Colorectal and Peritoneal Oncology Annual Service Report 2021 - 2022

Service Report 2022 Colorectal and Peritoneal Oncology Centre – The Christie NHS Foundation Trust

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INTRODUCTION

The Christie Colorectal and Peritoneal Oncology Centre (CPOC) Peritoneal Tumour Service (PTS) has experienced a 44% increase in appendiceal tumour activity with annual referrals rising from 259 patients in 20/21 to 373 patients in 21/22. We have also seen a 12.6% increase in colorectal peritoneal metastases (CRPM) referrals rising from 198 patients in 20/21 to 223 patients in 21/22, making this the busiest year for referrals in our 20-year history. In 21/22 we undertook 195 PTS procedures (compared to 188 in 20/21), also our highest annual number to date. 122 procedures were performed in appendiceal and 73 in CRPM patients. Other CPOC activity not mentioned in this report includes (i) Supporting other trusts in Greater Manchester with their primary colorectal cancer workload through converting from a ‘ Covid Green ’ to a ‘ Cancer Hub ’ site offering an additional operating list a week; (ii) Anal cancer centre; (iii) Centre for advanced & recurrent pelvic tumours including exenteration and sacrectomy; (iv) Regional retroperitoneal sarcoma service; and (v) Neuroendocrine tumours. We have supported our gynaecologists in 14 cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) procedures for ovarian cancer. Our outcomes indicate a high-quality service. For all patients undergoing CRS and HIPEC in 21/22, we achieved a complete (CC0/1) cytoreduction in 74%. In the 195 patients we operated on over the past year, we had a minor complication rate of 33.30%, a major complication rate of 9.20%, with a 1% 90-day mortality rate (2 patients). This was not significantly different to our overall minor complication rate of 25.9%, major complication rate of 13.2%, and 90-day mortality of 0.59% in 1,694 cases since 2011. Our 5-year overall survival in patients with low grade appendiceal mucinous neoplasms, malignant appendiceal tumours and colorectal peritoneal metastases of 86%, 64% and 37% respectively at 72 months’ post treatment. These results compare favourably to internationally published data. As a result of the Covid 19 pandemic, we kept biosecurity measures in place in 21/22 including wearing PPE in clinical areas, weekly PCR staff testing, restricting visitors, and offering remote consultations (video and telephone) where possible. Patients undergoing major surgery were swabbed within 5 days of the procedure and again on days 3 and 7 post-operatively, with most admitted on the day of surgery. We have not needed to close our main ward on a single occasion in the past year. We continue to be a hub for training hosting 2 ACPGBI/RCS advanced colorectal malignancy fellows, 5 European Society of Peritoneal Surface Oncology fellows, 1 NIHR Academic Clinical Lecturer, 1 European Society of Medical Oncology fellow, 1 Postgraduate Institute of Medicine Sri-Lankan fellow, and 1 International Fellow in Surgical Oncology from the National Board of Examiners in India. Our peritoneal research portfolio has grown with over £5m in active grants from CRUK, MRC, and NIHR. We have been supported by The Christie charity and Pseudomyxoma Survivor charity has made a significant contribution to our patients’ and their families experience.

Mr. Omer Aziz Lead Clinician The Christie CPOC PTS June 2022

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