High risk multi-disciplinary process for major cancer surgery

Kasivisvanathan, Ramanathan; Jhanji, Shaman; Waller, J; McLeod, Andrew; Baikady, Ravishankar Rao; Wigmore, Timothy; Gruber, Peter J.

doi:10.1093/bja/aew326

Cited by 6 publications

(10 citation statements)

References 11 publications

(10 reference statements)

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“…However, owing to advancements in both the fields of surgery and perioperative medicine, many high-volume cancer surgery centres have shown comparatively low mortality and morbidity following high-risk surgery. 2,7 In our specialist cancer treatment hospital, 1578 of 1621 (97.3%) patients over a 4 year period, having elective major complex abdominal high-risk cancer surgery deemed high risk were discharged to their homes. 2 Therefore, 'outcome' measures and thus decisions to proceed with surgery that may hold more significance are those pertaining to post procedure quality of life or disability-free living.…”

Section: Patient Outcome Has a Priority For The High-risk Surgical Pamentioning

confidence: 99%

“…2,7 In our specialist cancer treatment hospital, 1578 of 1621 (97.3%) patients over a 4 year period, having elective major complex abdominal high-risk cancer surgery deemed high risk were discharged to their homes. 2 Therefore, 'outcome' measures and thus decisions to proceed with surgery that may hold more significance are those pertaining to post procedure quality of life or disability-free living. There is limited research looking into quality of life following major oncological surgery but commonly used tools to measure these areas include patient questionnaires.…”

Section: Patient Outcome Has a Priority For The High-risk Surgical Pamentioning

confidence: 99%

“…8 Future perioperative research will need to shift the focus onto patient-centred outcomes such as these; Patient and caregiver engagement will be integral to this process. 2…”

Section: Patient Outcome Has a Priority For The High-risk Surgical Pamentioning

confidence: 99%

“…The most appropriate mode of surgery must also be considered. 2 In the appropriately selected patient, robot-assisted/ laparoscopic surgery, or endovascular techniques, may be associated with reduced physiological stress and reduced morbidity and length of stay. 2 The MDT approach also enables exploration of curative vs palliative intent, bearing in mind the patient's wishes, expectations, and current quality of life.…”

Section: Preoperative Nutritionmentioning

confidence: 99%

“…2 In the appropriately selected patient, robot-assisted/ laparoscopic surgery, or endovascular techniques, may be associated with reduced physiological stress and reduced morbidity and length of stay. 2 The MDT approach also enables exploration of curative vs palliative intent, bearing in mind the patient's wishes, expectations, and current quality of life. In some instances, patients may derive more benefit from the least invasive surgical option which is more likely to achieve the best balance between symptom control and quality of life.…”

Section: Preoperative Nutritionmentioning

confidence: 99%

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The multidisciplinary team approach for high-risk and major cancer surgery

2017

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Cancer is a leading cause of morbidity and mortality worldwide, with approximately 14 million new cases and 8.2 million cancer-related deaths reported in 2012. 1 Over the next 20 years, the number of new cancer cases is expected to rise by about 70% to 22 million new cases per year by 2030. 1 Surgical tumour resection remains the cornerstone of treatment for most cancers and with the increasing incidence of solid tumour diagnoses, surgery is likely to increase. With this comes an anticipated increase in health expenditure. These cost increases are not only attributed to an ageing and co-morbid population but more to a rapid advancements in available diagnostics and treatment. A considered and consistent decision-making process for those considered for high-risk surgery, including major cancer surgery, is paramount to ensure patients have the best outcome(s) and finite healthcare resources are utlilised effectively. 2 One such is the multidisciplinary team (MDT) approach described in some high-risk surgical groups. 2 The aim of this article is to discuss the role and important concepts of the MDT approach in high-risk surgery, with a focus on major cancer surgery.

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Section: Patient Outcome Has a Priority For The High-risk Surgical Pamentioning

confidence: 99%

Section: Patient Outcome Has a Priority For The High-risk Surgical Pamentioning

confidence: 99%

“…8 Future perioperative research will need to shift the focus onto patient-centred outcomes such as these; Patient and caregiver engagement will be integral to this process. 2…”

Section: Patient Outcome Has a Priority For The High-risk Surgical Pamentioning

confidence: 99%

Section: Preoperative Nutritionmentioning

confidence: 99%

Section: Preoperative Nutritionmentioning

confidence: 99%

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The multidisciplinary team approach for high-risk and major cancer surgery

2017

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Cardiopulmonary Exercise Testing Versus Frailty, Measured by the Clinical Frailty Score, in Predicting Morbidity in Patients Undergoing Major Abdominal Cancer Surgery

2020

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Background The primary outcome of this study is to investigate the association between the cardiopulmonary exercise testing (CPET) variables: anaerobic threshold (AT), peak oxygen uptake (VO 2 peak), peak work rate (WR), ventilatory equivalence of CO 2 (VE/VCO 2 ) at the anaerobic threshold (AT) with frailty, measured by the clinical frailty scale (CFS) in patients planned to undergo major abdominal cancer surgery. The secondary outcome is to compare the CPET variables (VO 2 peak, peak WR, VE/VCO 2 at AT) with frailty measured by the CFS in predicting postoperative surgical morbidity in patients following major abdominal cancer surgery. Methods This study was a single-centre prospective cohort analysis of consecutive adult patients undergoing CPET and CFS scoring as part of their pre-operative work-up for major abdominal cancer surgery. Results A total of n = 317 patients underwent CPET and CFS assessment ahead of planned abdominal oncological surgery. Negative correlations were observed between the CPET variables: AT -0.42 p \ 0.01; VO 2 peak -0.53 p \ 0.01; peak WR -0.54 p \ 0.01 with CFS scores and a positive correlation between CFS scores and VE/VCO 2 0.29 p \ 0.01. Only CFS remained statistically significant in a multivariate model OR 2.11 (1.42-3.15) 95% CI associated with Clavien-Dindo (CD) C 1 defined morbidity including the significant univariate variables (VO 2 peak, peak WR and CFS scores). No variables were associated with CD C 3 morbidity. Conclusions In patients scheduled to have major abdominal cancer surgery there was a weak association between poor performance on CPET and increasing frailty measured by the CFS. The CFS score unlike CPET was associated with all post-operative morbidity, but not major complications alone, in these patients. This suggests that CFS may be used as a less expensive alternative to CPET for predicting any postoperative morbidity in major abdominal cancer surgery.

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Preoperative anaesthesia and other team meetings for complex cases: a narrative review

Baumann,

Benhamou

2024

Anaesthesia Critical Care & Pain Medicine

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High risk multi-disciplinary process for major cancer surgery

Cited by 6 publications

References 11 publications

The multidisciplinary team approach for high-risk and major cancer surgery

The multidisciplinary team approach for high-risk and major cancer surgery

Cardiopulmonary Exercise Testing Versus Frailty, Measured by the Clinical Frailty Score, in Predicting Morbidity in Patients Undergoing Major Abdominal Cancer Surgery

Preoperative anaesthesia and other team meetings for complex cases: a narrative review

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