Every cancer patient hears the same question after diagnosis: Will I need surgery? It is one of the most loaded questions in medicine. Surgery can be the single step that removes a cancer permanently or, if chosen at the wrong time or for the wrong tumour, an intervention that delays something more effective. The answer is almost always nuanced, and it requires a specialist who has spent years learning precisely where that line sits.
Dr. John J Alapatt, Consultant in Surgical Oncology at NAVA Cancer Institute (BMH Oncology Institute), Baby Memorial Hospital, Kozhikode, is that specialist. He holds the FACS (Fellow of the American College of Surgeons, 2025), the FEBS in Surgical Oncology from Florence, Italy (2023), MRCS from Edinburgh, MNAMS from India, and his DrNB in Surgical Oncology from Malabar Cancer Centre a credential combination held by fewer than a handful of practicing surgical oncologists in Kerala.
His published research ten papers across ASCO's JCO, the Indian Journal of Surgical Oncology, The Sarcoma Journal, and other peer-reviewed journals spans oncoplastic breast surgery, cytoreductive surgery with HIPEC, sentinel node biopsy technique, and soft tissue sarcoma management.
This article is drawn from the clinical reasoning Dr. Alapatt applies every day in his practice. It is designed to help patients and families in Kerala, across India, and in the Gulf understand what they should be asking and what they should expect.
About Dr. John J Alapatt Your Surgical Oncologist
Dr. John J. Alapatt is a Consultant Surgical Oncologist at the NAVA Cancer Institute (BMH Oncology Institute), Baby Memorial Hospital, Kozhikode. With specialized training in surgical oncology and experience in managing a wide spectrum of cancers, he is committed to delivering evidence-based, patient-focused cancer care. His approach emphasizes precise surgical treatment, multidisciplinary collaboration, and personalized care plans designed to achieve the best possible outcomes while maintaining quality of life.
Having trained at leading institutions in India and earned internationally recognized surgical qualifications, Dr. Alapatt combines advanced oncological expertise with a strong academic foundation. He works closely with medical oncologists, radiation oncologists, radiologists, pathologists, and supportive care teams to ensure comprehensive cancer management from diagnosis through recovery and long-term follow-up.
Qualifications & Professional Credentials
- FACS: Fellow of the American College of Surgeons (2025)
- FEBS: Fellow of the European Board of Surgery in Surgical Oncology, Florence, Italy (2023)
- MRCS: Member of the Royal College of Surgeons, Edinburgh
- MNAMS: Member of the National Academy of Medical Sciences, India
- DrNB Surgical Oncology: Malabar Cancer Centre (PGIOSR), 2018–2021
- MS General Surgery: Amala Institute of Medical Sciences, KUHS, 2013–2016
- DNB General Surgery
- MBBS: Government Medical College, Kozhikode (University of Calicut), 2005–2011
Surgery in Cancer: Understanding the Four Types
Depending on the cancer, its stage, and the patient's overall health, surgery may serve one of four entirely different purposes:
1. Curative Surgery
The goal is complete removal of the tumour with clear histological margins, meaning no cancer cells at the cut edges. This is the gold standard for early-stage, localised solid tumours, and when achieved, it offers the patient the best realistic chance at a permanent cure. The success of curative surgery depends on precise pre-operative staging, surgical technique, and the ability to achieve clean margins without compromising surrounding healthy tissue.
2. Debulking (Cytoreductive) Surgery
When complete tumour removal is not possible, debulking surgery reduces the overall cancer burden in the body to a level where subsequent chemotherapy or radiation can work more effectively. By removing the bulk of the tumour mass, this approach can slow disease progression, improve treatment response, and extend survival. It is particularly relevant in cancers such as ovarian cancer and peritoneal surface malignancies, where tumours may spread across multiple sites.
3. Diagnostic Surgery
Before any treatment plan can begin, an accurate tissue diagnosis is essential. Diagnostic surgical procedures, including biopsy, excisional sampling, and sentinel lymph node assessment, confirm the cancer type, molecular subtype, grade, and extent of spread. This information is foundational: it determines whether a tumour is benign or malignant, guides the choice of treatment, and ensures patients are not overtreated or undertreated based on assumptions alone.
4. Palliative Surgery
Not every patient is a candidate for curative surgery, and in these cases, palliative procedures serve a different but equally important purpose. These interventions aim to relieve pain, restore function, and improve quality of life, whether that means clearing a blocked bowel, decompressing a nerve, or addressing a tumour causing significant discomfort. While the goal is not cure, the right palliative surgical decision at the right time can be profoundly meaningful for both the patient and their family.
What Determines Whether You Are a Surgical Candidate?
Dr. Alapatt considers several interconnected factors before recommending an operation.
1. Tumour Stage and Whether It Has Spread
Surgery is most strongly indicated when cancer is confined to its organ of origin or has spread only to nearby (regional) lymph nodes, Stages I through III for most solid tumours. Once cancer has metastasised to distant organs (liver, lungs, bones, brain), surgery on the primary tumour alone rarely achieves cure, and systemic therapy typically becomes the priority.
There are meaningful exceptions. Colorectal cancer with isolated, technically resectable liver metastases is one of them, curative-intent surgery may still be possible, and this is an area of Dr. Alapatt's subspecialty competence. The key word is 'resectable': not all metastases are, and that judgment requires both imaging expertise and surgical experience.
2. Tumour Biology and Type
The molecular behaviour of a cancer is as important as its location. Some cancers, rectal cancer, for example are routinely treated with neoadjuvant chemoradiation before surgery. Shrinking the tumour first allows the surgeon to achieve cleaner margins and, in many cases, preserve the anal sphincter, which changes the patient's life permanently. Some cancers, small cell lung cancer, lymphoma, are systemic diseases where surgery plays almost no curative role at all.
3. Patient Fitness for Major Surgery
A technically resectable tumour is not automatically an operable one. Cardiac function, lung reserve, nutritional status, diabetes, and other comorbidities all affect surgical risk. A patient with severe heart failure may be better served by radiation or targeted therapy for a locally advanced cancer, even if the tumour itself could theoretically be removed. The NAVA Cancer Institute's multidisciplinary team systematically reviews fitness alongside oncological factors, not as an afterthought.
4. Surgeon Expertise and Infrastructure
For complex procedures, CRS-HIPEC for peritoneal cancers, hepatopancreatic resections, robotic colorectal surgery, outcomes are measurably and significantly better at high-volume centres with dedicated infrastructure and formally trained subspecialists. This is not a subjective opinion; it is well-established in the surgical outcomes literature. Choosing where to have a complex cancer operation is as important as deciding whether to have it.
Also Read: Second Opinion for Cancer in India: How to Get One Remotely at BMH
When Surgery Is Not the Right First Step?
Dr. Alapatt is direct about this. For several common cancers, operating first would either be wrong or less effective than another approach:
- Locally advanced cervical cancer: concurrent chemoradiation is the international standard of care. Surgery is reserved for specific early stages (Stages IA–IIA in selected patients).
- Small cell lung cancer: this is a rapidly systemic disease. Systemic chemotherapy, sometimes with immunotherapy, is the primary treatment. Surgery is rarely curative.
- Lymphomas and leukaemias: these are haematological malignancies managed with chemotherapy, immunotherapy, CAR-T therapy, or bone marrow transplantation. Surgery has no primary role.
- Metastatic disease with widespread dissemination: aggressive surgery rarely improves quality of life or survival in this setting compared to palliative systemic therapy.
- Locally advanced rectal cancer: neoadjuvant chemoradiation first, then surgical assessment. This sequence, not surgery alone, defines the modern standard of care.
At NAVA Cancer Institute, no single specialist not even the surgical oncologist, makes a unilateral treatment recommendation. Every new cancer case is reviewed by the full tumour board: surgical oncology, medical oncology, radiation oncology, radiology, and pathology together. This model is the global standard at leading cancer centres, and it is the reason patients receive treatment that fits their specific case, not a generalisation.
Minimally Invasive Surgery: What It Changes for Patients
One of the most meaningful advances in surgical oncology over the last decade is the widespread adoption of laparoscopic and robotic techniques. Compared with open surgery, minimally invasive approaches in eligible cases offer:
- Smaller incisions and significantly less post-operative pain
- Shorter hospital stays (often 2–3 days versus 7–10)
- Faster return to daily activities and, crucially, faster start of adjuvant chemotherapy if needed
- Lower risk of wound infection and hernia
Dr. Alapatt's practice integrates robotic and laparoscopic techniques for colorectal, breast, and peritoneal surface malignancy cases where the approach is clinically indicated. Minimally invasive vs. open surgery, typical comparison for eligible patients
| Factor | Open Surgery | Minimally Invasive Surgery (Laparoscopic/Robotic) |
|---|---|---|
| Hospital Stay | 7–10 days | 2–4 days |
| Post-Operative Pain | Typically higher due to larger incision and greater tissue disruption | Generally lower because of smaller incisions and reduced tissue trauma |
| Return to Daily Activities | Approximately 4–6 weeks | Approximately 2–3 weeks |
| Start of Adjuvant Chemotherapy | May be delayed due to longer recovery period | Often possible sooner, which can be important for treatment outcomes |
| Wound Complications | Higher risk of wound infection, delayed healing, and incisional hernia | Lower risk of infection, wound-related complications, and hernia formation |
Why Patients Choose NAVA Cancer Institute at Baby Memorial Hospital, Kozhikode
Baby Memorial Hospital (BMH) is one of North Kerala's most established tertiary-care hospitals, and its NAVA Cancer Institute serves as a dedicated centre for comprehensive cancer care. Designed to manage complex cancer cases under one roof, it brings together diagnosis, surgery, medical oncology, radiation therapy, and long-term follow-up through a coordinated multidisciplinary approach. Key reasons patients consider NAVA Cancer Institute include:
- Comprehensive cancer care under one roof, including surgical, medical, radiation, paediatric, and haemato-oncology services.
- Multidisciplinary tumour board reviews, ensuring treatment decisions are guided by collective specialist expertise rather than a single opinion.
- Specialised surgical oncology expertise, including advanced cancer surgery and evidence-based treatment planning.
- Access to modern cancer diagnostics and treatment infrastructure within a single institution.
- Affordable care for domestic and international patients, particularly families from the Gulf seeking quality treatment closer to home.
- Patient-friendly coordination and continuity of care, reducing the need to visit multiple hospitals during treatment.
For patients comparing cancer treatment options in Kerala, NAVA Cancer Institute offers a combination of specialised expertise, collaborative care, and accessibility.
What to Expect at Your First Consultation with Dr. Alapatt
Patients who come to NAVA Cancer Institute, whether referred by another physician, self-referred after a symptom, or seeking a second opinion after a diagnosis elsewhere, can expect the following:
- Review of all existing investigations: scans, pathology reports, biopsy results, blood work. Dr. Alapatt will request anything missing before forming a recommendation.
- Clinical staging discussion: an explanation of where the cancer appears to be, what the current staging means, and why that matters for treatment selection.
- Surgical options (if applicable): specific explanation of the procedure being considered, what it involves, how long it takes, what recovery looks like, and what the realistic curative or palliative intent is.
- Non-surgical alternatives: where radiation or systemic therapy is equally or more appropriate, that will be stated directly. A surgical oncologist who only recommends surgery is not serving patients well.
- Tumour board review: if the case warrants multidisciplinary input, and most do; it will be presented at the next tumour board meeting before a final recommendation is confirmed.
- Cost and timeline: advance cost estimates and a realistic treatment timeline, particularly relevant for patients travelling from outside Kerala or from the Gulf.
Also Read: 20 Questions To Ask Your Oncologist: Complete Guide
Conclusion
Surgery is not the right answer for every cancer and it is not a simple answer even when it is right. The question of when to operate, how to operate, and what to do first is precisely what a specialised surgical oncologist spends years learning to answer. Dr. John J Alapatt's consultations at NAVA Cancer Institute are designed to give patients that clarity: a specific, individualised recommendation rooted in evidence, experience, and honest conversation.
If you or someone in your family has been diagnosed with cancer or suspects something is wrong, the most important single step you can take today is an early consultation.
Dr. John J Alapatt and the NAVA Cancer Institute team at Baby Memorial Hospital, Kozhikode offer specific, evidence-based answers, not generic reassurance. The earlier the consultation, the more options remain open. Book a consultation with Dr. John J Alapatt today.
_Medical Disclaimer This article is intended for general informational purposes and does not constitute medical advice. Cancer treatment decisions must be made in consultation with a qualified oncologist based on individual clinical evaluation. The information here does not replace a professional medical opinion, diagnosis, or personalised treatment plan. _