Setting-up a PSM Service in Pakistan - Our Experience

Setting-up a PSM Service in Pakistan - Our Experience Raza Sayyed Peritoneal Surface Malignancy Service Patel Hospital, Karachi

Peritoneal Malignancy Service @ Patel Surgical Oncology: Raza Sayyed, Samiullah Niazi

(Faraz Khan, Basingstoke)

Pathology: Asad Jafri Radiology: Mehwish Raza, Sadia Rashid Medical Oncology: Fawad Qureshi, Shakeel Amanullah, Tariq Siddiqui Anesthesia, Intensive Care, Nephrology, Nutrition, Hematology

Overview ●

Evolution of treatment for Peritoneal Surface Malignancies ○

Colorectal Peritoneal metastases as a case in point

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Need for a PSM service in Pakistan

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Patient care requirements for a PSM service

Not all cases with PSM are same ●

Heterogenous histopathologies ○

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AJCC Staging Colorectal / Ovarian / Gastric

Disease Biology Disease Extent Ability to withstand treatment Cure Vs Control of disease Quality of life

Evolution of treatment ● ● ● ● ● ●

Considered End-stage Locoregional disease New aggressive treatments (Cytoreductive surgery and HIPEC) Outcomes compared to systemic chemotherapy Inclusion of peritoneal metastases in clinical trials Surgical series

Sugarbaker PH, Jablonski KA Ann Surg. 1995 Feb; 221(2):124-32.

Colorectal Peritoneal Metastases Glehen O et al. J Clin Oncol. 2004;22(16):3284-92. Elias D et al. J Clin Oncol. 2010;28(1):63-8.

French multi-institution studies

Glehen O et al. J Clin Oncol. 2004;22(16):3284-92.

Elias D et al. J Clin Oncol. 2010;28(1):63-8.

Completeness of Cytoreduction

Glehen O et al. J Clin Oncol. 2004;22(16):3284-92. Elias D et al. J Clin Oncol. 2010;28(1):63-8.

Extent of disease

Glehen O et al. J Clin Oncol. 2004;22(16):3284-92.

Elias D et al. J Clin Oncol. 2010;28(1):63-8.

Glehen O. Cancer 2010:5609

Need for a service ● ● ● ● ● ● ● ● ●

Operative skills Building multidisciplinary team Case selection Decision making Patient treatment process of care Collaborations Staying current Teaching/training Research/Registry

Operative skills ● ● ● ●

Declared Interest European courses Clinical Attachments European School of Peritoneal Surface Oncology

Decision making ●

Multidisciplinary team ○

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Staging Information ○ ○ ○

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Cross sectional imaging Staging laparoscopy Findings on exploration

Disease biology ○ ○

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Peritoneal MDT

Detailed review of histopathology Response to therapy

Patient fitness ○ ○

ECOG Stress Echocardiography

Process of Care

Research and Audit

Summary

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Outcomes for PSM have improved with aggressive locoregional therapies PSM treatment needs to be individualized Dedicated centres for management of PSM Standardized management