nssg og audit day 2012 south tees hospitals foundation trust sam dresner, consultant surgeon helen...
TRANSCRIPT
NSSG OG AUDIT DAY 2012NSSG OG AUDIT DAY 2012
South Tees Hospitals Foundation TrustSouth Tees Hospitals Foundation Trust
Sam Dresner, Consultant SurgeonSam Dresner, Consultant SurgeonHelen Wescott, OG Cancer CNS Helen Wescott, OG Cancer CNS
MDT Workload
• New patients discussed Jan - Dec 2011– 474
• New patients discussed Jan – Dec 2010– 493
Upper GI New PatientsOG 2010 2011
Oesophagus 147 144
OG 19 9
Stomach 114 93
Small Bowel 5 2
GIST 10 10
Total 285 258
HPB New CasesHPB 2010 2011
Pancreas 57 62
Bile duct 23 32
Liver 11 14
Total 93 118
New cases - otherOther 2010 2011
Unknown 23 22
Not UGI Cancer 21 24
Not Cancer 61 52
Total 115 98
Number of MDT discussions
Patients By Referral Unit
Histological Subtype
Oesophagus Cell Type
2010 2011
Adenocarcinoma 85 81
Carcinoma 5 2
HGD 9 4
Squamous cell carcinoma
42 43
Small Cell 1
Not known 11
NET 1 2
Treatment ModalityTumour Type Curative / Radical Treatment 2010 2011 Non Curative
2010 2011Oesophagus Surgery
NeoadjuvantChemo/rad2nd opinionEMR
15222601
1028131
BSCStentBrachytherapyAPCPall chemoPall Radio
422012219
5212613
Total 144
64 52 83 92
Stomach SurgeryNeoadjuvantEMR
23181
2191
BSCPall chemoPall RadioSurgery(bypass)Brachytherapy2nd opinion
62315311
481331
Total 93
42 31 103 62
GOJ SurgeryNeoadjuvantEMRChemo/rad
2211
3APCBSCPall chemoPall Radio
0491
231
Total 9
6 3 13 6
Small Bowel SurgeryPall chemoBSCHPB
0490
2
Total 2
13 2
GIST SurgeryEMR
31
4 W&WGlivecRTBSC
1301
231
Total 10
4 4 5 6
OG Resection Audit
• Elective / emergency OG resection JCUH
• 01/01/10 – 01/01/11
• 2010 – 81 patients• 2011 – 104 patients
• Median age 65 (31-82), M:F 80:24
Procedures
• 104 cases
• 3 cases benign– TG for AUGIB– 2x STG
• peptic ulcer disease• LAGB complication
• 6 EMR
ProceduresProcedure SMD PAD YKSV
Open oesophagectomyMinimally invasive oesophagectomyOesophagectomy with colonic interpositionOesophagectomy and lung resectionOesophageal EMRInoperable oesophagectomy Gastric EMROpen total gastrectomyLaparoscopic total gastrectomyOpen subtotal gastrectomyLaparoscopic subtotal gastrectomyLaparoscopic gastric wedge excisionLaparoscopic assisted gastrectomyLaparoscopic gastric bypassOpen gastric bypass
Total
9810114241133020
49
1400102050400000
28
8100001100101311
27
Outcome• Median post-operative stay 12 days (1-90)
• Level 3 critical care 7/95 (7.3%)• Anastomotic leak 3/95 (3.2%)• Re-operation 1/95 (1%)
• 30-day mortality 1/95 (1%)– PE day 2 after oesophagectomy for T2N1MO ACA oesophagus
• 90-day mortality 3/95 (3.2%)– MI day 42 after total gastrectomy T1N0MO ACA stomach– Pneumonia / MOF day 49 after inoperable T4 ACA oesophagus
Summary
• 95 OG cancer surgical resections• 6 EMR
• Inoperability– 4.2% (4/95) 2011– 14% (11/78) 2010
• 30-day mortality 1%