Oral Presentation

Establishment of a Complex Pelvic MDT

Corina Lavelle (GB)

[Lavelle] Royal Liverpool University Hospital

Liverpool Women's Hospital is the Gynaecology Cancer Centre for the Mersey and Cheshire region. As a stand alone Obstetrics and Gynaecology hospital it has several significant advantages over those services provided by a General Hospital, including Gynaecology Oncology specialist nurses, protection of elective services, and a lack of disruption from emergency and winter concerns. Despite this, a lack of on-site surgical colleagues, specifically those within the Colorectal and Urology specialities, has become a developing concern with respect to the management of complex gynaecology oncology cases. A Complex Pelvic MDT has therefore recently been established in the region. Prior to its establishment, Gynaecologists had often undertaken cases on their own, involving Colorectal Surgeons and Urologists if and when needed on an ad-hoc basis. The aim of this MDT is to improve the surgical dialogue for primary or recurrent pelvic cancers requiring a multidisciplinary surgical approach. Meetings occur once weekly and involve input from consultant gynaecology, urology and colorectal surgeons; radiologists, and colorectal, gynaecology and urology nurse specialists. Between September 2016 and February 2017, 33 patients have been discussed at this meeting. 17 of these patients have had suspected gynaecological primaries on presentation. These patients included 8 with ovarian cancer, 3 patients with endometrial cancer, 2 patients with cervical cancer, and a further 4 patients with benign gynaecological disease. Surgery went ahead in 10 of these patients, with joint procedures between gynaecologists, colorectal surgeons and urologists in 8 cases (80%). Debulking surgery was performed in 5 patients with ovarian cancer, with ententerative surgery performed in 2 of these patients. Less than 2cm of residual disease was achieved in 4 out of 5 of these patients. The development of this service in conjunction with Colorectal, Urological and Radiological colleagues has allowed greater preoperative planning of complex surgical cases, both for the surgical approach but also for pre-operative patient counselling and post operative patient care. For a stand-alone Cancer Centre, this has been invaluable in improving patient care and developing improvements in the Gynae Oncology service.