highly specialised services (hss) colorectal and …...surgery (crs) and hipec, 80% had a cc0/1...

Highly Specialised Services (HSS) Colorectal and Peritoneal Oncology Centre Report March 2018

The Christie NHS Foundation Trust Wilmslow Road Withington Manchester M20 4BX http://www.christie.nhs.uk/cpoc “I know treat each day as a bonus day – one that I would never have been able to enjoy were it not for you and your dedicated team. I can assure you that what you have given me is treasured, never squandered”

CPOC Patient feedback, operated January 2017

http://www.christie.nhs.uk/cpoc

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Contents

1. Introduction ................................................................................................................................ 2

2. Workforce .................................................................................................................................. 3 2.1. Staffing ................................................................................................................................ 4

3. Patient and Public Engagement ................................................................................................ 5 3.1. Patient Day ......................................................................................................................... 5 3.2. Patient Satisfaction Survey ................................................................................................. 5

3.3. Complaints .......................................................................................................................... 5 3.4. Website & Social Media ...................................................................................................... 6

4. Research, Education and Training ............................................................................................ 7 4.1. Education and Training ....................................................................................................... 7 4.2. Oral presentations ............................................................................................................... 8 4.3. Poster presentations ........................................................................................................... 9 4.4. Publications ......................................................................................................................... 9

5. Charitable funds: Approved Applications 2017/18 ................................................................... 10 6. Additional activity throughout 2017/18 ..................................................................................... 11 7. Future Events: 2018-19 ........................................................................................................... 11 8. Referral Activity ....................................................................................................................... 12

9. Demographics ......................................................................................................................... 13 10. Assessments and Treatment ................................................................................................ 14

11. Specialist Commissioning (Appendix) Assessment/Follow Up Activity ................................. 15 12. Quality .................................................................................................................................. 16

13. Complications ....................................................................................................................... 18 14. Survival ................................................................................................................................ 20

15. Appendices I: Procedure Activity (Including PP) .................................................................. 22 16. Appendix II: Outcomes by disease group ............................................................................. 24 17. Appendix III: Patient Satisfaction Survey .............................................................................. 27

18. Appendix IV: Abstracts ......................................................................................................... 27

Service Report March 2018 Colorectal and Peritoneal Oncology Centre – The Christie NHS Foundation Trust _______________________________________________________________________________________

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1. Introduction

The Christie Colorectal and Peritoneal Oncology Centre (CPOC) continue to provide a growing service nationally for patients with peritoneal disease. The last full year’s data (2016-17) indicate a slight rise in the number of patients referred with appendiceal tumours (260) compared to the previous year’s activity (216). The data for the current year (2017-18) shows a similar level of referral at 259. Equally a similar rise has been seen in the Colorectal Peritoneal Metastases (CRPM) group. However, the fraction of referred patients who then undergo cytoreduction has slightly fallen over the past 3 years (67.7%, 2014-15; 63.4%, 2015-16; 56.5% 2016-17). Our results remain consistent: for those with appendiceal neoplasia undergoing cytoreduction surgery (CRS) and HIPEC, 80% had a CC0/1 cytoreduction, with 65.9% having no complications and 8.3% having G3/4 complications. There were five 90-day mortalities. The unit has now performed 66 laparoscopic risk-reducing CRS+HIPEC with no complications in 80.3%, 6% G3/4 complications and no 90-day mortalities. The service has been active in education, audit and research with papers accepted in peer reviewed publications on quality of life after CRS+HIPEC, the changing pattern of referral to the service for PMP and outcomes for appendiceal cancers. We continue to have a very active educational profile with a second fellow completing the ESSO fellowship and achieving accreditation in peritoneal tumour management expected at the PSOGI meeting in September 2018. In 2017 we introduced a course dedicated to explaining the patient pathway and outcomes for patients with colorectal peritoneal metastases. The last course was also available by live web streaming and feedback from the attendees has been very positive. We have a stable complement of committed Clinical Nurse Specialists (CNS) incorporating a band 8, a band 7 and two band 6 nurses. They are now providing a Nurse of the Week system to complement the Consultant of the Week to allow efficient and robust management of new referrals. In addition, regular telephone follow up clinics and the second Patient Day (May 2018) are organised and run by the CNS team. We have conducted a patient satisfaction survey on patients treated in the past 18 months with reassuringly high levels of appreciation identified (9.7 out of 10 for the care provided), details of which are included in this report. We have had problems with long term illness affecting one of our consultants over the past 18 months, but the team has managed to maintain and expand the service. Another of our consultants is planning to move to a new post in London and consequently we will be looking to appoint up to 3 new full-time consultants over the next 2 years. There has been some changes in the service management recently that has stretched the team but we are working with the Executive team to restore a more robust administration and management supporting the service for the rest of this and future years.

MS Wilson and ST O’Dwyer


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2. Workforce

Name Job Title

Prof ST O’Dwyer Consultant Surgeon/Lead Clinician for PTS service

Mr MS Wilson Consultant Surgeon/ Lead Clinician Colorectal service

Mr PE Fulford Consultant Surgeon

Prof AG Renehan Professor of Cancer Studies and Surgery, Honorary Consultant

Mr CR Selvasekar Consultant Surgeon/ Lead Minimal Access Surgery

Mr O Aziz Consultant Surgeon/ Lead Endoscopy services

Miss AM Minicozzi Consultant Surgeon

Mr H Abudeeb Locum Consultant Surgeon

Mr R Deshpande Consultant Hepatobiliary Surgeon

Dr MP Saunders Consultant Oncologist

Dr S Mullamitha Consultant Oncologist

Dr M Braun Consultant Oncologist

Dr R Kochhar Lead Consultant Radiologist

Dr D Mullan Consultant Radiologist

Dr V Kasipandian Lead Consultant Anaesthetist

Dr B Chakrabarty Lead Consultant Histopathologist

Rebecca Halstead Lead Clinical Nurse Specialist

Lisa Wardlow Clinical Nurse Specialist

Rachel Connolly Clinical Nurse Specialist

Amanda Coop Clinical Nurse Specialist

Rachel Aziz HIPEC Senior Theatre Practitioner

Andy Colclough HIPEC Practitioner

Rachelle Wood HIPEC Practitioner


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Sarah Madden HIPEC Practitioner

Alexandra Daly Service Manager

Heather Marley Support Manager

Adam Ansell Data Manager

Gill Harrison Medical Secretary

Bev Tyrrell Medical Secretary

Rebecca Brown Medical Secretary

Laura Elliott Medical Secretary

Marion McKenna Medical Secretary

Mary Cunningham Medical Secretary

Kim Haw Medical Secretary

Lee Malcomson Research Associate

Jonathon Lebeter/Sally Corbett MDT Co-ordinator

2.1. Staffing

There have been a number of changes to our workforce during the past year. The Clinical Nurse Specialist (CNS) team now comprises of one band 8a, one Band 7 and two band 6’s. There have been changes within the Admin/Secretarial service with two secretaries leaving the team. We have successfully recruited to these posts and are now up to full establishment. The team welcomed Adam Ansell, Data Manager who joined in April 2017. Adam oversees all aspects of data related to the service and works closely with all members of the team. The service would like to thank Hannah Rogers; Service Manager for all her hard work. Hannah has successfully secured a role at another trust. Alexandra Daly has now commenced in post to support the on-going development of the service. Work is on-going to streamline the Administrative service and work is underway to hold an away day for the Admin team, Clinical Nurse Specialists, Data Manager and Service Manager.


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3. Patient and Public Engagement

3.1. Patient Day

The CPOC service planned to build on the successes of the PTS patient day in September 2016 and host a second event during 2017. Unfortunately due to changes in staff and general pressure on the team this did not go ahead. However, we are pleased to announce that we are to host the 2nd Peritoneal Tumour Service (PTS) Patient Day on the 17th May 2018. Further details of this event will be advertised in due course.

3.2. Patient Satisfaction Survey

After the pilot survey in 2016, during this year the CPOC service sent out 105 Patient Satisfaction Surveys to patients who had received CRS & HIPEC within the last 18 months. In total we received 68 responses to this survey (65% response rate) with a generally very positive response. Quality indicators included:

98.53% of patients were given a named key worker (1 patient unsure)

83.82% of patients were given written information, up from 77.8%

We scored 9.7 out of 10 for overall care patients received General Feedback included:

“Excellent team, Excellent Consultant, Excellent Nurses. Thank you”

“I found my treatment & stay was expertly handled. I was looked after very well, the nurses and staff were very friendly and answered any questions that I asked. 10/10.”

A full copy of the Patient Survey report is added to this report as an attachment in Appendix III. Actions and improvements will be discussed with the patients on 17th May 2018 following which agreed objectives for improvements will be outlined.

3.3. Complaints

All patient feedback is collected and discussed at our monthly PTS business meetings as a recurring agenda item. The Christie Patient Advisory Liaison Service (PALS) reported two complaints from a patient in this service for the 2017/2018 year (1st April to 31st December). The first complaint related to the fact that after subsequent review of the patient’s pathology, the initial advice given to her about the risk of her going on to develop PMP was changed and increased slightly. This advice did not change the management recommended to the patient (non-operative - surveillance). The processes of the unit were reviewed and the patient received a full response to her complaint in writing explaining that sometimes additional pathology specimens come to light which result in us updating our opinion.


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The second complaint related to a patient with PMP feeling that their treatment had been delayed due to a lack of communication between the Christie CPOC, the referring hospital and the patient. The case was reviewed and whilst no inappropriate delays in processing this case, the communication back to the patient and the referring hospital was sub-optimal. A series of processes were put in place to ensure that regular holding letters are sent to the patients at each stage of the process. A full written apology was made to the patient. There were many positive comments some of which include:

“I now treat each day as a bonus day – one that I would never have been able to enjoy were it not for you and your dedicated team”. “I can only praise your professional conduct, skills and meticulous attention to detail. Your foresight and preparedness for all eventualities puts the patient and their family members at ease during difficult times.” “Fantastic treatment and care by all the staff at the Christie Manchester. All the staff put you at ease which helps so much. Thank you so very much for looking after me.

3.4. Website & Social Media

Development of our website (http://www.christie.nhs.uk/cpoc) has continued in 2017, with the implementation of a communications plan and dedicated time spent on portraying our efforts to professionals and the wider public. In addition to the website, the Colorectal and Peritoneal Oncology Centre (CPOC) have introduced a LinkedIn page (https://www.linkedin.com/christie-colorectal-and-peritoneal-oncology-centre/) Both the website and LinkedIn give an opportunity for our peers and patients to gain an insight into the complex nature of the service as well as offer relevant and up to date information. 2018 will see us more routinely update our media outlets in a timely manner, as well as establishing a way of communicating the good work that the team undertake via social media such as Twitter and Facebook. This will allow the team to continually communicate and essentially improve our service for our patients and their families as well as the hospital teams that refer patients into the service.

http://www.christie.nhs.uk/cpoc

https://www.linkedin.com/showcase/christie-colorectal-and-peritoneal-oncology-centre/


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4. Research, Education and Training

The research activities continue along two broad work streams: clinical studies and trials; and basic science research. The IDEAL-PM Study (Development of an IDEAL framework to standardise the complex intervention of cytoreductive surgery for colorectal peritoneal metastases: a necessary step to phase III trials: led by Professor Renehan), is a collaborative project with Hampshire Hospitals NHS Foundation Trust. The study has first evaluated variation in twelve core data fields between centres (100 consecutive operative cases from each centre), and second, has begun recruiting participants for the video-assisted validation of the PCI scoring system. The results of this study were presented at the Dublin meeting in 2017, and were well received. Specifically, the preliminary work has identified problems of reproducibility with PCI scoring. Under amended ethics, this is now being extended to more international centres and an iterative process of consensus is being initiated. The Christie was chosen as one of the five ‘A-list’ sites to recruit participants to the Prevention of Respiratory Insufficiency after Surgical Management (PRISM) Trial in early 2016. The PRISM Trial is a pragmatic randomised controlled trial of continuous positive airway pressure (CPAP) to prevent respiratory complications and improve survival following major abdominal surgery. We agreed that CRS and HIPEC patients should be the initial target cases for this trial. To-date, we have recruited over 70 patients with no serious adverse events recorded. In 2017 we commenced a research theme on the role of biomarkers in predicting outcome for CRPM. This research is currently being undertaken by a Masters in Research student at the University of Manchester. We also secured a MRC CASE award to fund a 3-year PhD student developing novel mass spectrometry techniques to study CRPM. In 2018 a MRes student has undertaken a literature review investigating biomarker concordance of primary and peritoneal metastatic colorectal cancer. This will form the basis of an appointment of a MD/PhD research fellow to investigate this in depth and in co-operation with the Biobank will extract matched samples for evaluation. These projects are under the joint supervision of Mr Aziz and Prof O’Dwyer.

4.1. Education and Training

European Society of Surgical Oncology (ESSO) Fellowships

The unit has been designated by ESSO for Training in Peritoneal Oncology. Since 2015 there have been two registered Fellows; Andreas Larentzakis certified in Peritoneal Oncology in Washington in November 2016, who is now setting up a unit in Greece. The second Fellow, Adam Stearns, is currently a Consultant Surgeon, in Norwich, and will complete in 2018 with conferment of the fellowship in Paris September 2018. Two new Fellows have registered to start in mid-2018

The RanD Academy project has matured with sponsorship of the course addressing pathways for peritoneal metastases. The courses ran in March and November 2017 and March 2018. The recent course was also delivered as a live web stream for remote access with the intention of improving overseas awareness of peritoneal neoplasia.


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Under the RanD Academy sponsorship a team from Jordon are planning to observe our Peritoneal service and we intend to support them in their progression at their base hospital. Mr Aziz attended a workshop in Italy in 2017 to present the units experience in peritoneal tumours and explain referral pathways for CRPM. Professor O’Dwyer was invited to lecture on the ESSO course in November, the Intensive Care and Anaesthetic Conference in Basingstoke, and the Emirates Oncology Conference, Abu Dhabi in December 2017. Evaluation of the perioperative and critical care has been audited under the supervision of Dr Kasipandian with results presented in the First International Conference on Peri-operative Anaesthetic and Critical Care Management of Patients undergoing CRS with HIPEC for Peritoneal Malignancy at Basingstoke, 4th Annual UK & Ireland Peritoneal Malignancy Meeting at Dublin and at the 13th International Symposium of regional cancer therapies, Society of Surgical Oncology, Florida USA in Feb 2018.

4.2. Oral presentations

Annual Meeting of the Association of Coloproctology of Great Britain & Ireland (ACPGBI), Bournemouth, July 2017

Quality of life after cytoreductive surgery and heated intraperitoneal chemotherapy for pseudomyxoma peritonei: a long-term study: Mr A Stearns


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Predicting survival after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) for adenocarcinoma of the appendix: Mr O Aziz

4th UK Peritoneal Malignancy Conference, Dublin, October 2017

Re-operative surgery for peritoneal malignancy: Professor ST O’Dwyer

Development of an IDEAL framework to standardise the complex intervention of cytoreductive surgery for colorectal peritoneal metastases: a necessary step to phase III trials: Professor AG Renehan

Clinical Trials – what questions should new trials address and how can the UK & Ireland Group Initiate: Professor AG Renehan

Activity and outcomes from Peritoneal Surgery: Mr MS Wilson

Anaesthetic impact on the outcome following cytoreductive surgery: Dr Vidya Kasipandian

ESSO course in Peritoneal malignancy, Belgium, October 2017

Selection of patients for CRS and HIPEC: Professor ST O’Dwyer

Palliative strategies in peritoneal malignancy: Professor ST O’Dwyer

Critical Care and Anaesthetic management of CRS and HIPEC, Basingstoke, October 2017

CRS, history, learning curve and results: Professor ST O’Dwyer

Perioperative management of patients undergoing CRS and HIPEC: Dr P Chalakova

Anaesthetic management of the HIPEC phase: Dr V Kasipandian

Open discussion with specialist panel: Prof ST O’Dwyer, Dr V Kasipandian

Emirates Oncology Conference Abu Dhabi, December 2017

Current application of CRS and HIPEC for GI malignancies: Professor ST O’Dwyer

Indo UK Oncology Summit, December 2017

Advanced colorectal malignancies: Professor ST O’Dwyer

Society of Surgical Oncology Regional therapies Conference, Florida, Feb 2018

Perioperative anaesthetic management for cytoreductive surgery and heated intraperitoneal chemotherapy: influence on morbidity and mortality in peritoneal tumours: Dr P Chalakova

4.3. Poster presentations

In 2017, all our submitted PTS (appendiceal) abstracts received oral presentations

4.4. Publications

Aziz O, Jaradat I, Chakrabarty B, Selvasekar CR, Fulford P, Saunders MP, et al. Predicting survival after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) for adenocarcinoma of the appendix [in press]. Diseases of Colon and Rectum 2018. Salih Z, Lamarca A, Nonaka D, Hubner RA, de Liguori-Carino N, McNamara MG, et al. The dark side of T1 non-appendiceal small bowel neuroendocrine tumors. Hum Pathol 2017;66:239-240.


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Stearns AT, Malcomson L, Punnett G, Abudeeb H, Aziz O, Selvasekar CR, et al. Long-term Quality of Life After Cytoreductive Surgery and Heated Intraperitoneal Chemotherapy for Pseudomyxoma Peritonei: A Prospective Longitudinal Study. Ann Surg Oncol 2018;25(4):965-973. Verwaal VJ, Rau B, Jamali F, Gilly FN, de Hingh I, Takala H, et al. Registries on peritoneal surface malignancies throughout the world, their use and their options. Int J Hyperthermia 2017;33(5):528-533. Submitted

Fish R, Renehan AG, Punnett G, Aziz O, Fulford P, Selvasekar CR, et al. Referral and treatment pathways for pseudomyxoma peritonei of appendiceal origin within a national treatment programme: (2002 to 2015) [submitted]. Colorectal Disease 2018. Larentzakis A, O’Dwyer ST, Becker J, Shuweihdi F, Aziz O, Selvasekar CR, et al. Treatment Pathways and Outcome of patients with colorectal peritoneal metastasis (CRPM) [submitted]. BJS 2018.

5. Charitable funds: Approved Applications 2017/18

Equipment

Non-invasive ventilation device Philips V60 £12,025

Theatre video link and recorder - £32,000 Endoscopic carbon dioxide (CO2) regulation unit for endoscopic procedures £11,500

Education and research Funding has been allocated to support the following

Educational support for CNS degree studies

PIPAC training course for two consultants

Travel to present data in Florida Due to the lack of management support the Business case for approval of the charitable funds submission has been on hold but it is hoped this can be re-invigorated in 2018-19. The following projects have received clinical support to be put forward for funding:

A pervasive prehabilitation program for patients undergoing major abdominal surgery at CPOC - Research Fellowship £40,000

Early detection of complications in colorectal cancer patients receiving systemic chemotherapy using a pervasive wearable device - Research Fellowship £40,000

External validation of the Consensus for Classification and Pathologic Reporting of Pseudomyxoma Peritonei and associated Appendiceal Neoplasia - Research Fellowship £54,225

Co-ordinator for patient involvement including social media / information development. Patient event development (2years) - £60,000

Biomarkers predicting outcome in patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) for peritoneal metastases from colorectal cancer (PMCR) - Research Fellowship and laboratory costs £150,000


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6. Additional activity throughout 2017/18

Celebrations of our 1000th CRS & HIPEC procedure was planned but our patient was unable to attend hence this is to be included in the next patient day in May 2018

Prof O’Dwyer and Mr Aziz attended the Charite hospital in Berlin to observe PIPAC procedures with a view to introducing the technique for palliative treatments in 2018-19

7. Future Events: 2018-19

The 2nd PTS Patient day scheduled for 17th May 2018.

Peritoneal MDT course November 2018.


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8. Referral Activity

Specialist Commissioning (Appendix) Referrals

10-11 11-12 12-13 13-14 14-15 15-16 16-17 17-18

Q30 - NORTH EAST 3 10 6 3 5 6 11 36

Q31 - NORTH WEST 45 50 54 61 105 109 108 112

Q32 - YORKSHIRE & THE HUMBER 18 24 23 35 39 35 49 6

Q33 - EAST MIDLANDS 6 4 8 9 13 13 17 16

Q34 - WEST MIDLANDS 9 10 7 16 12 27 29 49

Q35 - EAST OF ENGLAND 0 2 2 0 1 5 7 4

Q36 - LONDON 0 1 0 0 0 1 3 1

Q37 - SOUTH EAST COAST 1 1 0 0 0 0 4 5

Q38 - SOUTH CENTRAL 0 1 2 0 0 0 0 2

Q39 - SOUTH WEST 1 1 0 0 0 7 7 4

ENGLAND - NOT KNOWN 0 0 0 0 0 0 0 0

W01 - WALES 8 12 3 8 5 5 10 8

NORTHERN IRELAND 2 2 1 1 2 2 5 5

SCOTLAND 6 4 4 12 4 5 9 8

OTHER GB 0 0 0 3 0 1 1 1

OTHER 0 0 0 0 0 0 0 2

TOTAL 99 122 110 148 186 216 260 259 CRPM Referrals

10-11 11-12 12-13 13-14 14-15 15-16 16-17 17-18

Q30 - NORTH EAST 1 1 2 1 1 7 4 31

Q31 - NORTH WEST 15 10 31 28 57 82 83 98

Q32 - YORKSHIRE & THE HUMBER 3 2 3 6 22 16 21 6

Q33 - EAST MIDLANDS 4 1 2 3 6 6 10 14

Q34 - WEST MIDLANDS 3 0 2 5 4 14 25 32

Q35 - EAST OF ENGLAND 0 0 1 2 7 6 10 5

Q36 - LONDON 0 0 0 2 1 1 3 0

Q37 - SOUTH EAST COAST 0 0 2 0 0 0 1 7

Q38 - SOUTH CENTRAL 0 0 0 0 0 1 1 1

Q39 - SOUTH WEST 1 0 0 0 1 2 2 7

ENGLAND - NOT KNOWN 0 0 0 0 0 0 0 0

W01 - WALES 0 1 1 0 1 2 1 2

NORTHERN IRELAND 0 0 0 0 0 1 0 2

SCOTLAND 0 1 1 1 0 3 3 9

OTHER GB 0 0 0 2 2 2 0 1

OTHER 0 0 0 0 0 0 0 0

TOTAL 27 16 45 50 102 143 164 215


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9. Demographics

Specialist Commissioning (Appendix) Demographics

Age

10-11 11-12 12-13 13-14 14-15 15-16 16-17 17-18

Median - Male: 55 57 62 58 64 65 62 59

Median - Female:

61 62 59 61 62 62.5 62 60

Range: 23-92 29-85 28-86 20-86 21-91 19-89 19-87 23-84

N = 99 122 110 148 186 216 260 259

Gender

10-11 11-12 12-13 13-14 14-15 15-16 16-17 17-18

Male 42 55 37 51 58 88 108 117

Female 57 67 73 97 128 128 152 142

Total 99 122 110 148 186 216 260 259

CRPM Demographics

Age

10-11 11-12 12-13 13-14 14-15 15-16 16-17 17-18

Median - Male: 61 59 65 61 63 63 62 61

Median - Female:

54 57 62 58 55 60 60 61

Range: 35-81 34-73 33-78 28-81 22-84 20-83 22-86 28-81

N = 27 16 45 50 102 143 164 215

Gender

10-11 11-12 12-13 13-14 14-15 15-16 16-17 17-18

Male 11 4 20 24 54 69 80 109

Female 16 12 25 26 48 74 84 106

Total 27 16 45 50 102 143 164 215


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10. Assessments and Treatment

Figure 1: Appendix tumours – Cases and Operations This graph includes all patients including private patients

Figure 2: CRPM - Cases and Operations This graph includes all patients including private patients


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11. Specialist Commissioning (Appendix) Assessment/Follow up Activity

10-11 11-12 12-13 13-14 14-15 15-16 16-17 17-18

First Assessment IP 4 0 0 0 2 3 5 0

First Assessment OP 75 80 78 82 127 141 135 149

Re Assessment IP 45 40 14 26 53 47 21 4

Re Assessment OP 63 51 65 56 69 59 23 45

Follow Ups 189 239 236 291 332 414 427 518

Telephone Follow Ups

0 65 91 102 178 263 297 377

Chemo Appointments 226 199 212 189 296 313 286 225

Total 602 674 696 746 1057 1240 1194 1318


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12. Quality

Operation times

08-09 09-10 10-11 11-12 12-13 13-14 14-15 15-16 16-17 17-18

Median Op Time 8.5 8.67 7.83 9.03 8.43 8.47 8.72 8.55 8.52 8.48

Range Op Time 4.17-10.83 6.45-12.55 5.77-13.00 6.42-14.00 5.30-13.72 4.83-14.05 6.53-11.92 4.52-12.48 2.98-12.58 4.08-12.75

Median Op Time 4.22 3.91 3.89 3.86 3.82 3.45 4.7 4.38 4.05 4.48

Range Op Time 3.27-6.33 2.00 - 7.00 2.28-5.00 1.8-9.83 1.57-5.98 1.48-8.17 2.15-8.08 3.02-7.7 2.53-8.52 2.5-6.5

Cytoreduction

Major Debulk

Length of Stay

Level 2

CCU StayTotal Stay

Level 2

CCU StayTotal Stay

Level 2

CCU StayTotal Stay

Level 2

CCU StayTotal Stay

Level 2

CCU StayTotal Stay

Level 2

CCU Stay

Total

Stay

Level 2

CCU

Stay

Total

Stay

Level 2

CCU

Stay

Total

Stay

Median 2 11 2 12 2 10 2 10 2 11 2 12 1 10 1 13

Range 0-7 05-28 0-8 05-25 0-12 06-41 0-12 05-77 0-9 06-54 0-22 05-51 0-8 4-66 0-4 4-58

2017-182014-15 2015-16 2016-172010-11 2011-12 2012-13 2013-14


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CC Scores – All cases

CC Scores – Appendix tumours CC0/1 = 75%

CC Scores – CRPM


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13. Complications

Complications Unit Overview (2017-2018)

n %

No Complications 952 124.28%

Minor Complications (NCI grade 1 - 2) 115 15.01%

Major Complications (NCI grade 3 - 4) 52 6.79%

Peri-Operative (30 Day) Mortality 9 1.17%

Peri-Operative (31-90 Day) Mortality 3 0.39% Complications Appendix/PMP (2017-2018)

n %





Peri-Operative (31-90 Day) Mortality 0 0.00% Complications CRPM (2017-2018)

n %





Peri-Operative (31-90 Day) Mortality 0 0.00% Complications CRPM overview (up to 2017-2018)

n %





Peri-Operative (31-90 Day) Mortality 2 0.67%


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Complication rates overview for Cyto & HIPEC/Debulk procedures

Cases n % n % n % n %

2011-2012 81 9 11.11% 18 22.22% 0 0.00% 0 0.00%

2012-2013 89 20 22.47% 12 13.48% 0 0.00% 0 0.00%

2013-2014 101 23 22.77% 17 16.83% 1 0.99% 1 0.99%

2014-2015 151 43 28.48% 16 10.60% 1 0.66% 1 0.66%

2015-2016 159 40 25.32% 31 19.62% 0 0.00% 2 1.26%

2016-2017 184 36 19.57% 27 14.67% 0 0.00% 2 1.09%

2017-2018 179 58 32.40% 13 7.26% 1 0.56% 1 0.56%

Total 944 229 23.13 134 14.95 3 0.32 7 0.65

Peri-Operative (90 Day) MortalityMinor Complications* Major Complications** Peri-Operative (30 Day) Mortality

*Defined as Grade 1 or 2 NCI Common Terminology Criteria for Adverse Events (v4.0) ** Defined as Grade 3 or 4 NCI Common Terminology Criteria for Adverse Events (v4.0)

Grade 3: Severe or medically significant but not immediately life-threatening; hospitalization or prolongation of hospitalization indicated; disabling; limiting self-care activities of daily living. Grade 4: Life-threatening consequences; urgent intervention indicated. Grade 5: Death related to AE.


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Minimal Access Laparoscopic Cytoreduction & HIPEC – overview

Cases Median Hospital Stay Median CCU Stay Median PCI Score PCI Range Median Op Time

2011-2012 5 8 1 0 0 9.03

2012-2013 7 6 1 0 0-2 8.53

2013-2014 7 5 1 0 0 8.32

2014-2015 13 6 0 1 0-4 7.22

2015-2016 6 5.5 0 1 0-2 9.28

2016-2017 18 7.5 0 0 0 8.75

2017-2018 16 6.5 0 3 0-8 7.29

Total 72 6 0 0 0-8 8.53 Minimal Access Laparoscopic Cytoreduction & HIPEC Complications (n=66)

n %




Peri Operative (30 Day) Death 0 0.00%

Peri Operative (90 Day) Death 0 0.00%

14. Survival

0.0

00

.20

0.4

00

.60

0.8

01

.00

Su

rviv

al

110 80 55 39 19 11 6Major Debulk369 318 278 224 181 136 112Cyto & HIPEC

Number at risk

0 12 24 36 48 60 72Time - Months

Cyto & HIPEC Major Debulk

PMP - Cyto & HIPEC Vs Major Debulk


21

0.0

00

.20

0.4

00

.60

0.8

01

.00

Su

rviv

al


Number at risk

0 12 24 36 48 60 72Time - Months


Appendix Ca - Cyto & HIPEC Vs Major Debulk

0.0

00

.20

0.4

00

.60

0.8

01

.00

Su

rviv

al


Number at risk

0 12 24 36 48 60 72Time - Months


CRPM Cyto & HIPEC Vs Major Debulk


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15. Appendices I: Procedure Activity (Including PP)

All Procedure Activity by year

Major Debulk Cytoreduction Total

2001-2002 0 4 4

2002-2003 4 2 6

2003-2004 10 8 18

2004-2005 5 13 18

2005-2006 5 20 25

2006-2007 12 17 29

2007-2008 6 30 36

2008-2009 3 47 50

2009-2010 15 42 57

2010-2011 4 55 59

2011-2012 10 71 81

2012-2013 13 74 87

2013-2014 21 81 102

2014-2015 17 134 151

2015-2016 19 140 159

2016-2017 34 150 184

2017-2018 16 163 179

Total 194 1051 1245


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Appendix Procedure Activity by year

Undergone Cyto/Debulk

Confirmed Cases

1999-2000 0 1

2000-2001 0 4

2001-2002 4 4

2002-2003 5 11

2003-2004 16 33

2004-2005 16 45

2005-2006 18 42

2006-2007 27 57

2007-2008 31 52

2008-2009 37 73

2009-2010 45 94

2010-2011 49 91

2011-2012 66 110

2012-2013 64 101

2013-2014 78 127

2014-2015 107 169

2015-2016 98 173

2016-2017 99 224

2017-2018 112 235

Total 872 1646

CRPM Procedure Activity by year

Undergone Cyto/Debulks

Confirmed Cases

2002-2003 0 1

2003-2004 0 1

2004-2005 1 2

2005-2006 4 5

2006-2007 1 2

2007-2008 3 8

2008-2009 5 10

2009-2010 9 25

2010-2011 8 28

2011-2012 12 14

2012-2013 18 46

2013-2014 19 49

2014-2015 41 110

2015-2016 53 152

2016-2017 47 158

2017-2018 67 185

Total 288 796


24

16. Appendix II: Outcomes by disease group

PMP n %

Cytos/Debulks procedures 496

Cytoreduction & HIPEC 385 77.62%

Debulking Procedure 111 22.38%

Total Procedures 496

PCI Median 21

PCI Range 0-39

CC0 Count 123 24.80%

CC1 Count 204 41.13%

CC2 Count 46 9.27%

CC3 Count 85 17.14%

CC Score Missing 38 7.66%

LAMN 1 n %




Total Procedures 8

PCI Median 6

PCI Range 3-16

CC0 Count 7 87.50%

CC1 Count 1 12.50%

CC2 Count 0 0.00%

CC3 Count 0 0.00%



25

LAMN 2 n %





PCI Median 0

PCI Range 0-35

CC0 Count 95 77.87%

CC1 Count 19 15.57%

CC2 Count 1 0.82%

CC3 Count 5 4.10%


Appendix

Adenocarcinoma (incl

MCP - High Grade)

n %





PCI Median 17

PCI Range 0-39

CC0 Count 104 57.46%

CC1 Count 25 13.81%

CC2 Count 13 7.18%

CC3 Count 26 14.36%



26

Goblet Cell Carcinoid

(TANG A)




Total Procedures 31

PCI Median 3

PCI Range 0-13

CC0 Count 29 93.55%

CC1 Count 0 0.00%

CC2 Count 0 0.00%

CC3 Count 0 0.00%


n %

Adenocarcinoma ex Goblet Cell Carcinoid n %

(TANG B & C)




Total Procedures 52

PCI Median 3

PCI Range 0-36

CC0 Count 36 69.23%

CC1 Count 4 7.69%

CC2 Count 4 7.69%

CC3 Count 8 15.38%



27

CRPM n %





PCI Median 9

PCI Range 0-39

CC0 Count 197 66.33%

CC1 Count 27 9.09%

CC2 Count 36 12.12%

CC3 Count 29 9.76%


17. Appendix III: Patient Satisfaction Survey

Patient Questionnaire 2017.docx

CPOC Patient Survey report - 2017.pdf

18. Appendix IV: Abstracts

highly specialised services (hss) colorectal and …...surgery (crs) and hipec, 80% had a cc0/1...

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