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MDT I AARHUS

MDT I AARHUS

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MDT I AARHUS

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  1. MDT I AARHUS Søren Laurberg Professor of Surgery Aarhus University Hospital Denmark

  2. MDT I AARHUS • Evolving process • Background • MR rectum • Selective 5x5

  3. MDT I AARHUS • DECISION MDT • Rectal, recurrent,anal, sarcoma,hipec, rare tumours • Colonic cancer • FOLLOW-UP MDT • INTERNATIONAL MDT

  4. PRIMARY RECTAL CANCER-SIMPEL • CT/MR request, information letter • Letter: date of visit ,pt questionnaire • 1. visit • Diagnose ,proctoscopy and notes, anaesthesiologist • CT- MR • MDT conference ( 2x week) • 2. visit • Treatment plan • Check lists

  5. ENDOSKOPI Horsenssurgery Åthus • CT og MR oplysninger, endoskopi og ASA faxes og tlff • Pt oplyses skriftligt om plan i Århus – udfylder selvdeklaration • Biopsi svar kirurg anæstesi • Ct-MR-1-2 dage • MDT og svar

  6. MDT DECISION CONFERENCE • ↑ treatment of patients • ↑ quality of investigations • Better inter and intra disciplinary collaboration • Better decision • ↑teaching

  7. MDT DECISION CONFERENCE 2 x week 10- 15 cases app. 60 min • Primary RC /Anal cancer • Treatment plan • Re-evaluation neo-adjuvant therapy • Stick to the strategy? • Recurrent and advanced cancers • See them? , strategy? Progression? • Sarcoma, pseudomyxoma rare tumours • See them?, strategy?

  8. 1 IDENTIFICATION OF CASE

  9. 2 PRESENTATION OF CASE • COLORECTAL FELLOW • STANDARDISED PROFORMA

  10. 3 PRESENTATION OF CT

  11. PRESENTATION OF CT • CT FIRST- curative, complex or palliative? • ONLY CLEAR DECISIONS: • No suspicion • Metastasis • Suspicion • Further investigations • Control in 3 months • Evaluation by other

  12. 4 PRESENTATION OF MR

  13. PRESENTATION OF MR • Follows a proforma • Clear decisions

  14. 5 DISCUSSION • Palliative- curative • Neoadjuvant (standard/short course+delayed) • Direct surgery (PME, TME,APE,Evtended) • Minor treatment (contact,TEM) • VRAM, brachy, TPE,sacral resection • Complex: involving hepar, lung

  15. 6 SUMMARY, CONCLUSION, ACTION • LOUD AND CLEAR • Decision clear to all • Mistakes are recognized • Action • Who is going to see the patient? • Who will contact other departments directly? • Time for first visit in oncology decided?

  16. 7. INFORMATION • MDT FRIDAY 8-9 • CLINIC AFTER 10 • DECISION DIRECTLY TO REFERRAL • TELEPHONE PTS • MDT TUESDAY 14-15 • NEXT DAY • DECISION DIRECTLY TO REFERRAL • TELEPHONE PTS

  17. CHECK LIST • AIM • IT IS EASY, FAST AND UNIFORM • WE DO NOT FORGET THINGS • WE DOCUMENT THAT PTS ARE INFORMED

  18. NURSE-RANDOMIZEDTRIAL • Contact nurse • Case manager

  19. 2.COLON CANCER • SURGEONS –RADIOLOGIST-DAILY • Direct surgery-lap? • MDT? CRC?-LIVER?

  20. QUALITY CONTROL • 1 hour every second week • Study max 10 cases-rectum and colon • AIM: • Quality of MR • Quality of surgery • Grading CME,PME,TME,APE • Extend of resection • Cebtral ligation?

  21. INTERNATIONAL MDT • INTERNATIONAL DATABASE • Advanced recurrent cancer • Trials • Observational studies