under the leadership of experts like Dr. Sandeep Nayak, the focus remains on adopting innovative, patient-centered approaches to cancer care. By combining cutting-edge techniques with compassionate care, we are paving the way for a brighter future in oncology.

In conclusion, early recovery protocols like ERAS are revolutionizing the way we approach complex surgeries. They are a testament to the power of innovation and collaboration in healthcare, offering hope and healing to patients when they need it most.

Understanding Radiation After Robotic Radical Prostatectomy: A New Era of Hope for Prostate Cancer Patients

Prostate cancer is one of the most common cancers affecting men worldwide, particularly those over the age of 65. While many cases are slow-growing and manageable, some require more aggressive treatment. For patients diagnosed with localized prostate cancer, radical prostatectomy (RP)—a surgical procedure to remove the prostate gland—is often the first line of treatment. However, the journey doesn’t always end there. For some, radiation therapy after surgery becomes a necessary step, and understandably, this can be a source of worry. But recent advancements in both surgical and radiation techniques are offering new hope and better outcomes for patients.

The Role of Radiation After Prostate Surgery

After undergoing radical prostatectomy, some patients face the risk of cancer recurrence. This is where radiation therapy comes into play. Radiation can be used in two main ways post-surgery:

1. Adjuvant Radiation Therapy: This is administered shortly after surgery to eliminate any remaining cancer cells that might not be detectable but could lead to recurrence.
2. Salvage Radiation Therapy: This is used when there’s evidence of cancer returning, often indicated by rising prostate-specific antigen (PSA) levels.

While radiation therapy is effective in reducing the risk of recurrence, it has traditionally been associated with side effects such as urinary incontinence, bowel issues, and sexual dysfunction. These potential complications often make patients hesitant to pursue this treatment. However, advancements in radiation techniques are changing the narrative.

Robotic Radical Prostatectomy: A Game-Changer in Surgery

Before diving deeper into radiation, it’s important to highlight the advancements in prostate surgery itself. Robotic-assisted radical prostatectomy (RARP) has revolutionized the way prostate cancer is treated surgically . Unlike traditional open surgery, RARP uses robotic technology to perform the procedure with unparalleled precision. This minimally invasive approach offers several benefits:

• Reduced Blood Loss: The robotic system allows for smaller incisions and better control, minimizing blood loss during surgery.
• Nerve-Sparing Techniques: Surgeons can better preserve the delicate nerves around the prostate, which are crucial for urinary and sexual function.
• Faster Recovery: Patients experience less pain, shorter hospital stays, and quicker returns to normal activities compared to traditional surgery.

At MACS Clinic, Bangalore, under the leadership of experts like Dr. Sandeep Nayak, robotic surgery has become a cornerstone of patient care, offering hope to those seeking effective and less invasive treatment options.

Innovations in Radiation Therapy: Stereotactic Body Radiotherapy (SBRT)

For patients requiring radiation after surgery, the introduction of advanced techniques like Stereotactic Body Radiotherapy (SBRT) is a significant breakthrough. Unlike conventional radiation therapy, which involves multiple sessions over several weeks, SBRT delivers high doses of radiation in just a few sessions. This approach is not only more convenient but also comes with several advantages:

• Precision Targeting: SBRT uses advanced imaging techniques, such as MRI guidance, to precisely target the prostate bed while sparing surrounding healthy tissues.
• Shorter Treatment Duration: With only five sessions required, SBRT significantly reduces the time commitment for patients.
• Fewer Side Effects: Studies, such as the SCIMITAR trial, have shown that SBRT is well-tolerated, with minimal impact on urinary, bowel, and sexual function compared to traditional radiation therapy.

The SCIMITAR trial, for instance, demonstrated that SBRT offers comparable outcomes to conventional radiation therapy while being more patient-friendly. Patients reported no significant decline in quality of life, and the treatment was associated with lower rates of severe side effects.

Addressing Patient Concerns

It’s natural for patients to feel apprehensive about radiation therapy after surgery. Common concerns include the fear of side effects, the financial burden of treatment, and the emotional toll of extended therapy. However, the advancements in both robotic surgery and radiation therapy are addressing these worries head-on:

• Improved Quality of Life: With nerve-sparing robotic surgery and precision radiation techniques, patients are experiencing fewer complications and better long-term outcomes.
• Convenience: The shorter treatment duration of SBRT means less disruption to daily life.
• Reassurance Through Research: Studies have shown that early salvage radiation therapy, when needed, does not compromise outcomes and can be safely administered without significant long-term side effects.

The Future of Prostate Cancer Treatment

The combination of robotic radical prostatectomy and advanced radiation techniques like SBRT represents a new era in prostate cancer care. These innovations are not only improving survival rates but also enhancing the quality of life for patients. As technology continues to evolve, we can expect even more personalized and effective treatments, reducing the burden of cancer on patients and their families.

At MACS Clinic, Bangalore, the focus remains on patient-centric care, leveraging the latest advancements to provide hope and healing. Whether it’s through cutting-edge robotic surgery or state-of-the-art radiation therapy, the goal is clear: to empower patients with the best possible outcomes and a brighter future.

In conclusion, while the prospect of radiation after surgery may seem daunting, it’s important to remember that medical science is constantly advancing. With the right approach and expert care, patients can navigate their treatment journey with confidence and optimism. Prostate cancer is no longer the formidable challenge it once was, thanks to the dedication of clinicians and researchers working tirelessly to improve outcomes for all.

Rectal cancer, a prevalent form of colorectal cancer, poses significant challenges to surgeons due to its location in the pelvis and the need for precise removal of the tumor while preserving essential structures. Over the years, advancements in surgical techniques have transformed how rectal cancer is treated, with robotic-assisted surgery (RAS) emerging as a promising alternative to traditional open and laparoscopic approaches.

A recent landmark study conducted by the Indian Collaborative Group on Rectal Resections (ICGRR) has shed light on the outcomes of open, laparoscopic, and robotic-assisted rectal resections in the Indian healthcare context. This study, the largest of its kind in India, analyzed data from 829 patients across 11 centers and provides valuable insights into the short-term outcomes of these surgical techniques. As a contributor to this study, I, Dr. Sandeep Nayak, operated on many of these cases at Fortis Hospital, Bangalore. Here, I share key findings and discuss the broader implications of robotic-assisted surgery in rectal cancer care.

Rectal cancer arises in the rectum, the last segment of the large intestine. Its treatment often involves surgical resection following the principles of Total Mesorectal Excision (TME), which ensures the removal of the tumor and surrounding tissues to prevent recurrence. However, the rectum’s narrow location in the pelvis makes surgery particularly challenging. Surgeons must navigate intricate anatomy, protect critical nerves and blood vessels, and achieve clear margins to ensure the cancer is removed completely.

For decades, open surgery, which involves a large incision, was the standard approach. However, it often resulted in significant blood loss, longer recovery times, and higher complication rates. The advent of laparoscopic surgery, a minimally invasive technique using small incisions and a camera, addressed some of these challenges but had its own limitations, such as restricted visibility and reduced instrument maneuverability in the narrow pelvic cavity.

Robotic-assisted surgery (RAS) has emerged as a transformative advancement, combining the benefits of minimally invasive techniques with cutting-edge technology. With enhanced precision, 3D visualization, and superior instrument dexterity, robotic surgery allows surgeons to operate more effectively in confined spaces like the pelvis.

1. Shorter Hospital Stays:

• Patients in the RAS group had the shortest average hospital stay (7.8 days), compared to the LG (10.3 days) and OG (14 days) groups.
• At experienced centers like ours, where both robotic and laparoscopic surgeries are performed in high volumes, the average hospital stay for both approaches is approximately 4 days, reflecting the importance of expertise in achieving optimal outcomes.




2. Reduced Blood Loss and Complications:
• Robotic-assisted surgery resulted in significantly less blood loss compared to laparoscopic and open surgeries, reducing the need for transfusions and associated risks.
• Postoperative complications were lowest in the RAS group (13.7%) compared to LG (19.9%) and OG (36.6%).
  
  
  3. Better Surgical Precision:
• The RAS group had the lowest rate of positive circumferential resection margins (CRM)—a critical measure of how completely the tumor was removed—at 87%, compared to 6.8%in LG and 26.5% in OG.




4. Early Start of Adjuvant Therapy:
• Patients in the RAS group could begin adjuvant treatments like chemotherapy sooner (median 24.5 days) than those in LG (31 days) and OG (32.5 days). Early initiation of therapy is linked to better long-term outcomes.




5. Longer Operating Times:
• Robotic surgeries took longer to perform (average 326 minutes) than laparoscopic (287 minutes) and open surgeries (256 minutes). This is largely due to the time required for robotic system setup and docking.

One of the key insights from this study is the skill-dependent nature of surgery. While robotic-assisted surgery offers advanced technology that enhances precision and efficiency, its success relies heavily on the expertise of the surgeon and the surgical team.

At high-volume centers like Fortis Hospital, Bangalore, where I performed many of the robotic and laparoscopic surgeries included in this study, both techniques yield comparable outcomes in terms of hospital stay and recovery time, with most patients being discharged within four days. However, this is not uniform across all centers. The ICGRR study involved 11 hospitals, each with varying levels of expertise and case volumes. Not all centers performed both laparoscopic and robotic surgeries in high volumes, and this variability impacts the generalizability of the study’s findings.

The study highlights that while robotic surgery offers significant advantages, outcomes are closely tied to the experience and proficiency of the surgical team. Centers with extensive experience in robotic and laparoscopic techniques tend to achieve better results, whereas centers with limited experience may face challenges in replicating these outcomes.

Robotic-assisted surgery is a valuable tool in the treatment of rectal cancer, offering several advantages:

• Enhanced precision and visualization, particularly in complex pelvic anatomy.
• Reduced blood loss, postoperative complications, and shorter hospital stays.
• Improved ability to achieve clear margins, reducing the risk of recurrence.

However, robotic surgery also has limitations:

• Cost: Robotic systems are expensive, which may limit their accessibility for patients in some regions.
• Learning Curve: Surgeons require extensive training and experience to fully harness the benefits of robotic technology.
• Longer Operating Times: As seen in this study, robotic surgeries often take longer than laparoscopic or open surgeries, though this improves with experience.

The ICGRR study is a landmark effort in Indian healthcare, involving data from 11 centers and 829 patients. This collaboration between public and private institutions provides a comprehensive overview of real-world outcomes for rectal cancer surgery in India.

As a contributor to this study, I had the privilege of performing many of the robotic and laparoscopic surgeries at Fortis Hospital, Bangalore. My contribution reflects the importance of high-volume centers and skilled teams in achieving the best outcomes for patients.

The ICGRR study is a landmark effort in Indian healthcare, involving data from 11 centers and 829 patients. This collaboration between public and private institutions provides a comprehensive overview of real-world outcomes for rectal cancer surgery in India.

As a contributor to this study, I had the privilege of performing many of the robotic and laparoscopic surgeries at Fortis Hospital, Bangalore. My contribution reflects the importance of high-volume centers and skilled teams in achieving the best outcomes for patients.

Link to paper: https://link.springer.com/article/10.1007/s11701-025-02375-5

Hysterectomy is the surgical removal of the uterus. It’s a standard procedure to treat various conditions affecting a woman’s reproductive system. Even after such a definitive procedure, the possibility of developing cancers, such as vaginal cancer, still exists.  

Dr. Sandeep Nayak, an accomplished oncologist in Bangalore, explains:

“Hysterectomy is also performed to address malignant or premalignant diseases of the cervix. But, vaginal cancer after hysterectomy, though rare, can still occur. This is because cells in the remaining vaginal tissue can still undergo harmful changes. If left untreated, it can lead to cancerous growth. This underscores the importance of ongoing vigilance and awareness post-surgery.”

Join us as we delve into the warning signs, stages, and challenges linked with vaginal cancer. Additionally, we will discuss the available treatment options and their implications for patients.

Recognizing warning signs of cancer can lead to early detection and better outcomes. Let’s delve into understanding our body’s signals to alert us.

Vaginal cancer demands attention and awareness. Here’s what to watch out for, regardless of whether you’ve undergone hysterectomy or not:

Bleeding after menopause or unusual bleeding between periods warrants prompt attention. Also, pay attention to any bleeding during or after sexual intercourse.

Persistent discharge unrelated to menstruation or infection can indicate vaginal cancer. A sudden change in vaginal discharge may signal a problem, particularly if it becomes:

• Watery
• Bloody
• Foul-smelling

Don’t ignore persistent pelvic pain, often described as a constant ache or pressure. Pain during urination or bowel movements may also signal underlying issues.

Discomfort or pain during sexual intercourse, unrelated to lubrication or emotional factors, merits attention.

Feeling a lump inside the vagina is a direct indication of something abnormal needing prompt attention.

Persistent pain in the lower back, hips, or legs, unrelated to other conditions or injuries may indicate advanced vaginal cancer. Cancer can cause pain due to pressure from a tumor or as a result of cancer spread.

From the initial stages to advanced progression, understanding the stages of vaginal cancer is crucial. Let’s look at each stage to gain insights and empower ourselves with knowledge.

Vaginal cancer stages indicate the extent of the disease:

Stage 0: Precancerous cells are present but confined to the surface of the vagina.

Stage I: Cancer has formed and is confined to the vaginal wall.

Stage II: Cancer has spread beyond the vagina to the tissue around it but not to the pelvic wall.

Stage III: Cancer has spread to the pelvic wall and/or nearby lymph nodes.

Stage IV: Cancer has spread to distant body parts, such as the lungs or liver.

Facing vaginal cancer can be daunting. Let’s explore the hurdles patients face with resilience and empathy.

Individuals encounter various challenges along their journey, such as:

Managing the costs associated with cancer treatment, including medical bills, medication expenses, and transportation costs, can be overwhelming. Lost income due to treatment and recovery leave may add to the financial burden.

After completing treatment, survivors may face challenges related to rehabilitation. These include managing long-term side effects, regaining physical strength, and adjusting to life after cancer. Survivorship care plans and services can help individuals address ongoing healthcare needs.

According to the seasoned oncologist in Bangalore and Samrohana founder, Dr. Sandeep Nayak:

“It’s crucial to address patients’ psychological and emotional needs throughout the cancer journey. Counseling and support groups can provide valuable support and coping strategies for patients and their families.”

When it comes to treating vaginal cancer, patients have several options available. Let’s explore each option to help you make informed decisions about your care.

Here’s a breakdown of the treatment modalities commonly used:

Immunotherapy uses the body’s immune system to spot and attack cancer cells. Checkpoint inhibitors, a form of immunotherapy, exhibit remarkable potential in combating specific cancers. These include those associated with the vaginal, colorectal, and cervical regions. Checkpoint inhibitors may help where other treatments have failed to boost the body’s natural defenses.

Palliative care focuses on improving the quality of life for patients. It addresses symptoms such as pain, fatigue, and emotional distress. Additionally, it may involve dietary guidance to optimize nutrition and overall well-being. Palliative caregivers also provide crucial support by offering comfort and assistance to patients and their families.

Dr. Sandeep Nayak, a renowned oncologist in Bangalore, elaborates:

“The choice of treatment for vaginal cancer depends on various factors. These include the cancer stage, location, patient’s overall health, and personal preferences. A multidisciplinary team of healthcare providers work together to develop treatment plans tailored to each patient’s needs.”

Vaginal cancer after hysterectomy is relatively rare. However, being aware of the signs and treatment options available are vital steps in managing this disease effectively. Regular follow-ups with healthcare providers ensure any potential issues are addressed promptly.

Despite the challenges, individuals can find support and resources to navigate their journey with resilience and strength. Healthcare providers and support networks empower patients by addressing physical, emotional, and practical needs. This approach helps patients face challenges head-on and achieve the best possible outcomes.

Unveil FAQs about breast cancer after menopause. Let’s get your questions answered.

1. At what age is vaginal cancer most common?

Vaginal cancer is most commonly diagnosed in women aged 60 and older, but it can occur at any age.

2. Who is at high risk for vaginal cancer?

High-risk groups include:

• women with a history of HPV infection
• those who have had previous cervical or uterine cancer
• women who have undergone pelvic radiation therapy

3. Is a recurrence vaginal cancer after hysterectomy possible?

Yes, cancer can spread after a total hysterectomy if:

• microscopic cancer cells had already escaped the uterus before the surgery
• cancer develops afresh in the remaining vaginal tissue

The likelihood of vaginal cancer recurring after a hysterectomy depends on various factors. These include the cancer stage during diagnosis, treatment success, and individual health factors.