Surgery at The Christie is Specialised, Safe, Effective, Multidisciplinary, Compliant, Innovative
The Christie provides a comprehensive range of cancer services consistent with the initial recommendations of the Calman-Hine Report on cancer centres. Services include radiotherapy, chemotherapy, palliative care, pathology, radiology, haematology and surgical care all of which are essential elements of a comprehensive cancer centre.
Our aim is to be recognised as one of the top five cancer centres globally. To achieve this we must continue to together combine all these aspects of service provision with research and education to maintain the integrated approach which is the defining feature of an internationally competitive comprehensive cancer centre.
The Christie provides specialist surgery, integrated with chemotherapy, radiotherapy and haematology services:
1. Rare conditions designated for cancer centre care e.g. Penile cancer, testicular cancer, peritoneal surface cancers, neuro-endocrine cancers, melanoma, anal cancer etc.
2. Advanced or recurrent cancers often considered inoperable at other centres e.g. Advanced ovarian, rectal, cervical or other pelvic cancers where we provide the only specialised pelvic cancer team in the north of England
3. Cancers for which there are multiple treatment options which need to be available together e.g. Surgery, external beam radiotherapy, brachytherapy and other treatments for prostate cancer
Patients with these conditions are referred from hospitals across the north of England (e.g. penile and testicular cancer) or nationally (e.g. Peritoneal surface cancers, advanced pelvic cancers etc.)
The Christie does not provide routine surgical care that is best provided at other hospitals with specialist teams (e.g. Primary colorectal cancer, breast cancer, oesophageal cancer, lung cancer, neurological cancers, head and neck cancers etc.)
The safety record of surgical care at The Christie is outstanding:
1. Post-operative complication rates are extremely low
2. Post-operative mortality rates are extremely low with only 1 death within 30 days of operation in the past three years (that death was due to disease progression not complications)
3. There have been no cases of MRSA for 3 years
The Christie has a purpose built, peer review compliant, critical care unit which is appropriate for the needs of surgical patients as well as patients undergoing intensive systemic therapies such as chemotherapy or stem cell transplants. Survival rates for patients treated in the critical care unit are good.
The operating theatre capacity available at The Christie means that unlike most hospitals cancer operations are rarely if ever cancelled because of emergency cases. This means that procedures can be properly planned and scheduled with the correct range of surgical expertise available in all cases thereby providing the safest environment.
Patients undergoing surgical care are carefully assessed. Patients with significant comorbidities are less likely to be suitable for specialist procedures and careful selection and assessment adds to the safety of care.
The outcomes of surgical care are well documented and for many types of patient show long term survival rates comparable or better than published benchmarks. For some types of care where surgery has been refused elsewhere the data shows a high proportion of long survival in patients who elsewhere were considered inoperable.
1. The peritoneal surface tumour service has well documented outcomes which compare well with international data
2. Survival from radical pelvic surgery shows high levels of five year survival in patients deemed inoperable elsewhere
3. Published data on the outcomes of urological cancer surgery have set international benchmarks for standards of practice
The reasons for our surgical care being both safe and effective lie in its multidisciplinary organisation.
Operations at The Christie are undertaken by specialists working in multidisciplinary surgical teams of a type not found elsewhere:
1. Operations involving the bowel, uterus, bladder etc can be undertaken at the same time with the involvement of colorectal surgeons, gynaecologists and urologists in the same operation.
2. The Christie is able to provide intraoperative chemotherapy treatments such as in the treatment of peritoneal surface tumours
3. Patients who may require other treatments as well as surgery can have this provided on the same site e.g. Radiotherapy and chemotherapy
4. The Christie has a specialist palliative care service and psycho-oncology service developed for the needs of patients including those undergoing surgery
5. Surgical care is immediately available for those patients with complications of non-surgical cancer treatments (required in about 20 operations per year)
Audit data shows that in a 12 month period (2015) from a total of 512 major operations performed by the Colorectal and Peritoneal Surface Surgical team there were 158 operations involving more than one of the core pelvic team disciplines of colorectal, gynaecological and urological surgery. For example, In 55 operations colorectal surgeons supported gynaecological surgeons and in 46 operations gynaecologists worked with colorectal surgeons making a total of 101 procedures in which these two disciplines worked together. In another example, in 12 operations colorectal surgeons supported urological surgeons and in 45 operations urological surgeons supported colorectal surgeons making a total of 57 procedures in which these disciplines worked together. In 37 operations there was involvement of all three core pelvic surgical disciplines.
Surgical services have the following consultant staff: Plastic surgery (4 surgeons), Gynae oncology (4 surgeons), Uro oncology (4 surgeons), Colorectal surgery (7 surgeons). These surgeons work in parallel operating sessions which allows multidisciplinary operating in a way which cannot be guaranteed elsewhere. Patients with rare, recurrent or advanced cancers undergoing care at The Christie have access to the full range of supportive services which they require and which are the hallmark of a cancer centre. We are not aware of this scale of multi-disciplinary operating, combined with the specialist non-surgical specialist support being available anywhere else in the world.
Services at The Christie are compliant with nationally and internationally set standards:
1. National Standards
Surgical services at the Christie have high levels of compliance with national standards with the most recent compliance rates of our MDTs being: Specialist Gynaecological Cancer Service (100% June 2015), Colorectal and Pelvic Cancer Service (90.9% June 2015), Anal Cancer Service (94.1% September 2014), Regional Penile Cancer Service (100% September 2013), Regional Testicular Cancer Service (90.6% September 2013)
2. National Clinical Audits
We participate and perform well in the cancer related national clinical audits.
3. International Standards
We are a fully accredited Comprehensive Cancer Centre in the official designation process of the European Union. This designation requires the centre to provide a full range of cancer services including specialist cancer surgery. We have compared our data with data published for the leading centres in North America and assess ourselves as meeting all those standards for which comparable measures are available. Again this includes provision of a comprehensive range of clinical services, including surgery, fully integrated with research and education.
In 2012 surgical services at The Christie underwent an external peer review, commissioned by the board of directors. This demonstrated a high level of safety and effectiveness
Surgical services at The Christie are innovative, research active and active in teaching:
1. The Christie was first to invest in robotic surgery in the north west and has had a robotic prostatectomy service for 9 years
2. The peritoneal surgical service is one of only two in the UK offering this leading edge treatment
3. Our surgeons receive referrals from throughout the UK for second opinions and assessment of patients deemed inoperable elsewhere
4. We undertake training of laparoscopic surgeons with one of our colorectal surgeons being a national RCS training lead for minimally invasive surgery
5. Two of our colorectal surgeons hold academic chair positions
6. Our professor of urological oncology is also director of the Manchester Cancer Research Centre biobank which is the largest and best performing nationally
7. We have one of only two national Movember Prostate Centre of excellence awards.
8.. Our colorectal, peritoneal surface and urological cancer surgical teams have published outcome data showing the effectiveness of the care provided.
The Christie provides a regional and national service for many tumour types with almost 10% of patients coming from outside Greater Manchester.
69% of surgical procedures carried out at The Christie are for Greater Manchester residents, 22% for people living elsewhere in the North West and 9% for people living across the UK. These figures include operations carried out by multiple specialities under the lead specialty.
Click the link below to to see the full tables.