Safe skills transfer and mentorship: The all-Wales colorectal peritoneal metastasis service-A collaborative strategy to develop a new national service.

AIM

Until recently, there was no access to cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for Welsh patients with resectable colorectal peritoneal metastases. A pilot programme, funded by Moondance Cancer Initiative, aimed to improve colorectal peritoneal metastases management and offer CRS and HIPEC to selected patients. Service development strategies and short-term outcomes are presented.

METHOD

The service was developed in three phases: preparation, mentorship and independence. Multidisciplinary team meetings, surgery and team development were performed in conjunction with the Peritoneal Malignancy Institute Basingstoke during the first two phases. After this period of supervision and mentorship, the Welsh team continued independently.

RESULTS

Over 34 monthly meetings, there were 228 multidisciplinary team discussions of 174 patients. Overall, 36/174 patients (20.7%) were selected for CRS and HIPEC and, to date, 31 have had surgery. Median age was 63 years and 54.8% were men. Median intraoperative peritoneal carcinoma index was 7. Complete cytoreduction was achieved in 27 patients (87.1%) and median length of stay was 10 days. Complications occurred in 25.8% with four Clavien-Dindo classification II, four Clavien-Dindo classification IV and no 30-day postoperative deaths. Operative duration, blood loss and length of stay were significantly shorter during the independence phase.

CONCLUSION

This project has demonstrated a successful and safe introduction of the All-Wales Colorectal Peritoneal Metastasis Service through an innovative approach of non National Health Service funding and expert mentorship. The excellent results support the aim to secure sustainable funding to permanently commission this beneficial service for Welsh patients.