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Liver Surgery For Colorectal Metastases
Mr Jeremy French HPB Surgeon Freeman Hospital
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Key Questions What Liver directed therapies do we have?
Who to refer to the HPB service? When to refer to the HPB service? How to refer to the HPB service? What we do with the referral? What are the lines of communication? What are the areas for improvement? Improvement – my suggestions and your suggestions
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Liver directed therapies
Surgery Ablation RFA Microwave IRE SIRT SIRTEX Theraspheres
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Liver directed therapies
Surgery Ablation RFA Microwave IRE SIRT SIRTEX Theraspheres
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Liver directed therapies
Surgery Ablation RFA Microwave IRE SIRT SIRTEX Theraspheres
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Liver directed therapies
Surgery Ablation RFA Microwave IRE SIRT SIRTEX Theraspheres
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Liver directed therapies
Surgery Ablation RFA Microwave IRE SIRT SIRTEX Theraspheres Theraspheres Glass microspheres microns HCC branch or partial portal vein occlusion SIRTEX 32 microns 1st picture – shows hypertrophy 2nd picture – patient being done (erci Maughan ) today – hoping for left lateral hypertrophy
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Who to refer Poor performance status Inoperable primary
Who not to refer for treatment Don’t be put off by… Poor performance status Inoperable primary Peritoneal disease Extensive para-aortic lymphadenopathy Extensive pulmonary mets Primary in situ <5 Lung metastases Liver lesions involving both lobes Perforated tumours So really its everyone! Information only referrals
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When to refer As soon as a liver metastasis is detected
Why? - HPB input into patient care Resectable? When to resect? Chemotherapy discussion Staging investigations Early patient contact HPB service integration Surgeon allocation / MDM discussion HPB service integration -
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How to refer to the HPB unit Lines of communication
Telephone – on call consulatnt Emergency/urgent cases Fax HPB office Referral proforma Clinical updates
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What we do with the referral
Referral outcome Clinic Transfer MDM Further investigations Referral Logged Entered onto database (HPB and Somerset) Allocated to a consultant Immediate action if needed Telephone for further information Plan of action determined
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Areas for improvement Referrals MDM capacity Communication
Proforma. Minimum data set? (2ww/62) Online referral? MDM capacity Liver MDM AND Pancreas MDM Communication Referral response MDM outcome General discussions
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