1. NSSG OG AUDIT DAY 2012 South Tees Hospitals Foundation Trust Sam Dresner, Consultant Surgeon Helen Wescott, OG Cancer CNS

2. MDT Workload New patients discussed Jan - Dec 2011 – 474 New patients discussed Jan – Dec 2010 – 493

3. Upper GI New Patients OG20102011 Oesophagus147144 OG199 Stomach11493 Small Bowel52 GIST10 Total285258

4. HPB New Cases HPB20102011 Pancreas5762 Bile duct2332 Liver1114 Total93118

5. New cases - other Other20102011 Unknown2322 Not UGI Cancer2124 Not Cancer6152 Total11598

6. Number of MDT discussions

7. Patients By Referral Unit

8. Histological Subtype Oesophagus Cell Type 20102011 Adenocarcinoma8581 Carcinoma52 HGD94 Squamous cell carcinoma 4243 Small Cell1 Not known11 NET12

9. Treatment Modality Tumour TypeCurative / Radical Treatment 2010 2011Non Curative 2010 2011 OesophagusSurgery Neoadjuvant Chemo/rad 2 nd opinion EMR 15 22 26 0 1 10 28 13 1 BSC Stent Brachytherapy APC Pall chemo Pall Radio 42 20 1 2 21 9 52 1 26 13 Total 144 64528392 StomachSurgery Neoadjuvant EMR 23 18 1 21 9 1 BSC Pall chemo Pall Radio Surgery(bypass) Brachytherapy 2 nd opinion 62 31 5 3 1 48 13 3 1 Total 93 423110362 GOJSurgery Neoadjuvant EMR Chemo/rad 22112211 3 APC BSC Pall chemo Pall Radio 04910491 231231 Total 9 63136 Small BowelSurgery Pall chemo BSC HPB 04900490 2 Total 2 132 GISTSurgery EMR 3131 4W&W Glivec RT BSC 13011301 231231 Total 10 4456

10. OG Resection Audit Elective / emergency OG resection JCUH 01/01/10 – 01/01/11 2010 – 81 patients 2011 – 104 patients Median age 65 (31-82), M:F 80:24

11. Procedures 104 cases 3 cases benign – TG for AUGIB – 2x STG peptic ulcer disease LAGB complication 6 EMR

12. Procedures ProcedureSMDPADYKSV Open oesophagectomy Minimally invasive oesophagectomy Oesophagectomy with colonic interposition Oesophagectomy and lung resection Oesophageal EMR Inoperable oesophagectomy Gastric EMR Open total gastrectomy Laparoscopic total gastrectomy Open subtotal gastrectomy Laparoscopic subtotal gastrectomy Laparoscopic gastric wedge excision Laparoscopic assisted gastrectomy Laparoscopic gastric bypass Open gastric bypass Total 9 8 1 0 1 4 2 4 1 13 3 0 2 0 49 14 0 1 0 2 0 5 0 4 0 28 8 10 0 1 0 1 0 1 3 1 27

13. Outcome Median post-operative stay 12 days (1-90) Level 3 critical care 7/95 (7.3%) Anastomotic leak 3/95 (3.2%) Re-operation 1/95 (1%) 30-day mortality 1/95 (1%) – PE day 2 after oesophagectomy for T2N1MO ACA oesophagus 90-day mortality 3/95 (3.2%) – MI day 42 after total gastrectomy T1N0MO ACA stomach – Pneumonia / MOF day 49 after inoperable T4 ACA oesophagus

14. Summary 95 OG cancer surgical resections 6 EMR Inoperability – 4.2% (4/95) 2011 – 14% (11/78) 2010 30-day mortality 1%