1
|
Doyle JP, Patel PH, Doran SLF, Jiao LR, Cunningham D, Nicol D, Mavroeidis VK, Allum WH, Chaudry AM, Bhogal RH, Kumar S. ASO Visual Abstract: The Cancer Hub Approach for Upper Gastrointestinal Surgery During COVID-19 Pandemic: Outcomes from a UK Cancer Centre. Ann Surg Oncol 2023; 30:2276-2277. [PMID: 36609639 PMCID: PMC9821338 DOI: 10.1245/s10434-022-12657-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Joseph P Doyle
- Department of Surgery, The Royal Marsden Hospital, London, UK
- Upper GI Surgical Oncology Research Group, The Institute for Cancer Research, London, UK
| | - Pranav H Patel
- Department of Surgery, The Royal Marsden Hospital, London, UK
- Upper GI Surgical Oncology Research Group, The Institute for Cancer Research, London, UK
| | | | - Long R Jiao
- Department of Surgery, The Royal Marsden Hospital, London, UK
- GI Unit, The Royal Marsden Hospital, London, UK
| | | | - David Nicol
- Department of Surgery, The Royal Marsden Hospital, London, UK
| | - Vasileios K Mavroeidis
- Department of Surgery, The Royal Marsden Hospital, London, UK
- GI Unit, The Royal Marsden Hospital, London, UK
| | - William H Allum
- Department of Surgery, The Royal Marsden Hospital, London, UK
- GI Unit, The Royal Marsden Hospital, London, UK
| | - Asif M Chaudry
- Department of Surgery, The Royal Marsden Hospital, London, UK
- GI Unit, The Royal Marsden Hospital, London, UK
| | - Ricky H Bhogal
- Department of Surgery, The Royal Marsden Hospital, London, UK
- GI Unit, The Royal Marsden Hospital, London, UK
- Upper GI Surgical Oncology Research Group, The Institute for Cancer Research, London, UK
| | - Sacheen Kumar
- Department of Surgery, The Royal Marsden Hospital, London, UK.
- GI Unit, The Royal Marsden Hospital, London, UK.
- Upper GI Surgical Oncology Research Group, The Institute for Cancer Research, London, UK.
- Digestive Disease & Surgery Institute, Cleveland Clinic London Hospital, London, UK.
| |
Collapse
|
2
|
Doyle JP, Patel PH, Doran SLF, Jiao LR, Cunningham D, Nicol D, Mavroeidis VK, Allum WH, Chaudry AM, Bhogal RH, Kumar S. The Cancer Hub Approach for Upper Gastrointestinal Surgery During COVID-19 Pandemic: Outcomes from a UK Cancer Centre. Ann Surg Oncol 2023; 30:2266-2275. [PMID: 36609639 PMCID: PMC9579643 DOI: 10.1245/s10434-022-12571-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/28/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic caused unprecedented disruption to global healthcare delivery. In England, the majority of elective surgery was postponed or cancelled to increase intensive care capacity. Our unit instituted the 'RM Partners Cancer Hub' at the Royal Marsden Hospital in London, to deliver ongoing cancer surgery in a 'COVID-lite' setting. This article describes the operational set-up and outcomes for upper gastrointestinal (UGI) cancer resections performed during this period. METHODS From April 2020 to April 2021, the Royal Marsden Hospital formed the RM Partners Cancer Hub. This approach was designed to coordinate resources and provide as much oncological treatment as feasible for patients across the RM Partners West London Cancer Alliance. A UGI surgical case prioritisation strategy, along with strict infection control pathways and pre-operative screening protocols, was adopted. RESULTS A total of 231 patients underwent surgery for confirmed or suspected UGI cancer during the RM Partners Cancer Hub, with 213 completed resections and combined 90-day mortality rate of 3.5%. Good short-term survival outcomes were demonstrated with 2-year disease free survival (DFS) and overall survival (OS) for oesophageal (70.8% and 72.9%), gastric (66.7% and 83.3%) and pancreatic cancer resections (68.0% and 88.0%). One patient who developed perioperative COVID-19 during the RM Partners Cancer Hub operation made a full recovery with no lasting clinical sequelae. CONCLUSION Our experience demonstrates that the RM Partners Cancer Hub approach is a safe strategy for continuing upper gastrointestinal (GI) resectional surgery during future periods of healthcare service disruption.
Collapse
Affiliation(s)
- Joseph P Doyle
- Department of Surgery, The Royal Marsden Hospital, London, UK
- Upper GI Surgical Oncology Research Group, The Institute for Cancer Research, London, UK
| | - Pranav H Patel
- Department of Surgery, The Royal Marsden Hospital, London, UK
- Upper GI Surgical Oncology Research Group, The Institute for Cancer Research, London, UK
| | | | - Long R Jiao
- Department of Surgery, The Royal Marsden Hospital, London, UK
- GI Unit, The Royal Marsden Hospital, London, UK
| | | | - David Nicol
- Department of Surgery, The Royal Marsden Hospital, London, UK
| | - Vasileios K Mavroeidis
- Department of Surgery, The Royal Marsden Hospital, London, UK
- GI Unit, The Royal Marsden Hospital, London, UK
| | - William H Allum
- Department of Surgery, The Royal Marsden Hospital, London, UK
- GI Unit, The Royal Marsden Hospital, London, UK
| | - Asif M Chaudry
- Department of Surgery, The Royal Marsden Hospital, London, UK
- GI Unit, The Royal Marsden Hospital, London, UK
| | - Ricky H Bhogal
- Department of Surgery, The Royal Marsden Hospital, London, UK
- GI Unit, The Royal Marsden Hospital, London, UK
- Upper GI Surgical Oncology Research Group, The Institute for Cancer Research, London, UK
| | - Sacheen Kumar
- Department of Surgery, The Royal Marsden Hospital, London, UK.
- GI Unit, The Royal Marsden Hospital, London, UK.
- Upper GI Surgical Oncology Research Group, The Institute for Cancer Research, London, UK.
- Digestive Disease & Surgery Institute, Cleveland Clinic London Hospital, London, UK.
| |
Collapse
|
3
|
Whibley J, Peters CJ, Halliday LJ, Chaudry AM, Allum WH. Poor performance in incremental shuttle walk and cardiopulmonary exercise testing predicts poor overall survival for patients undergoing esophago-gastric resection. Eur J Surg Oncol 2018; 44:594-599. [PMID: 29459017 DOI: 10.1016/j.ejso.2018.01.242] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 11/27/2017] [Accepted: 01/30/2018] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Esophageal and gastric cancer have a poor prognosis and surgical intervention is associated with considerable morbidity, highlighting the need for careful preoperative assessment. The Incremental Shuttle Walk Test (ISWT) and Cardiopulmonary exercise testing (CPET) can assess preoperative fitness. This study aims to investigate their correlation with both postoperative respiratory complications and overall survival. PATIENTS AND METHODS Patients were identified who underwent esophageal or gastric resections for cancer between 2010 and 2014 and had ISWT and/or CPET assessments. Tumor differentiation, stage, postoperative respiratory complications, and outcome were documented and then correlated with the results of the preoperative fitness assessments. RESULTS Neither the ISWT result, anaerobic threshold (AT) nor VO2 Max correlated well with perioperative complications. However, ISWT (p < 0.001), AT (p < 0.001) and VO2 Max (p < 0.001) all correlated strongly with overall survival. No patient with a score of less than 350 m on ISWT survived beyond 3 years. In a subset of patients with ISWT results both pre and post chemotherapy (n = 49), those that had an improvement in result had a 19% incidence of post-operative respiratory complications compared to 45% where the result did not change or declined, though due to small numbers this only approached significance (p = 0.08). CONCLUSION ISWT and CPET can be useful preoperative tools to predict overall survival for patients undergoing esophago-gastric resection. Furthermore, patients that improve their functional status during chemotherapy seem to do better than those where it remains static or declines.
Collapse
Affiliation(s)
- Jessica Whibley
- Department of Physiotherapy, The Royal Marsden Hospital, Fulham Rd, London, SW3 6JJ, UK.
| | - Christopher J Peters
- Department of Surgery & Cancer, Imperial College London, St Mary's Hospital, Praed Street, London, W2 1NY, UK.
| | - Laura J Halliday
- Department of Surgery & Cancer, Imperial College London, St Mary's Hospital, Praed Street, London, W2 1NY, UK.
| | - Asif M Chaudry
- Academic Department of Surgery, The Royal Marsden Hospital, Fulham Rd, London, SW3 6JJ, UK.
| | - William H Allum
- Academic Department of Surgery, The Royal Marsden Hospital, Fulham Rd, London, SW3 6JJ, UK.
| |
Collapse
|
4
|
Whibley J, Peters CJ, Allum WH, Chaudry AM. 14. Poor performance in Incremental shuttle walk and cardiopulmonary exercise testing predicts poor overall survival for patients undergoing oesophago-gastric resection. Eur J Surg Oncol 2015. [DOI: 10.1016/j.ejso.2015.08.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|