NSSG OG AUDIT DAY 2013NSSG OG AUDIT DAY 2013

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 2012- 575

• New patients discussed Jan - Dec 2011- 474

Upper GI New PatientsOG 2011 2012

Oesophagus 144 177

OG 9 14

Stomach 93 84

GIST 10 13

Total 256 287

HPB New CasesHPB 2011 2012

Pancreas 62 85

Bile duct 32 34

Liver 14 22

Small bowel 2 7

Ampulla 1 4

Total 111 152

New cases - otherOther 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

2011 2012

Adenocarcinoma 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 ModalityTumour Type Curative / Radical

Treatment 2011 2012 Non Curative 2011 2012

Oesophagus SurgeryNeoadjuvantChemo/radRadical Rad2nd opinionEMRRFA

102813

1

640172531

BSCStentBrachytherapyAPCPall chemoPall Radio

5212613

482213515

Total 2012 177

52 74 92 103

Stomach SurgeryNeoadjuvantEMR2nd opinionOther

2191

1

1615212

BSCPall chemoPall RadioSurgery(bypass)

481331

33941

Total 201283

32 36 62 47

GOJ NeoadjuvantChemo/rad

3 41

BSCPall chemoPall Radio

231

45

Total 2012 14

3 5 6 9

Small Bowel SurgeryHPB

2 1

Pall chemoBSC

24

Total 2012 7

3 2 4

GIST SurgeryEMR

4 8 W&WGlivecRTBSC

231

32

1

Total 14

4 8 6 6

OG Resection Audit

• Elective / emergency OG database JCUH

• 2011 - 104 patients• 2012 - 96 patients

• M:F 65:31

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

ProceduresProcedure SMD PAD YKSV

Open subtotal gastrectomyLaparoscopic subtotal gastrectomyLaparoscopic assisted subtotal gastrectomyOpen total gastrectomyOpen total gastrectomy + splenectomyExtended total gastrectomyLaparoscopic / VATS oesophagectomyLaparoscopic / VATS oesophagectomy + lung resectionOpen oesophagectomyOpen oesophagectomy and splenectomyOpen oesophagectomy + colonic resectionInoperable

Total

290412207020

29

5006000016004

31

305400611114

26

Outcomes

• Inoperability (8/86) 9.3%• Re-operation (3/86) 3.5%

– Bleeding n=2, Perforation n=1

• Leak rate (Oesophagectomy 3/37) 8.1%• 30-day mortality 0%• 90-day mortality 0%• In-hospital mortality 0%

• LOS (1-74) Median 11 days