The Binational Colorectal Cancer Audit. A/Prof Paul McMurrick Head, Cabrini Monash University Dept of Surgery 2017

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1 The Binational Colorectal Cancer Audit A/Prof Paul McMurrick Head, Cabrini Monash University Dept of Surgery 2017

2 Binational Colorectal Cancer Database 2010 First Patient 2011 Contract between CMUDS and CSSANZ XDS All Monash Affiliates MDS 70+ centres

3 Binational Colorectal Cancer Database Colorectal Surgical Society ANZ Internet based, scalable, no local infrastructure Housed at DEPM Monash University MDS Minimum data set : Australasian database of the Colorectal Surgical Society of ANZ ( BCCA ) 17,000 cases, 70 centers Broad and shallow XDS Extended data set : seamless linkage to BCCA Participation by select academic departments 3000 cases, 5 centers Narrow but deep

4 Where did this come from? No national platform for data collection in treatment of bowel cancer Cabrini Monash University Dept database Cabrini Alfred and Avenue Hospital Cabrini Monash Dept of Surgery Benevolent funding from Lets Beat Bowel Cancer $250,000 plus salary costs Partnership with DEPM (John McNeil, Chris Reid) National roll out to CSSANZ 2014

5 Binational Colorectal Cancer Database Database is : Web based with no local infrastructure requirements Inbuilt checks and reminders Automated reporting Scalable Not all units have the same resources, requirements or research aspirations Choice of MDS (90%) or XDS (10%)

6 How is the XDS different? (Cabrini Monash Database) More information about patient background and comorbidities : 150 more fields More intense follow up data re survival Closer audit of data completeness and accuracy Random audits of data More structured capacity for individual units to participate in collaborative research Data structure aimed at more specific questions

7 What infrastructure is required for XDS participation Data completeness of more than 95% is essential Specific research tool Use it or lose it Data manager mandatory Regular M&M data cleaning meetings Regular review of data completeness Ongoing review of site suitability Duplicate files, outstanding fields, incongruity

8 Who participates in the XDS? Monash Partners AHSC affiliates Cabrini Alfred Avenue Hospital Southern Health Peninsula Other centers invited if they meet requirements of participation

9 Ease of data entry Data entry during : Operation report Follow up

10 Automated reporting module 24/7

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12 Gender and Cancer type distribution Gender Type Male Female Rectal Colon

13 Age distribution, all neoplasia Age at diagnosis TVA CANCER Age in years

14 Risk stratification data : ASA distribution and LOS implications ASA LOS from surgery ASA I ASA II ASA III ASA IV ASA V ASA1 ASA2 ASA3 ASA4 ASA5 average LOS median LOS

15 Risk stratification data : Operative urgency distribution and LOS implications Operative urgency Operative urgency LOS Emergency Urgent Elective ELECTIVE URGENT EMERGENCY average median

16 Right hemicolectomy Extended right hemicolectomy Left hemicolectomy Sigmoid colectomy Transverse colectomy Total colectomy Sub total colectomy Proctocolectomy High anterior resection ( ) Low anterior resection (6.1-10) Ultra low anterior resection (0-6) APR Hartmanns Colo-anal anastomosis Local excision Transanal Endoscopic Microsurgery (TEMS) Laparotomy only Miscellaneous operation (eg. for complication) Other Operation type

17 Open Laparoscopic Hybrid Conversion of Laparoscopic Robotic Transanal Surgical Entry 914 Conversion of Robotic, 35, 2% Laparoscopic, 131, 7% Transanal, 13, 1% Hybrid, 112, 6% 568 Open, 568, 32% Laparoscopic, 914, 52% Open Laparoscopic Hybrid Conversion of Laparoscopic Robotic Transanal

18 Stoma STOMA FORMATION Stoma type 383 Already present 1% Yes 31% 125 No 68% Loop ileostomy End ileostomy Loop colostomy End colostomy

19 Neoadjuvant therapy by T stage Rectal Cancer Rectal pre-op T3 staging Rectal pre-op T4 staging 51, 19% 31, 12% 4, 19% 1, 5% 3, 1% SC LC other Tx no Tx SC LC other Tx no Tx 183, 68% 16, 76%

20 Nodal spread Nodal spread all neoplasia rectal cancer nodal spread and Tx options neo A/T no neo A/T >50 Nodes retrieved >50 Nodes retrieved

21 Abdominal/pelvic collection Anastomotic leak Enterocutaneous fistula Superficial wound dehiscence Deep wound dehiscence Wound infection - Abdominal - Perineal - Drain tube site Temperature >38.5 C with haemodynamic features of sepsis Prolonged ileus Small bowel obstruction Urinary retention Ureteric injury Splenectomy Postoperative Haemorrhage Other surgical complication Outcome data Surgical Complications

22 Follow up and survival data : XDS specific individual patient follow ups local recurrence distant mets developed deceased <= 1yr 1-2 yrs 2-3 yrs 3-4 yrs 4-5 yrs >5 yrs Last follow up from day of surgery

23 Death numbers and cause 73 Cause of death 1% 45 1% 32 81% 17% Post-op complications Chemo toxicity Non-cancer related Cancer related 11 1 <=1yr <=2yr <=3yr <=4yr <5yr Number of deaths in years from surgery

24 Cumulative % deaths for patients after surgery February /02/ % 9.28% 9.34% 6.80% 4.21% <=1yr <=2yr <=3yr <=4yr <5yr Years from surgery until death

25 First publication : DCR 2014

26 Research projects stemming from XDS Studies requiring patients with complete follow up CP response in relation to mesorectal invasion Oncologic outcome in conventional APR Outcome of diabetic patients with bowel cancer Who dies in 90 days post resection? Mortality risk stratification modeling Prediction of LN mets in early malignant polyps

27 Research projects stemming from XDS Multiple translational projects TMA blocks for > 2000 patients linked to data Tissue organoids in CRC

28 MDS BCCA CSSANZ Annual report Released 2016 ASC RACS

29 BCCA Audit : Minimum data set Binational audit, 70 Centers CSSANZ supported and run Less fields, registry level data 18 months current recruitment 10,000 patients (includes 5 years of old data) First annual report released this week

30 Usefulness of XDS vs MDS BCCA XDS : specific research projects, translational, treatment based etc MDS : Quality assurance. Risk Stratification

31 Data Completion Improving

32 End Stoma Rate

33 Impact of NBCSP

34 Inpatient Mortality

35 Risk Adjusted Complications

36 ANZ recruitment

37 Conclusions Robust model for data collection Demonstrated data completeness Scalable and adaptable 70 centers MDS 5 centers XDS Allow risk stratification analysis Reliable data source for quality assurance, research, future resource planning Funded by benevolence in private sector