Peritonectomy surgery limit to stay in place

NSW Health has no plans to increase the number of peritonectomy surgeries at St George Hospital.

It will instead adopt a more rigorous approach to selecting suitable patients, said NSW Cancer Institute chief executive David Currow.

Professor David Morris at St George Hospital. Picture: Tamara Dean

Professor David Morris at St George Hospital. Picture: Tamara Dean

Professor Currow said the 72 surgeries funded each year was in line with the number of patients who needed it most.

"There is a group of people who are clearly disease-free and doing well a long time down the track [post surgery] when carefully selected," Professor Currow said.

"But the issue is you have to select the right people because this is one of the most invasive procedures you can do to another human being and come out alive the other end."

All peritonectomy surgeries in NSW are performed at the hospital by David Morris and his team.

Professor Morris has in the past been openly critical of waiting times for the surgery, citing shortfalls in budgets and resources.

Professor Currow said: "What's important here more than anything else put forward is ensuring in NSW the public health system is buying 72 of these procedures each year, which is what is needed for the whole of NSW, and we can be absolutely confident that the public system is purchasing the resources needed."

"Part of the multidisciplinary team's role [at St George] from here on will be to ensure that the waiting list is managed, prioritised in that process, and that again is a joint team decision."

Peritonectomy surgery involves the removal of cancers in the tissue [peritoneum] that line the abdominal cavity and envelopes vital organs.

It is argued to be the standard of care for selected patients with three types of cancers, including peritoneal mesothelioma.

The surgery is one of the most complex surgeries in the world and can take up to 14 hours to perform.

After surgery many patients can spend months in intensive care, which is one of the most expensive departments to run in a hospital, said the Agency of Clinical Innovation's director of surgery, anaesthesia and critical care, Donald MacLellan.

"Peritonectomy surgery is certainly not for the faint-hearted and the patient really needs to know what they are getting themselves into," Mr MacLellan said.

In NSW, the five-year survival rate following a patient's first peritonectomy is 49.6 per cent.

Of those patients who received it as an emergency procedure, 14 per cent died within 90 days and 31.6 per cent within the first year.

The Leader reported on October 17 that a decision was made to allow Professor Morris to operate on six additional category-one patients on the waiting list at Prince of Wales Hospital.

Those surgeries will now be performed at St George Hospital before December 11.

Mr MacLellan and Professor Currow's comments were made during a media briefing at NSW Health's head office on Tuesday.

Professor Morris was not invited to the briefing.

"If the 72 cases were adequate, then why would we have had up to 40 patients waiting?" Professor Morris said afterwards.

"I very much doubt whether the 72 [funded surgeries] are going to be adequate, based on what we know.

"And the '72' isn't based on anything or any scientific knowledge — it's just a number."