Transcript Document

NSSG OG AUDIT DAY 2013
South Tees Hospitals Foundation Trust
Sam Dresner, Consultant Surgeon
Helen Wescott, OG Cancer CNS
MDT Workload
• New patients discussed Jan – Dec 2012
575
• New patients discussed Jan - Dec 2011
-
474
Upper GI New Patients
OG
2011
2012
Oesophagus
144
177
OG
9
14
Stomach
93
84
GIST
10
13
Total
256
287
HPB New Cases
HPB
2011
2012
Pancreas
62
85
Bile duct
32
34
Liver
14
22
Small bowel
2
7
Ampulla
1
4
Total
111
152
New cases - other
Other
2011
2012
Unknown
22
13
Not UGI Cancer
24
38
Not Cancer
52
84
Total
98
135
Number of MDT discussions
Patients By Referral Unit
Histological Subtype
(oesophagus, juctional, stomach)
Oesophagus Cell
Type
Adenocarcinoma
2011
2012
181
199
Carcinoma
2
12
HGD
4
8
Squamous cell
carcinoma
43
38
Small Cell
1
1
Not known
11
10
NET
2
7
Treatment Modality
Tumour Type
Oesophagus
Total
2012
177
Stomach
Total
83
Surgery
Neoadjuvant
EMR
2nd opinion
Other
2012
GOJ
Neoadjuvant
Chemo/rad
Total
2012
14
Small Bowel
Total
7
GIST
Curative / Radical
Treatment
Surgery
Neoadjuvant
Chemo/rad
Radical Rad
2nd opinion
EMR
RFA
Non Curative
2011
10
28
13
1
2012
6
40
17
2
5
3
1
52
74
21
9
1
16
15
2
1
2
1
32
36
3
4
1
3
5
Surgery
HPB
2
1
2012
BSC
Stent
Brachytherapy
APC
Pall chemo
Pall Radio
BSC
Pall chemo
Pall Radio
Surgery(bypass)
BSC
Pall chemo
Pall Radio
Pall chemo
BSC
3
Surgery
EMR
4
8
W&W
Glivec
RT
BSC
2011
52
1
26
13
2012
48
2
2
1
35
15
92
103
48
13
3
1
33
9
4
1
62
47
2
3
1
4
5
6
9
2
4
2
4
2
3
1
3
2
1
OG Resection Audit
• Elective / emergency OG database JCUH
• 2011
• 2012
• M:F 65:31
- 104 patients
- 96 patients
Procedures
• 96 patients
• EMR n=5
• Palliative bypass local hospital
– metastatic gastric cancer (DMH) n=1
– metastatic pancreatic cancer (FHN) n=1
• Emergency (perforation/obstruction)
– palliative resection n=1
• Small bowel resections n=2
• 86 elective OG cancer resections
– 95 OG cancer resections 2011
Procedures
Procedure
SMD
PAD
YKSV
Open subtotal gastrectomy
Laparoscopic subtotal gastrectomy
Laparoscopic assisted subtotal gastrectomy
Open total gastrectomy
Open total gastrectomy + splenectomy
Extended total gastrectomy
Laparoscopic / VATS oesophagectomy
Laparoscopic / VATS oesophagectomy + lung resection
Open oesophagectomy
Open oesophagectomy and splenectomy
Open oesophagectomy + colonic resection
Inoperable
2
9
0
4
1
2
2
0
7
0
2
0
5
0
0
6
0
0
0
0
16
0
0
4
3
0
5
4
0
0
6
1
1
1
1
4
Total
29
31
26
Outcomes
• Inoperability (8/86)
• Re-operation (3/86)
9.3%
3.5%
– Bleeding n=2, Perforation n=1
•
•
•
•
Leak rate (Oesophagectomy 3/37)
30-day mortality
90-day mortality
In-hospital mortality
• LOS (1-74)
Median
8.1%
0%
0%
0%
11 days