India’s journey in cancer surgery is a remarkable blend of ancient wisdom, colonial influences, and modern innovation, with Kerala playing a pivotal role in shaping this narrative. From the surgical techniques documented in ancient texts to the contributions of missionary surgeons and the establishment of world-class cancer care institutions, the evolution of cancer surgery in India, and particularly in Kerala, reflects resilience, innovation, and a commitment to accessible healthcare. This article explores the historical milestones, key institutions, pioneering figures, and technological advancements in cancer surgery, with a special focus on Kerala’s contributions within the broader Indian context.

Ancient Foundations: The Legacy of Sushruta

The origins of surgical practices in India date back to the Sushruta Samhita, a seminal text attributed to the ancient physician Sushruta, often regarded as the "father of surgery." Written around 600 BCE, this text detailed sophisticated surgical techniques, including procedures resembling tumour excisions, despite the limited understanding of cancer at the time. These early practices laid the groundwork for surgical interventions across India, including in Kerala, where traditional Ayurvedic medicine thrived alongside surgical innovations. While specific references to cancer surgery in ancient Kerala are scarce, the state’s rich tradition of Ayurveda likely complemented Sushruta’s surgical principles, fostering a culture of medical inquiry.

Colonial Influences: Missionary Surgeons in Southern India

From the early 17th century, missionary surgeons from the UK and Western Europe, arriving with various East India Companies, introduced Western surgical practices to southern India, including Kerala. Although their primary mission was to spread religion, many offered their professional skills to treat local populations, often in private mission hospitals. A notable example is the Neyyoor Mission Hospital, established in 1838 by the London Missionary Society near Nagercoil, just south of Kerala’s border in present-day Tamil Nadu but serving many patients from southern Kerala. By the turn of the 20th century, it had grown into the world’s largest mission hospital.

Pioneering surgeons at Neyyoor, such as Dr Arthur Fells (1892–1902) and Dr Bentall (1901–1907), made significant contributions to cancer surgery by documenting the high prevalence of oral cancer in the region. They published articles in the British Medical Journal and The Lancet, describing the surgical management of bucco-gingival complex cancers, with hemimandibulectomy - often without reconstruction - as the primary procedure.

Dr T H Somervell (1922–1945), a renowned surgeon at Neyyoor and an Olympic medallist for mountaineering (1924 Paris Olympics), became legendary for performing an estimated 15,000 hemimandibulectomies, averaging three per operating day over four days a week. He also conducted numerous gastrojejunostomies, showcasing his versatility. Dr R Kesavan Nair, the first FRCS-qualified surgeon in Travancore, trained under Dr Somervell. Dr Ian Orr (1926–1937), another key figure, was a breast surgeon and epidemiologist who first described the symptoms of oral submucous fibrosis and hypothesised that tobacco and shell lime use contributed to the high prevalence of oral cancer in coastal Travancore compared to hilly areas. These contributions laid a critical foundation for cancer surgery in Kerala, bridging traditional and Western medical practices.

Institutional Milestones: Building a Framework for Cancer Care

The 20th century marked a turning point for cancer surgery in India, with the establishment of dedicated institutions that transformed treatment and research. Kerala, known for its robust healthcare system, emerged as a leader in this domain.

National Pioneers in Cancer Care and Surgery

1) Neyyoor Mission Hospital (LMS Hospital), Tamil Nadu (1838) Asia’s earliest documented centre for cancer surgeries, specialising in oral cancer due to high prevalence in South India. Pioneering Surgeons were Dr Arthur Fells (1892–1902), Dr W C Bentall (1901–1907) and Dr T H Somervell (1922–1945).

2) Government X-ray Institute (Later Bernard Institute of Radiology), Chennai (1924) India’s first civilian X-ray facility, transitioning to cancer treatment by 1924 with 200-kV X-ray units and radium therapy.

3) Cancer Institute (WIA), Adyar, Chennai (1954) India’s first comprehensive cancer centre, founded by Dr Muthulakshmi Reddy (social reformer and first woman legislator). Dr S Krishnamurthi (Reddy’s son) and Dr Shantha V: Dr S Krishnamurthi’s and Dr Shantha’s transformative contributions to cancer surgery in India redefined oncologic care by pioneering a multidisciplinary approach at the Cancer Institute (WIA), Chennai, where they integrated surgery with radiotherapy and chemotherapy, significantly improving cure rates for oral cancers. They started India’s first M Ch program in Surgical Oncology in 1984, training over 250 surgeons in organ-preserving and reconstructive techniques. Their vision extended to paediatric oncology with the establishment of the country’s first unit for childhood cancers, emphasising minimally invasive procedures. Her legacy endures through the Cancer Institute’s global reputation and influence on major institutions like Tata Memorial and RCC Trivandrum, making her a foundational figure in ethical, evidence-based surgical oncology in India. Similarly, Prof Mayilvahanan Natarajan performed India’s first limb-salvage surgery for bone tumours (1988).

4) Tata Memorial Hospital, Mumbai (1941) Established after Sir Dorabji Tata’s wife died of leukaemia; pioneered multidisciplinary cancer care. Founded under the leadership of Dr Ernest Borges and Dr Darab Jussawala, TMH became India’s cornerstone for cancer treatment. It set standards for surgical oncology, training surgeons who would influence practices nationwide, including in Kerala. Dr John Spies (First Director) was a surgeon trained at Memorial Sloan Kettering, introduced radical cancer surgeries integrated with radiotherapy.

5) Chittaranjan Cancer Hospital, Kolkata (1950) Eastern India’s first dedicated cancer hospital, later renamed Chittaranjan National Cancer Institute (CNCI). Dr R Subodh Mitra was not only associated with the Chittaranjan Cancer Institute in Kolkata but was its founder and first director and Gynaec-oncologist. Dr B K Aikat, who was primarily a pathologist and institutional leader, contributed to the development of surgical oncology at CNCI. Dr S K Sen was one of the initial luminary surgeons.

Pioneers in Surgical Oncology: Leading the Charge

India’s progress in cancer surgery owes much to visionary pioneers, many of whom had a direct impact on Kerala’s oncology landscape.

Pre-1950s: Missionary surgeons focused on ablative surgeries (e.g., hemimandibulectomies).

Post-1960s: Centres like Tata Memorial and Cancer Institute (WIA) adopted organ-preserving and reconstructive techniques.

Father of Cancer Surgery of India

Dr Devendra D Patel (1932–2022) was a pioneering figure in surgical oncology, often regarded as the "father of cancer surgery in India" for his transformative contributions to the field. Born in Gujarat, he trained at BJ Medical College and later earned his FRCS in the UK, followed by advanced cancer surgery training at the Lahey Clinic in the USA.(1) Returning to India in 1966, he joined the Gujarat Cancer Research Institute (GCRI), where he served as Director (1993–2003) and revolutionised cancer care by establishing the first M Ch Surgical Oncology course, training hundreds of surgical oncologists who now practise across India. A founder of the Indian Association of Surgical Oncology (IASO) and the Association of Breast Surgeons of India, he fostered international collaborations, elevating India’s standing in global oncology.(1) His legacy includes prestigious honours like the Padma Shri (2017) and the Dr B C Roy Award, reflecting his dual impact as a clinician and educator. (1) Known for his humility and dedication, Dr Patel’s work laid the foundation for modern surgical oncology in India, inspiring generations of oncologists to advance cancer care.

Other National Pioneers

Dr Ernest Borges and Dr Darab Jussawala at TMH laid the foundation for surgical oncology in India, influencing training programmes that benefited Kerala’s surgeons. Dr Prafulla Desai, who performed India’s first bone marrow transplant in 1983, elevated TMH’s reputation, inspiring similar ambitions in Kerala’s medical community. Dr (Mrs) Mehta, a pioneer in head and neck cancer surgeries, made Pune a hub for oncologic surgery, indirectly influencing surgical practices in Kerala through knowledge exchange at national forums.

In Kerala, Dr R Kesavan Nair, the first Civil Surgeon of Travancore after earning his FRCS in 1930, was a key figure. He collaborated with Dr T H Somervell at Neyyoor Mission Hospital, learning cancer surgery techniques and applying them at the General Hospital, Trivandrum. As the first Professor of Surgery and Superintendent at the Medical College Hospital (MCH), Trivandrum, he mentored a generation of surgeons, including Prof K Sivarajan, Prof P A Abraham, Prof P A Thomas, Prof Jayasimhan, Prof Balsalam and Prof Mohandas, who excelled in surgeries for breast, thyroid, prostate, and head and neck cancers.

Father of Cancer Surgery of Kerala - Dr Thomas Cherian

Dr Thomas Cherian, born in 1940 in Alleppey, Kerala, emerged as a transformative figure. After overcoming Pott’s spine as a child, treated at Christian Medical College (CMC), Vellore, under the care of Dr Paul Brand, Dr Cherian was inspired by the compassion of doctors like Brand, Dr Ida Scudder and Dr T H Somervell. Graduating from Kasturba Medical College (KMC), Manipal, in 1965, he trained in general surgery, anaesthesia and plastic surgery, equipping him with a unique skill set. In 1984, he founded the Department of Surgical Oncology at RCC, Trivandrum, starting in a modest room with an attached washroom. Known for his ingenuity, he improvised surgical instruments with local materials, often collaborating with mechanics. Dr Cherian pioneered reconstructive techniques, insisting on plastic correction alongside cancer resections to improve patients’ quality of life. His passion for wound care and dignified treatment for cancer patients, especially those with infected wounds, set a high standard. After a British Council Fellowship in the UK in 1986, he furthered his expertise, later establishing the surgical oncology department at KMC, Manipal, in 1992. Even after retirement, he continued his work at Soumya Apollo Hospital, Vijayawada, and a cancer centre in Cherthala, Kerala, until his passing. Dr Cherian’s legacy endures through his trainees, including Dr Iqbal Ahamed and Dr Paul Sebastian, and his emphasis on conservative, function-preserving surgeries like breast conservation and functional neck dissections.

Kerala’s Contribution: The Regional Cancer Centre (RCC), Thiruvananthapuram and Beyond

In 1981, the Regional Cancer Centre (RCC) in Thiruvananthapuram was established, becoming a landmark in Kerala’s fight against cancer. RCC integrated surgery, radiotherapy, and chemotherapy, offering comprehensive care and serving as a hub for research and training. Its multidisciplinary approach made it a model for cancer care in India, particularly in addressing the high incidence of cancers like oral and breast cancer prevalent in Kerala due to lifestyle factors such as tobacco use. RCC’s outreach programmes, including mobile cancer detection units, brought screening and early diagnosis to rural Kerala, significantly enhancing surgical outcomes by enabling early interventions.

Other institutions in Kerala, such as the Amrita Institute of Medical Sciences (AIMS) in Kochi (established in 1998) and the Malabar Cancer Centre (MCC) in Thalassery (established in 2001), further strengthened the state’s cancer care infrastructure. AIMS introduced advanced surgical techniques, including minimally invasive procedures, while MCC focused on serving northern Kerala, reducing the need for patients to travel to urban centres like Mumbai or Chennai.

Cancer Surgery Training Programmes in India: Key Initiatives and Pioneers

Manpower training is a crucial milestone in the development of any speciality for optimal cancer surgery. Surgeons must be trained not only in the principles of cancer surgery but also in other disciplines of cancer care, such as medical oncology, radiation oncology, and more. The introduction of structured training programmes in cancer surgery marked a significant advancement in the field in India, elevating the standard of cancer care to a new level. The national training programmes and pioneers behind these comprehensive training programmes and their invaluable contributions are described below.

Adyar Cancer Centre

The first M Ch (Surgical) Programme was started in 1984.

GCRI Ahmedabad

Dr Devendra D Patel was instrumental in starting the M Ch Surgical Oncology programme at GCRI in 1988, the second such course in India after Chennai’s Adyar Cancer Institute. GCRI became a hub for training hundreds of surgical oncologists, many of whom now lead cancer care across India. The programme emphasised hands-on training, multidisciplinary approaches, and international collaborations (e.g., with the British Association of Surgical Oncology).

Tata Memorial Hospital (TMH), Mumbai

Regional Cancer Centres (RCCs)

Many RCCs now run M Ch Surgical Oncology Programmes, and the National Board of Examination runs Certificate Programmes in Surgical Oncology.

As of 2025, India trains approximately 189 M Ch (Magister Chirurgiae) and 82 DrNB (Doctorate of National Board) candidates in Surgical Oncology annually. In Kerala, RCC has been a pioneer in offering super-specialty courses in surgical oncology, training professionals to address the state’s growing cancer burden. Institutions like AIMS and the Government Medical College in Thiruvananthapuram further support this ecosystem, ensuring a steady supply of skilled oncologists.

Other Site-Specific Fellowships

Many Fellowships (e.g., microvascular reconstruction training initiated by Dr Patel at GCRI with UK experts like Bruce Bailey) and organ-specific specialisation (e.g., ortho-oncology, uro-oncology, pioneered at GCRI) are also offered to train surgeons in various disciplines of Oncology.

Technological Advancements: Embracing Modernity

The late 20th and early 21st centuries brought a technological revolution to cancer surgery in India, with Kerala adopting these innovations swiftly due to its advanced healthcare ecosystem:

• Minimally Invasive Surgery: Laparoscopic techniques, adopted in the 1990s, reduced recovery times and complications. RCC and AIMS in Kerala were early adopters, performing laparoscopic resections for colorectal and gynaecological cancers.
  
  

• Robotic Surgery: While institutions like the Rajiv Gandhi Cancer Institute in Delhi pioneered robotic-assisted surgeries, Kerala’s AIMS and RCC introduced robotic surgery systems, enhancing precision in complex procedures like prostate and thoracic cancer surgeries.

Kerala’s high literacy and healthcare awareness offer opportunities to address these challenges through community education, early screening, and telemedicine. RCC’s initiatives, such as cancer awareness campaigns and mobile screening units, are steps in this direction.

Conclusion: A Legacy of Resilience and Innovation

The history of cancer surgery in Kerala and India is a story of resilience, from the ancient techniques of the Sushruta Samhita to the pioneering work of missionary surgeons at Neyyoor Mission Hospital and modern innovations like robotic surgery and telesurgery. Kerala’s contributions, led by institutions like RCC and pioneers like Dr Thomas Cherian and Dr Paul Sebastian and Dr Iqbal Ahamed, have made the state a beacon of cancer care in India. As Kerala and India continue to integrate advanced technology with compassionate, accessible care, the future holds promise for equitable and effective cancer treatment, ensuring that no patient is left behind in the fight against this disease.