OGC P40 The RM Partners Cancer Hub approach to Upper Gastrointestinal Surgery during the COVID-19 pandemic. (7th December 2022) - Doyle, Joseph
Abstract: Background: The COVID-19 pandemic led to significant cancellations of major surgery to maximise critical care capacity. Our unit instituted the 'RM Partners Cancer Hub' based at the Royal Marsden Hospital in London, which allowed cancer surgery from multiple NHS Trusts to continue in a 'COVID-lite' setting. We present the outcomes for Upper GastroIntestinal (UGI) surgery managed via this approach over the course of the pandemic. Methods: From April 2020 to April 2021, the Royal Marsden Hospital formed the 'RM Partners Cancer Hub'. This was designed to co-ordinate resources and deliver as much oncological treatment and cancer surgery as feasible for patients across the RM Partners West London Cancer Alliance. An UGI clinical case prioritisation strategy, along with strict infection control pathways and pre-operative screening protocols were adopted. Results: Overall, 231 patients underwent surgery for confirmed UGI cancer via the RM Partners Cancer Hub, with 213 completed resections and combined 90-day mortality rate of 3.5%. Good short-term survival outcomes were demonstrated with 2-year Disease Free Survival (DFS) and Overall Survival (OS) for oesophageal (DFS 70.8%; OS 72.9%), gastric (DFS 66.7%; OS 83.3%) and pancreatic cancer resections (DFS 68.0%, OS 88.0%). One patient developed peri-operative COVID-19 during the RM Partners Cancer Hub operation; they made a full recovery with no lasting clinical sequelae. Conclusions: The 'RM Partners Cancer Hub' approach provided a workable model for delivering multidisciplinary UGI cancer care and surgery with favourable 2-year DFS and OS when compared to nationally published pre- and post-pandemic data. It also established a template for cancer service during periods of marked disruption to healthcare service delivery and should be a useful guide in the future planning of safe operating pathways.