AB139. SOH25_AB_187. Right care, right place, right time: colonic cancer surgery in a model III hospital

Background: The ethos of Sláintecare is “right care, right place, right time”. Geographical centralisation of colonic cancer surgery (CCS) is incompatible with this concept, forcing patients to wait and travel for care that could be provided locally (right place) with quicker access (right time). This study reports surgical and oncological outcomes (right care) following CCS in a model III hospital by a co-located, specialist, colorectal surgeon.

Methods: Demographic, perioperative and mid-term oncological outcomes for 50 successive patients undergoing CCS in a model III hospital were collected. Outcomes were compared to colorectal cancer key performance indicators (KPIs) and textbook outcomes.

Results: Forty-one elective and nine emergency resections were identified. Median follow-up was 49 months. There were 31 right hemicolectomies, 19 left-sided resections, and one subtotal colectomy. The majority (64%) were completed laparoscopically. Overall anastomotic leak rate was 4.3% (KPI <5%). Major morbidity (Clavien Dindo ≥ III) was 14%. There was no 30-day mortality (KPI <3%) or readmission. Reoperation rate was 8% (KPI >95%) and >12 lymph nodes (KPI >95%), and median lymph node yield was 20. Textbook outcome was achieved in 54% (international norm =54%). Overall survival was 96% and 78%, and disease-free survival was 86% and 77% at 1 and 3 years respectively. All patients were discussed at model IV multidisciplinary team (MDT).

Conclusions: CCS delivered in model III hospitals by trained subspecialists is safe and comparable to international standards. It can deliver high-quality oncological surgery close to home and in a timely manner.

Keywords: Centralisation; colonic cancer; colorectal cancer; sub-specialisation; surgical oncology