CHRISTIAN MEDICAL COLLEGE, VELLORE

The speciality of Colorectal surgery has traditionally remained under the general surgeon in most places of India and so also in Christian Medical College, Vellore. A dedicated Colorectal Unit was formed in 2003 but still functions as one of the units of the Department of general surgery.

The unit is staffed by four consultants and four junior surgeons and is supported by a technician and a group of nurse specialists trained in stoma therapy, evaluation of continence and colorectal oncology. The spectrum of diseases managed by the colorectal unit include colorectal cancers, polyposis syndromes, inflammatory bowel disease, pelvic floor disorders, rectal prolapse and complex anal, rectal, and entero-cutaneous fistulae. The unit also provides CRS and HIPEC for colorectal peritoneal metastasis and pseudomyxoma peritonei and mesothelioma.

Open, Laparoscopic and Robotic approaches are all used appropriately in the management as indicated.

As many of these cases, particularly cancer and inflammatory bowel disease, need to be approached by a multidisciplinary approach, there are weekly Colorectal cancer and IBD MDT meetings with consultants from other specialties (Medical gastroenterology, Radiation therapy, medical oncology, Radio-diagnosis, and Pathology) to discuss and plan treatment.

The unit is actively engaged in training at all levels. This includes medical students, General surgical trainees as well as colorectal fellows. The unit offers a 2-year fellowship program, with 2 seats per year through a common entrance examination. In addition, short-term observer ships and work experience opportunities are also available.

The unit is actively engaged in surgical research. Some of the ongoing research in colorectal cancer in the unit include:

• A randomised controlled trial of standard vs extralevator abdominoperineal resection in improving outcomes in rectal cancer
• Are young rectal cancers different from the old: A mutational analysis study (ICMR funded)
• A randomised controlled trial on the role of GTN application to reduce sphincter damage during stapled colorectal anastomosis
• MSI analysis and clinical outcomes in rectal cancer

Some of the completed studies in colorectal cancer include:

• A randomised controlled trial on the routine use of drains in pelvic surgery
• A randomised controlled trial on the routine use of a colostomy rod
• A randomised controlled trial on midline vs. transverse incisions in colonic resections
• A randomised controlled trial on wound wash to reduce surgical site infections
• Role of C reactive protein to predict anastomotic leak

The unit also works with the Global Surgery Collaboration based in Birmingham and funded by NIHR and is the South India sub-hub for the same. We have been involved in large-scale global cohort studies, as well as developing and delivery of trials in low- and middle-income countries.

This collaboration aims to develop local evidence in low- and middle-income countries for its own use. It also works towards capacity building and promotion of safe surgery. We have been involved in developing guidelines for surgical site infections specifically tailored to low- and middle-income countries. Multiple publications through this collaboration, including the FALCON and CHEETAH trials, have led to notable changes in practice and reduced surgical complications.