Page last updated at 23:05 GMT, Monday, 13 October 2008 00:05 UK

Too few surgeons for cancer ops

By Michelle Roberts
Health reporter, BBC News

surgeon
Radical surgery is often necessary

One in 10 hospital trusts in England and Wales does not have enough specialist surgeons doing operations for gullet cancer, figures show.

The Department of Health says trusts need a minimum of three surgeons to provide round-the-clock care for patients with this common cancer.

The target was meant to be met by all trusts by December 2007.

Experts said the shortfall meant some patients might potentially be put at unnecessary risk.

Three specialist surgeons is the absolute bare requirement. Otherwise you are getting by on a wing and a prayer
Richard Hardwick
Report co-author

Each year in England and Wales about 13,500 people are diagnosed with either oesophageal or gastric (stomach) cancer, making it the fifth most common type of cancer.

It is also one of the more difficult to treat, requiring radical surgery, which is why skilled specialist surgeons are needed.

Oesophago-gastric cancer care in England and Wales is undergoing a substantial transformation because of this, with a focus on centralised, specialist services.

Richard Hardwick, consultant surgeon and lead clinician for upper gastrointestinal cancer for the Association of Upper GI Surgeons (AUGIS), said: "If you are going to provide a comprehensive service it is almost impossible to do with two surgeons.

"Three specialist surgeons is the absolute bare requirement. Otherwise you are getting by on a wing and a prayer.

"Patients undergoing this type of surgery are complicated and it is vital that they are constantly monitored by a specialist."

Slow progress

He said there was no evidence available yet to show that increasing the number of expert surgeons would improve outcomes for patients.

However, data shows that hospitals and surgeons that do more of these operations routinely have lower mortality rates.

The situation has improved recently.

A snapshot of the standard of care given to gullet cancer patients in England and Wales in September 2007, part of a national audit, found 39 out of 63 trusts performing these operations had fewer than three surgeons.

More than half of these were specialist cancer centres dedicated to this type of work.

We are confident that with further effort to concentrate expertise we can make progress faster in the future
Professor Peter Johnson
Cancer Research UK

By the target deadline three months later, the number of non-conforming trusts fell to eight.

But in the last nine months, only one more trust has succeeded in meeting the target.

A spokesman for the Department of Health said: "We are working with trusts to help them comply."

Professor Peter Johnson, Cancer Research UK's chief clinician, said: "The national audit report findings highlight the importance of developing specialist treatment centres, with all the necessary support services.

"We know that results are better in those centres which have been able to do this, and good progress has been made in many places in the UK.

"Oesophago-gastric cancer is often diagnosed late, and until recently the results of treatment have not been good, although trials using chemotherapy are showing promise.

"We are confident that with further effort to concentrate expertise we can make progress faster in the future."

The National Audit, which began in October 2006, is a three-year study and a joint collaboration between the Royal College of Surgeons, AUGIS, the British Society of Gastroenterology and the NHS Information Centre for health and social care.




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