The Upper GI Surgical Unit

This is the first of regular updates on the surgical unit that we will be providing for the OOSO website.
So much has changed since the Unit was created in 1997 - we have grown in that time into one of the biggest oesophagogastric cancer units in the country and now have four Consultant Surgeons (Nick Maynard, Bob Marshall, Bruno Sgromo and Richard Gillies) operating four days a week on patients with oesophageal or gastric cancer.
The strengths of the unit are of course the clinical outcomes from this surgery which are as good as anywhere in the world. The team is always striving to improve, and much attention in recent months has focussed on improving our ERAS (Enhanced Recovery after Surgery) pathway. This philosophy of care has been pioneered in Seattle, USA, and in September a small part of the team went to visit the Unit in Seattle which is led by Professor Don Low. The group consisted of doctors, nurses, physiotherapists and dieticians, and they returned full of ideas and enthusiasm. It is always fascinating visiting other units – not only does one usually pick up good ideas and new ways of doing things, but also it reinforces how good so much of our service already is! This was certainly the case with our visit to Seattle, and it was very clear to all of us that many aspects of our unit were better than the Unit in Seattle! Nevertheless, we picked up many good ideas about how to improve our ERAS pathway and the team has been very busy over the last few months revising it and implementing the improvements. We have already seen a remarkable reduction in length of stay following oesophagectomy, with many patients now going home on the seventh post-operative day.
Our ward (the Upper GI Centre) continues to thrive, and is continually talked about throughout the Trust as “the best ward in the hospital” – indeed the Upper GI Ward and Team won the team award of the year at the recent Oxford Mail Hospital Heroes Ceremony! This success is in large part due to the inspirational leadership the ward has had over the years from Sister Gill Dyer. Gill has recently left, and she will be greatly missed. We are, however, incredibly lucky that Claire Coleman has taken over as Ward Sister. Claire was one of our Senior Staff Nurses on the ward, and is already proving a brilliant successor to Gill.
We do still have our frustrations – lack of critical care beds in the Cancer Centre remains a major problem. January was one of our worst months ever, with multiple cancellations of oesophagectomies on the day of surgery due to a lack of an ICU bed. It is an appalling experience for patients to have their operation cancelled on the day of surgery, and it is a situation that remains as bad now as it was in 1997. There simply are not enough ICU beds in Oxford, and despite the Consultants repeatedly raising this with the Trust Senior Management, little progress has been made. It may well be that we ask OOSO to help raise the profile of this unacceptable situation!
I will update you next time about our progress in these matters, and also tell you something about the research we are doing in our Unit.
Nick Maynard
Consultant Surgeon
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