OGC P40 An exploration into the duration patients undergoing surgical resection of Oesophageal or Gastric cancers require specialist Upper Gastrointestinal dietetic support

Abstract

Abstract Background Patients recovering from UGI resection are nutritionally complex, vulnerable, and face multiple dietetic challenges. Surgical guidelines exist in terms of gold standard follow up for UGI Cancer patients in UGI surgical clinics, however currently there is no guidance on how long they require intensive, specialist UGI dietetic support. Disparity exists amongst surgical centres in terms dietetic resource and service provision, thus no guideline on how long to keep under the tertiary UGI dietetic care currently exists. As an established, regional, UGI surgical dietetic service, an audit was conducted discerning the specialist UGI dietetic need for 5 years post resection. Methods A retrospective audit was conducted observing follow up of patients undergoing UGI surgery at a tertiary centre for UGI surgery in 2018. All patients had undergone Oesophagogastrostomy (OG), Total Gastrectomy (TG), or Sub-Total Gastrectomy (STG) and were under the care of the UGI RD by means of a blanket referral system. Patients were followed up by UGI surgery for 5 years. Electronic patients’ records were utilised, and the following information was collected per patient: Type of surgery, Number of dietetic contacts, Duration of follow up, Type of diet. This was collated, type of diet was compared, and average values obtained. Results Our results demonstrated that UGI surgical patient’s require significant specialist UGI RD follow up post resection regardless of the type of surgery. In terms of complexity, OG patients were most challenging with multiple dietetic interventions at the same time to meet nutritional needs and manage malabsorption. In all cases, the most prevalent intervention was using diet and Oral Nutritional Support. Surprisingly, STG required the longest dietetic follow up at almost double that of TG. OG patients required the second longest duration of specialist UGI dietitian follow up, however the most dietetic contacts, reiterating that their input was more intensive. Conclusions This audit identifies the need for specialist, frequent UGI dietetic support for at least 31/2 years post UGI resection, ideally at an experienced tertiary surgical centre. Whilst OG patients require more intensive dietetic support, TG and STG also have an equally long-term dietetic need. This data spreads across the pandemic period, therefore opportunities for follow up may have been impacted, thus this data could be an underreporting. It would be prudent to repeat this audit on post pandemic resections to ascertain if more frequent, longer term UGI dietetic review is observed. Further audit should include readmission rates, and patient feedback.