Paediatric Surgery in Fiji -Pacific Paediatric Oncology Conference 2016 Dr. Josese Turagava

Paediatric Surgical oncology Oncological Surgeons Radiologists Pathologists Nurses & oncologists Pharmacists Pediatricians Community Support groups

Layout Case studies Strategy Transformation at National level How we do it Strengths Sustainability –workforce planning Transformation at National level

J. S - 2006 3 years old Indo-Fijian male from Ba Presented to Lautoka Hospital in July for a right testicular swelling (orchidectomy – mature teratoma) and an abdominal mass Mass was from the RUQ to umbilicus level Non-tender and ballotable

CT films:

Pre – Chemo (Neoadjuvant )

Post. op Completed 6 cycles of chemo and has recovered very well

J. T - 2007 1year 5/12 old Fijian girl Mother noticed abdominal mass since 9/12 Painless Otherwise normal

Examination: Mass left side of upper abdomen to umbilical region Non-tender ballotable

Abdominal X-Ray:

CT with contrast:

Lt. nephrectomy done Child recovered well post op completed Chemotherapy once /month x 6 cycles Child is well

K. T - 2007 5 years old Vanuatu girl Right Abdominal mass x 3 years Dysuria x 1 year Haematuria x 1 year

CT with contrast:

Treatment: Neo-adjuvant chemotherapy April 2006 Radical nephrectomy June 2006 Post chemotherapy x 6 /12 Developed secondary metastasis in November & died

CXR : on admission, 1/12 post Rx.

9/12 post admission & 11/12

I. T -2007 Born:8/10/07 Abd. Swelling from birth Referred to CWMH Wednesday with distended abdomen

child

CT films

Retroperitoneal tumour 2008

Retroperitoneal Teratoma

Condition Number over a period of years (2009-2012) Expected case load Wilms’ 9 cases since 2007 1-2 cases per year Neuroblastoma 3 cases 1 case per 2-3 years Hepatoblastoma 3 cases (2 died) 1 case per 1-2 years Germ Cell tumours 2 cases (both died) 1 case per 2 years Teratomas 2 cases Osteo / Ewings sarcoma 1 case per year Brain Tumours 13 cases (8 died) 3 cases per year

Wilms 2015

Hepatoblastoma 2015

Post resection

A.L -Non Hodgkins - 2016

Burkitt’s Lymphoma –June 2016

Bleeding ruptured ovaries

Mesenteric component

En bloc resection

Ovarian tumour –Nov2016

Thoracic tumour 2016

Group of patients Local capacity Need to go overseas – beyond our local capacity Work up the patient locally and await visiting team Emergency – bleeding/ compartment syndrome

Strength! Team approach Surgery – where? Do we have the local capacity? Beyond local capacity? Local capacity building during visiting teams Visiting team – 2 times per year ( includes radiologist/ pathologist) Backup – Jitoko, Kiki, Phil, Vipul

Workforce planning Save – completing training in end of 2017 (Annette/ Colin - still not sure?)

Spin off Forerunner for oncology services in Fiji Model that adult oncology is trying to copy

Pacific Paediatric Oncology Society 2007