Shravan Nadkarni Profile picture
Dec 31, 2021 23 tweets 20 min read Read on X
It's the end of a very significant year and what an year it has been for me! Apart from all the other things that happened, here are some positive and good things to remember.

Much to be grateful, thankful and happy about !

Wish to share this with you all. 🤗
The bond year @TataMemorial after residency where you put into practice what you learnt painstakingly for the preceding 3 years. Fruits of hard earned skills and knowledge. And I savoured them @TMC_Varanasi. Nothing short of a surgical temple for me after @TataMemorial, Mumbai. ImageImage
And then stepping out into the #RealWorld of Surgical oncology at the Karnataka Cancer Therapy & Research Institute, Hubballi, Karnataka, operating and managing patients with cancer independently! ImageImage
Discovered my love for recording, editing & producing high-quality educational videos in surgical oncology. Developing this single skill helped win quite some appreciation. And I ensured this happened along with regular and intense surgical work which was complementary. ImageImage
Best surgical video awards at -

Indian Society of Thoracic Surgeons National conference (ISTSTCON) 2021

Indian Association of Gastrointestinal Endosurgeons (IAGES) 2021

Indian Cooperative Oncology Network (ICON) 2021

1st Runner up 'Prof Marko Turina' Award @MMCTS_Manual Residents tutorial competition at @EACTS Annual meet, Barcelona, Spain

Indian Association of Surgical Gastroenterology National Conference (IASGCON) 2021

Indian Association of Surgical Oncology National conf (NATCON) 2021 ImageImageImage
Dr C Palanivelu Gold Medal for the best surgical video at the Association of Minimal Access Surgeons of India (AMASICON) 2021 at the India Habitat centre, New Delhi ! ImageImageImage
And the cherry on top - "Outstanding Resident" Gold medal from the Homi Bhabha National University (HBNI) & Tata Memorial Centre, Mumbai. @TataMemorial My #NobelMedal 🤗 ImageImageImage
Would fail in my duties if I didn't acknowledge, thank and express my deep gratitude to some of my guardian angels @TataMemorial
@mentions@cspramesh someone I have had the opportunity to interact with closely, and learn from the experience and wisdom. He who "assisted" me (read patiently taught) during my 1st Esophagectomy as a first yr MCh resident @TataMemorial as is d tradition in the unit of Thoracic surgery!🙏 Image
@mentions@Shrikhande_SV D one who inspired me to take up Oncosurgery & specifically GI oncology way back when I was doing postgrad. It was surreal to finally learn from him, operate with him and get his pearls of wisdom on various aspects of surgery, oncology and life. My surgical God🙏 Image
#DrGeorgeKarimundackal - I owe all the awards, accolades and appreciation to this prof of mine who happened to spot something possibly niche with videos. He kept egging me on and provided the necessary material & guidance when I needed it. 🙏
#DrMaheshGoel - They say you learn the most from the hard times in life. He was one such prof who guided me during one of those phases. Sincere gratitude. 🙏
@mentions@drprathameshpai - shall always remember u honouring my request to understand Neck Dissection. You got me de-washed from an OT in d main OT complex & washed-in to ur theatre so that I could learn #NeckDissection. The surgeon who is surrounded by more on-lookers than assistants! Image
ProfSaklani & #DrAshwinDesouza - My mentor at TMH, Dr Ashwin is that brilliant, meticulous and consistent surgeon who is known to plan and execute the smallest detail of every surgery to the hilt. Amazed at the enthusiasm and drive both of these world-beating surgeons show! Image
@mentions@drsabita brilliant and diligent surgeon, pushed me to do more, achieve more, provided all help and aid and encouraged to no limits. Guiding light. 🙏 Image
#DrShraddhaPatkar - I sometimes wonder how can someone be so organised, hands-on and prompt at all times! If someone needs a Micro-management 101, she is the one! Just amazed at how she manages everything! Kept pushing and encouraging to keep doing more than the 'expected'. 🙏
@mentions@Manishbhandare4 & @DrVAChaudhari - Two of the best ppl in TMH, exceedingly awesome surgeons, great human beings and above all else, down to earth and approachable! Oh life would have been harder at TMH without you! 🙏 ImageImage
@mentions@nitaSnair - #WorkMom! Petrified of her to even utter anything slightly out of place while knowing that she is a tough exterior, gooey interior! 🤗 She is that Prof everyone is scared of, but know that she will look out for you!
@mentions@dnair78 Another #WorkMom! You can always count on her to look out for you. One thing I will always remember her for - she knew how much I had operated as a resident, kept a track of my training and ensured that I did d requisite. Also provided a roadmap for the future. Thank u!
@mentions@vivekanandkem - the senior you can always count on and look up to for advice, guidance and encouragement right from MS days! @jeetrohila ImageImage

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More from @OncoShravan

Dec 6, 2023
🚨 🚨 🚨 🚨 🚨 🚨 🚨

Post-hepatectomy Liver failure (PHLF) - Dreaded complication of a difficult surgery

Is there a unifying definition of PHLF?

What are the preventive strategies?

How best can it be managed?

Lets dive right in! Bookmark this thread 🧵

#MedTwitter Image
Leading cause of post-hepatectomy mortality

Rx Challenges?

🧩 Heterogeneity- Lack of uniform diagnostic Cx despite ISGLS Defn(2001)- variations prevalent

🧩 Predictability- Accurate preop predictions difficult

🧩 Therapy- No effective Rx once PHLF occurs

🚨 Prevention 🚨
PHLF - Incidence 1.2 - 32% (❌universally accepted defn)

🧿 ISGLS Defn (Rahbari 2011)-
Impairment of liver to maintain

🍀synthetic
🍀excretory
🍀detoxification ➡️ ꜛINR & ꜛSr bil on/after POD 5

Incidence 9-20%

Severity grading ⬅️ clinical impact

t.ly/xdlF2
Read 24 tweets
Oct 14, 2023
🚨 🚨 🚨

Should cancers of the esophagogastric junction be managed as esophageal cancers or gastric cancers?

What is the adequate lymphadenectomy template?

NACTRT vs FLOT?

Are they a different entity altogether requiring a unique approach?

Lets explore…🧵 Image
Why the discussion?

🧿 ⬆️ Incidence due to ⬆️ obesity & GERD

🧿GEJ is a histological transition zone from squamous to columnar ep. Tumours here can drain to lymph nodes above &/or below

🧿Locally-advanced Ca - Pre-operative chemo-radiation or peri-operative chemotherapy?
🧿Current surgical approaches are - total gastrectomy with distal esophagectomy or esophagectomy I.e., TTE/THE…

They differ significantly in the lymph node stations addressed.

🧿Only about 50% are amenable to receive curative therapy due to advanced stage at presentation
Read 28 tweets
Oct 8, 2023
🚨🚨

Do you know why Total Neoadjuvant therapy #TNT in locally advanced #RectalCancer (LARC) is getting so much attention?

Bookmark this thread 🧵- your own TNT🧨💣 ready reckoner!

#MedTwitter @me4_so @somedocs @PColorectal @ASCRS_1 @ESSOnews @escp_tweets @Cirbosque Image
SURGERY is still the definitive curative treatment in patients who don’t achieve clinical complete response and are not on the Wait and watch protocol.

The TNT protocol aims to deliver systemic and locoregional therapy all-in, before definitive surgical management.
Everything mentioned here is for LARC (T3-4 or N-positive)

SOC (std of care) for LARC until now has been -

Chemoradiation -> Surgery -> Adjuvant systemic therapy

(Locoregional Rx) -> (Locoregional Rx) -> (Systemic Rx)

A timeline of the significant trials -
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Image
Read 21 tweets
Aug 23, 2021
Learnings from a speciality residency at one of d top institutes in India -

In my last month of residency & 1-yr post-MCh bond as an adhoc Asst Prof at @TataMemorial Mumbai & @TMC_Varanasi here's a thread on what I learnt. (Might hv some snippets I wish I knew before I joined) Image
1. Oncology - To me, treating #CANCER is the highest form of medicine currently practised. If a fellow human being, is able to rid another, of d #EmperorOfAllMaladies, medicine shall hv achieved what it set out to. Cancer still lurks in d realm of that which needs 'conquering'
I saw this in TMH day in & out. The 'conquering'. I saw pts coming in the worst of conditions and walking back home. To a family. To a life.

I also saw d other end of d spectrum. Whr v had to meekly surrender to the malady. Where we could do precious little to 'save' someone.
Read 25 tweets

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