News from the Regions

December 2017

Scotland: A HepatoPancreatoBiliary Cancers education event will be held at Perth Royal Infirmary on Friday, 15 December. The programme includes Streamlining MDTs – IHDP and the HPB MCN, Neuroendocrine Tumours and HPB 2016 Audit Analysis.

The Scottish Cancer Networks Collaborative Oesophago-gastric Cancer Event was held on 27 October 2017 in Forth Valley Royal Hospital organised by the West of Scotland Cancer Network. Information Services Division (ISD) carried out survival analysis on UGI cancer data collected across Scotland for 2016.  The preliminary results of this analysis were presented and appeared to show survival differences across the three regions.  It was agreed that further indepth analysis should be carried out and a meeting has been arranged in January to define the scope of the further analysis required.  It was agreed that attendees should comprise of UGI Clinical Leads, Network Managers, Information Managers from the 3 Regional Cancer Networks and representatives from ISD.

South Thames: The South-East Thames region continues to be busy with mergers of Trusts and efforts to improve on hospital performance against government measures and targets. Currently, the tertiary HPB service is provided by King’s College Hospital and the Oesophagogastric Cancer Service by Guys and St Thomas’ Hospitals. Both trusts cover Kent as well as South-East London, making them some of the busiest units nationally. Kings College Hospital also provides the regional bariatric service together with Lewisham Hospital.

The dissolution of the London Cancer Alliance has led to the development of regional Accountable Clinical Networks (ACNs). The OG ACN has been in existance for over 6 months and is working on methods to improve the 62 day treatment pathways. This is a constant challenge and is putting pressure on the endoscopy services to provide 2 week wait assessments. The HPB ACN is due to start in the New Year.

On the OG side, the region held the autumn annual ‘Houses of Parliament’ meeting with both regional and international speakers. It was a great success with an update on the CROSS results. In November, King’s College Hospital held the 7th Endosurgery Masterclass which welcomed a record attendance. The OG symposium at the Royal College of Surgeons is due in March 2018.

East Anglia Report: Within the East of England significant progress has been made in organising the first regional AUGIS meeting between Addenbrooke’s hospital in Cambridge and the Norfolk and Norwich University Hospital. This joint meeting will be held in mid-January at Newmarket and is kindly sponsored by Medtronic. Both units are ever busy with OG cancer referrals and currently offer Fellowship training with a new collaboration in 2018 between Norwich and the Australian New Zealand Gastro-oesophageal Association (ANZGOSA). Both sites have worked closely together as pilot centres in the forthcoming RCS ‘Improving Surgical Training’ (IST) programme in 2018. Other meetings in the horizon include the 7th Cambridge Upper GI symposium at Addenbrookes as well as the Annual meeting of the British Oesophageal Group in Norwich.

Northern Ireland Report: The highly successful 20th Annual AUGIS Scientific meeting was attended by a healthy representation of upper gastrointestinal surgeons from the north of Ireland with a good turn-out of consultants, trainees and nurses/AHP’s. Over the course of the autumn we were delighted to report that two new appointees have recently joined the regional HPB service in the Mater Hospital and two are about to take up posts in the oesophago-gastric service in the Belfast City Hospital. These appointments are most encouraging as these expansions had been recommended by respective peer review processes in the previous two years. Both regional services continue to develop. Formal funding has just about been secured to resource a regional OG cancer surgical service. The HPB surgical cancer service continues to seek formal regional funding. On both the oesophago-gastric and the HPB sides we now have more or less regional CNS coverage which is proving most useful in assisting patients along their respective staging pathways and improving communication between regional and local teams during staging, treatment and follow-up. Our regional upper GI cancer network is currently focusing on refinement of staging pathways, exploration of appropriate protocolisation of MDM referrals and follow-up pathway following definitive treatment taking into consideration the oesophago-gastric cancer NICE guidelines currently under consultation.

A little money from Westminster has arrived to address waiting lists, however, the magnitude of the problem, recently highlighted by the BBC (https://www.bbc.co.uk/iplayer/episode/b09hckrm/spotlight-the-waiting-lists-crisis#), is enormous. Major reconfiguration of regional service delivery as proposed by the Bengoa report “Systems, not Structures” offers the only likelihood of a long term solution. Meanwhile a frenzied period of waiting list activity is about to commence, a very short term fix.

Oxford & Wessex Report: The Oxford & Wessex region is made up of five cancer centres (Oxford, Basingstoke, Portsmouth, Southampton and Bournemouth), and around 10 DGHs, stretching from Banbury to the Isle of Wight, and from Poole to Chichester. The Improving Outcomes Guidance was implemented reasonably swiftly in this region, and the position has been stable for over 10 years – referral patterns are ingrained, and all units are performing at nationally acceptable levels. Local Sustainability & Transformation Projects have instigated discussions about whether further centralisation might be beneficial – particularly on the South Coast; it is hoped that the clinicians in each unit will be engaged and empowered in planning for the future treatment of their patients.

Professor Underwood continues to bloom as the poster-boy for the upper GI cancer world – this year he was awarded an Advanced Clinician Scientist Fellowship by CRUK and RCSE, and during the autumn gave plenary lectures at AUGIS in Cork and ESDE in Utrecht. An administrative whirlwind with Professor Mo Abu-Hilal at its centre put together a hugely successful gathering of Laparoscopic Liver surgeons in February, leading to the publication of the Southampton Laparoscopic Liver Surgery Guidelines, and their public unveiling at AUGIS in Cork.

Following on from Krishna Moorthy’s Oesophagogastric Anastomisis symposium in London last June, Bruno Sgromo arranged a successful video symposium on Laparoscopic Gastric Mobilisation in Oxford in March; several of the Oxford & Wessex upper GI teams have embraced minimal access oesophagectomy, and are organising a MAO anastomosis video symposium in Spring 2018.

Trent: We have had a busy year with several successful local meetings. In February we hosted a regional Neuroendocrine Tumour Meeting in Nottingham and, in July, Professor Ashley Dennison and Mr Ali Arshad hosted the Midlands HPB meeting in Leicester. More recently, there has been a regional training day focusing on pancreatitis and pancreatic cancer pathways, with Mr Andrew Smith from Leeds proving a fantastic outside speaker.

As we look ahead to 2018, plans are already at an advanced stage for a local Trent AUGIS meeting in June which hopefully will involve speakers form every hospital in our region. The local database has been updated and all consultants involved with Upper Gastrointestinal surgery who are not members will receive another invitation to join us early in the New Year, as will all ANPs involved in Upper GI cancer care who are not yet members.


 

August 2017

Scotland: The AUGIS 2018 ASM will take place in Edinburgh – look our for further details soon!

There will be a Scottish Upper GI National Meeting 2017 taking place at the Learning, Education & Training Centre at the Forth Valley Royal Hospital on Friday, October 27.


February 2017

Scotland: The Scottish Cancer Networks for Oesophagogastric and Hepatopancreaticobiliary cancer held separate meetings in November. The HPB meeting at the Aberdeen Royal Infirmary included analysis of the surgical audit for 2015. It was well-attended meeting and included presentations on the management of pancreatic lesions and trial updates among other topics.

The oesophagogastric meeting at Perth Royal Infirmary was attended by all interested specialities and included a review of the Quality Performance Indicators for 2015. External opinion was provided by Professor Bill Allum from the Royal Marsden. As in previous years, issues highlighted included the lack of resource for dietetics and regional variations in curative treatments offered to oesophageal cancer patients. The issue of positive CRM in patients undergoing oesophagectomy is to be reviewed across the regions. The QPI reports for the two specialities are available on the Scottish Cancer Network website.


February 2017

North Thames: Over the last two years there has been a major re-configuration of cancer services in North, North East London and West Essex, which make up London Cancer, covering a population of 3.2 million. This included oesophagogastric cancer surgery with the merger of the surgical units at UCLH and The Royal London Hospital at UCLH in December 2015. One year on, the new centre, based on a hub and spoke model, is working well and providing excellent training. The centre is tracking outcomes but the centralisation of OG and urological cancer services in London Cancer and Manchester Cancer is also part of the RESPECT-21 (reorganising specialist cancer surgery for the 21st century: a mixed methods evaluation) study which will report in a few years.

An oesophageal anastomosis workshop was held at UCLH in June 2016, under the auspices of the UGI Collaborative. It was attended by 12 consultants and 9 trainees. In September, a symposium on recent advances in benign oesophageal disease was held at Imperial College, London. It was attended by 42 delegates. Feedback was excellent for both meetings.