mdt i aarhus søren laurberg professor of surgery aarhus university hospital denmark
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MDT I AARHUSMDT I AARHUS
Søren LaurbergSøren Laurberg
Professor of SurgeryProfessor of Surgery
Aarhus University HospitalAarhus University Hospital
DenmarkDenmark
MDT I AARHUSMDT I AARHUS
Evolving processEvolving process BackgroundBackground
MR rectumMR rectum Selective 5x5 Selective 5x5
MDT I AARHUSMDT I AARHUS
DECISION MDTDECISION MDT Rectal, recurrent,anal, sarcoma,hipec, Rectal, recurrent,anal, sarcoma,hipec,
rare tumours rare tumours Colonic cancerColonic cancer
FOLLOW-UP MDTFOLLOW-UP MDT INTERNATIONAL MDTINTERNATIONAL MDT
PRIMARY RECTAL PRIMARY RECTAL CANCER-SIMPELCANCER-SIMPEL
CT/MR request, information letter CT/MR request, information letter Letter: date of visit ,pt questionnaireLetter: date of visit ,pt questionnaire 1. visit1. visit
Diagnose ,proctoscopy and notes, Diagnose ,proctoscopy and notes, anaesthesiologistanaesthesiologist
CT- MRCT- MR MDT conference ( 2x week)MDT conference ( 2x week)
2. visit2. visit Treatment planTreatment plan Check listsCheck lists
ENDOSKOPI HorsensENDOSKOPI Horsenssurgery Åthussurgery Åthus
CT og MR oplysninger, endoskopi og CT og MR oplysninger, endoskopi og ASA faxes og tlffASA faxes og tlff
Pt oplyses skriftligt om plan i Århus Pt oplyses skriftligt om plan i Århus – udfylder selvdeklaration– udfylder selvdeklaration
Biopsi svar kirurg anæstesiBiopsi svar kirurg anæstesi Ct-MR-1-2 dageCt-MR-1-2 dage MDT og svarMDT og svar
MDT DECISION MDT DECISION CONFERENCECONFERENCE
↑ ↑ treatment of patientstreatment of patients ↑ ↑ quality of investigationsquality of investigations Better inter and intra disciplinary Better inter and intra disciplinary
collaborationcollaboration Better decisionBetter decision
↑↑teachingteaching
MDT DECISION MDT DECISION CONFERENCE 2 x week 10- CONFERENCE 2 x week 10-
15 cases app. 60 min15 cases app. 60 min Primary RC /Anal cancerPrimary RC /Anal cancer
Treatment planTreatment plan Re-evaluation neo-adjuvant therapyRe-evaluation neo-adjuvant therapy
Stick to the strategy?Stick to the strategy? Recurrent and advanced cancersRecurrent and advanced cancers
See them? , strategy? Progression? See them? , strategy? Progression? Sarcoma, pseudomyxoma rare Sarcoma, pseudomyxoma rare
tumourstumours See them?, strategy?See them?, strategy?
1 IDENTIFICATION OF 1 IDENTIFICATION OF CASECASE
2 PRESENTATION OF 2 PRESENTATION OF CASECASE
COLORECTAL COLORECTAL FELLOWFELLOW
STANDARDISED STANDARDISED PROFORMAPROFORMA
3 PRESENTATION OF CT3 PRESENTATION OF CT
PRESENTATION OF CTPRESENTATION OF CT
CT FIRST- curative, complex or CT FIRST- curative, complex or palliative?palliative?
ONLY CLEAR DECISIONS:ONLY CLEAR DECISIONS: No suspicionNo suspicion MetastasisMetastasis SuspicionSuspicion
Further investigationsFurther investigations Control in 3 monthsControl in 3 months Evaluation by otherEvaluation by other
4 PRESENTATION OF 4 PRESENTATION OF MRMR
PRESENTATION OF MRPRESENTATION OF MR
Follows a proformaFollows a proforma Clear decisionsClear decisions
5 DISCUSSION5 DISCUSSION
Palliative- curativePalliative- curative Neoadjuvant (standard/short Neoadjuvant (standard/short
course+delayed)course+delayed) Direct surgery (PME, Direct surgery (PME,
TME,APE,Evtended)TME,APE,Evtended) Minor treatment (contact,TEM)Minor treatment (contact,TEM) VRAM, brachy, TPE,sacral resectionVRAM, brachy, TPE,sacral resection Complex: involving hepar, lungComplex: involving hepar, lung
6 SUMMARY, 6 SUMMARY, CONCLUSION, ACTIONCONCLUSION, ACTION
LOUD LOUD ANDAND CLEAR CLEAR Decision clear to allDecision clear to all Mistakes are recognizedMistakes are recognized
ActionAction Who is going to see the patient?Who is going to see the patient? Who will contact other departments Who will contact other departments
directly?directly? Time for first visit in oncology decided?Time for first visit in oncology decided?
7. INFORMATION7. INFORMATION
MDT FRIDAY 8-9MDT FRIDAY 8-9 CLINIC AFTER 10CLINIC AFTER 10 DECISION DIRECTLY TO REFERRALDECISION DIRECTLY TO REFERRAL TELEPHONE PTSTELEPHONE PTS
MDT TUESDAY 14-15MDT TUESDAY 14-15 NEXT DAY NEXT DAY DECISION DIRECTLY TO REFERRALDECISION DIRECTLY TO REFERRAL TELEPHONE PTSTELEPHONE PTS
CHECK LISTCHECK LIST
AIMAIM IT IS EASY, FAST AND UNIFORMIT IS EASY, FAST AND UNIFORM WE DO NOT FORGET THINGSWE DO NOT FORGET THINGS WE DOCUMENT THAT PTS ARE WE DOCUMENT THAT PTS ARE
INFORMEDINFORMED
NURSE-RANDOMIZEDNURSE-RANDOMIZEDTRIALTRIAL
Contact nurseContact nurse Case managerCase manager
2.COLON CANCER2.COLON CANCER
SURGEONS –RADIOLOGIST-DAILYSURGEONS –RADIOLOGIST-DAILY Direct surgery-lap?Direct surgery-lap? MDT? CRC?-LIVER?MDT? CRC?-LIVER?
QUALITY CONTROLQUALITY CONTROL
1 hour every second week1 hour every second week Study max 10 cases-rectum and Study max 10 cases-rectum and
coloncolon AIM:AIM:
Quality of MRQuality of MR Quality of surgeryQuality of surgery
Grading CME,PME,TME,APEGrading CME,PME,TME,APE Extend of resectionExtend of resection Cebtral ligation?Cebtral ligation?
INTERNATIONAL MDTINTERNATIONAL MDT
INTERNATIONAL DATABASEINTERNATIONAL DATABASE Advanced recurrent cancerAdvanced recurrent cancer TrialsTrials Observational studiesObservational studies
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