1. Northern Region Colorectal Liver Metastases Study Guru Raghavendra

2. Background E J A Morris et al 2010 The rate of resection of liver metastases varied significantly across the country- 0.7- 6.8% -Patients who underwent liver resection had 5-year survival (44.2%) comparable to that of patients with stage III colorectal cancer (42.2%)

3. Aims Develop an understanding of the patterns of referral of patients with Colorectal Liver Metastases (CLM) in the Northern Region Improve the referral process Standardise treatment and reduce inequalities in resection rate Potentially reduce mortality from Colorectal Cancer (CRC)

4. Questions to be addressed How many patients have CLM in the Northern Region? Referral process? Standardise and improve? MDT decision? Imaging? Standardise? Number of synchronous CLM and metachronous CLM?

5. Retrospective data NORCCAG database Liver database at Freeman Liver unit at Leeds

6. Prospective data MDT co-ordinators and nurse specialists Clinical details, CEA, K-ras results and scans Scans to be transferred to the Freeman Hospital Oncology data-down staging Liver database at Freeman Hospital Liver unit at Leeds

7. Northern Region Population 3.1 million Trusts 9 Colorectal MDTs 11 Hospitals 17 Northern Cancer Network

8. NHS Trust in the region 1. City Hospitals Sunderland NHS Foundation Trust 2. County Durham and Darlington NHS Foundation Trust 3. Gateshead Health NHS Foundation Trust 4. Newcastle upon Tyne Hospitals NHS Foundation Trust 5. North Tees and Hartlepool NHS Foundation Trust 6. Northumbria Healthcare NHS Foundation Trust 7. South Tees Hospitals NHS Trust 8. South Tyneside NHS Foundation Trust 9. North Cumbria University Hospital NHS Trust

9. Number of Patients New cases of CRC in the Northern Region is approximately 1,600 per annum Synchronous CLM in 25% (400 patients) Metachronous CLM in 30% (240 patients) Annual incidence of CLM:approximately 640 10% may benefit from primary resection and a further 5% after down staging

10. Team Mr Guru Raghavendra Mr Seamus Kelly (Supervisor) Professor Derek Manas Miss Sarah Mills Additional Mr Bryon Jaques supervisors Mr David Borowski