Research to improve surgical oncological care on the surgical department, Maputo Central Hospital

Purpose: Regarding adequate care for oncological patients, requiring surgical interventions at the Surgical Department of Maputo Central Hospital (MCH), the largest hospital in Mozambique, the aim of those studies, was first to assess the surgical resources, surgical oncology team skills, identify and characterize prevalent cancers treated and general knowledge in oncology and surgical oncology, expecting the development of a comprehensive curriculum in surgical oncology fellowship fit for the Hospital and all Mozambique country. Methods: The study 1, done in 2017, was based on surgeons questionnaire (The Cancer Units Assessment Checklist for low- or middle-income African countries (annex I), visiting the unities (oncology service, ICU, operations room, etc.) collecting information according to the Portuguese-speaking African Countries Assessment of Surgical Oncology Capacity Survey (PSAC-Surgery – annex II). The study 2, done in 2018, by retrospective analysis of individual cancer patient registries of MCH, the prevalent cancers has been identified and characterized (annex IV). And the general knowledge in oncology and surgical oncology, this issue was evaluated by simple test administered anonymously and without prior notice to all surgeons and residents at the Surgical Department (annex V). The domains was about basis of Oncology, Radiotherapy, Pathology, Chemotherapy, Pain management, Surgical oncology and Clinical pathway. The study 3, done in 2019, a three-round modified-Delphi approach was implemented to obtain consensus on surgical oncology training curriculum. The participants were purposefully selected 23 experts in surgical oncology working in Mozambique. In round one, participants answered a questionnaire regarding the content of the curriculum and the timing and venue of training. Draft of the curriculum was produced. In round 2, answers from the first round and the curriculum draft were presented to a purposeful selected sample of nationally recognized experts in oncology and surgical oncology, including members of the Mozambican College of Surgeons and leadership of the Ministry of Health. A final round was carried out to discuss the final version of the training program in surgical oncology with extensive participation of majority of african experts in surgical oncology (Aortic, Maputo). Results: Breast, esophagus and colorectal cancers were the most commonly treated neoplasms in MCH (at Surgical department). A range of technical and resource needs as well as the gaps in knowledge and skills were identified. All surgeons recognized the need to create a training program in oncology at the undergraduate level, specific training for residents and continuing oncological education for general surgeons, to improve the practice of surgical oncology. Basic principles of oncology and basic principles of surgical oncology should be included in the curriculum of surgical residency in Mozambique, a 24-months fellowship in surgical oncology should take place after residency in the surgical field and should occur at Maputo Central Hospital and at comprehensive cancer centers. The final proposal for the program was divided into the following structure: a – theoretical components; b – duration; c – location; d – methodology; e – technical skills in oncology; and f – competency and paid particular attention to the oncological diseases prevalent in Mozambique.

Anastomotic leak following oesophagectomy: research priorities from an international Delphi consensus study

The Oesophago-Gastric Anastomosis Audit (OGAA) is an international collaborative group set up to study anastomotic leak outcomes after oesophagectomy for cancer. This Delphi study aimed to prioritize future research areas of unmet clinical need in RCTs to reduce anastomotic leaks.

A modified Delphi process was overseen by the OGAA committee, national leads, and engaged clinicians from high-income countries (HICs) and low/middle-income countries (LMICs). A three‐stage iterative process was used to prioritize research topics, including a scoping systematic review (stage 1), and two rounds of anonymous electronic voting (stages 2 and 3) addressing research priority and ability to recruit. Stratified analyses were performed by country income.

In stage 1, the steering committee proposed research topics across six domains: preoperative optimization, surgical oncology, technical approach, anastomotic technique, enhanced recovery and nutrition, and management of leaks. In stages 2 and stage 3, 192 and 171 respondents respectively participated in online voting. Prioritized research topics include prehabilitation, anastomotic technique, and timing of surgery after neoadjuvant chemo(radio)therapy. Stratified analyses by country income demonstrated no significant differences in research priorities between HICs and LMICs. However, for ability to recruit, there were significant differences between LMICs and HICs for themes related to the technical approach (minimally invasive, width of gastric tube, ischaemic preconditioning) and location of the anastomosis.

Several areas of research priority are consistent across LMICs and HICs, but discrepancies in ability to recruit by country income will inform future study design.

Recommendations for Head and Neck Surgical Oncology Practice in a Setting of Acute Severe Resource Constraint During the COVID-19 Pandemic: An International Consensus

The speed and scale of the global COVID-19 pandemic has resulted in unprecedented pressures on health services worldwide, requiring new methods of service delivery during the health crisis. In the setting of severe resource constraint and high risk of infection to patients and clinicians, there is an urgent need to identify consensus statements on head and neck surgical oncology practice. We completed a modified Delphi consensus process of three rounds with 40 international experts in head and neck cancer surgical, radiation, and medical oncology, representing 35 international professional societies and national clinical trial groups. Endorsed by 39 societies and professional bodies, these consensus practice recommendations aim to decrease inconsistency of practice, reduce uncertainty in care, and provide reassurance for clinicians worldwide for head and neck surgical oncology in the context of the COVID-19 pandemic and in the setting of acute severe resource constraint and high risk of infection to patients and staff.