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

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

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

4. 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

5. CT films:

6. Pre – Chemo (Neoadjuvant )

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

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

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

13. Abdominal X-Ray:

14. CT with contrast:

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

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

17. CT with contrast:

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

19. CXR : on admission, 1/12 post Rx.

20. 9/12 post admission & 11/12

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

23. child

24. CT films

25. Retroperitoneal tumour 2008

26. Retroperitoneal Teratoma

27. Condition
Number over a period of years ( )
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

28. Wilms 2015

29. Hepatoblastoma 2015

30. Post resection

31. A.L -Non Hodgkins

32. Burkitt’s Lymphoma –June 2016

33. Bleeding ruptured ovaries

34. Mesenteric component

35. En bloc resection

36. Ovarian tumour –Nov2016

37. Thoracic tumour 2016

38. 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

39. 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

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

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

42. Pacific Paediatric Oncology Society 2007