HSS CPOC Service Annual Report 2021

Service Report May 2021 Colorectal and Peritoneal Oncology Centre – The Christie NHS Foundation Trust

3 Impact of Covid-19 pandemic In March 2020 a global pandemic was acknowledged and NHS England issued guidance for preparation of The NHS to prepare for the exponential rise in cases expected based on the epidemiology of the disease noted from countries in Asia and Europe. The re-allocation of workforce and estates to increase ventilator capacity had a significant consequence for the elective surgical services. At The Christie, anaesthetic services were significantly affected due to re-deployment in support of acute COVID sites. The operating capacity for the CPOC team suffered a 45% reduction in operating theatre capacity. In parallel NHSE, the Royal Colleges and professional associations issued guidance relating to surgical practice during the COVID pandemic. This led to the adoption of NHSE guidance for prioritisation for surgery defined as: - • Priority level 1a: emergency operation needed within 24 hours to save life • Priority level 1b: urgent operation needed with 72 hours • Priority level 2: elective surgery/treatment with the expectation of cure needed within four weeks to save life/stop progression, taking into account symptoms and potential complications from lack of treatment • Priority level 3: elective surgery can be delayed for 10 to 12 weeks and will have no predicted negative outcome We agreed that P1 and P2 cases would continue but also recognised that a significant number of the Highly Specialised and Specialised commissioned case load fell into the P3 group. Cases were evaluated through the MDT and listed for the surgery as dictated by their disease independent of COVID and allocated a P level. Towards the end of April 2020, Greater Manchester Cancer created a Surgical Hub service to allow time critical cancer surgery to be offered on a ‘Covid free’ site. The Christie became the designated site to treat patients requiring Level 2/3 post-operative critical care support. During this time 70 primary colorectal cancer patients were operated on by Christie colorectal consultants at The Christie who would normally be operated on by other providers. As there had also been NHSE guidance regarding cancer treatments during the pandemic, which included deferring systemic anti-cancer treatment unless considered time critical, the peritoneal MDT concluded that it would be best to suspend HIPEC but that it remained appropriate to offer CRS in individual cases of appendix and colorectal cancer. We took the decision to stop using HIPEC in all of our patients on 8/4/20, with the last case to receive HIPEC being operated on in late March. We restarted HIPEC on 18/5/20 after achieving a consensus from the other UK and some European sites. Since that date all HIPEC procedures have been performed using the “closed technique” in order to reduce the risk of aerosol generation. This has now become the new normal for our surgeons. Following this change in practice we are now undertaking a comparative audit of closed versus open HIPEC delivery to ensure patient safety. Provision of the service continued apart from a break when all major surgical, non-emergency activity was stopped for 2 weeks to allow control to be achieved of an outbreak of Covid on the surgical ward in December 2020. No patients had significant damage as a result of catching Covid

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