Liver Surgery For Colorectal Metastases Mr Jeremy French HPB Surgeon Freeman Hospital

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

Liver directed therapies Surgery Ablation RFA Microwave IRE SIRT SIRTEX Theraspheres

Liver directed therapies Surgery Ablation RFA Microwave IRE SIRT SIRTEX Theraspheres

Liver directed therapies Surgery Ablation RFA Microwave IRE SIRT SIRTEX Theraspheres

Liver directed therapies Surgery Ablation RFA Microwave IRE SIRT SIRTEX Theraspheres

Liver directed therapies Surgery Ablation RFA Microwave IRE SIRT SIRTEX Theraspheres Theraspheres Glass microspheres 20-30 microns HCC branch or partial portal vein occlusion SIRTEX 32 microns 1st picture – shows hypertrophy 2nd picture – patient being done (erci Maughan 13-5-39) today 12-9-14 – hoping for left lateral hypertrophy

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

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 -

How to refer to the HPB unit Lines of communication Telephone – on call consulatnt Emergency/urgent cases Fax 0191 2231441- HPB office Referral proforma Email Clinical updates

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

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