For those unable to attend Muntzer Mughals' Inaugural professorial lecture last week at University College London, I thought I would record a brief summary of some of the points that he talked about.
Muntzer came down to London four years ago from Preston with a vision to improve Upper GI patient experience and outcomes at University College Hospital. When he started his career, around 30 years ago, oesophagectomies were being conducted by general surgeons in a very large number of hospitals. the 90-day mortality rate was then about 35%, something that seems spectacularly poor if not scandalous by today's standards. The surgeons who performed them would sometimes do, perhaps, one a year.
One of the benefits of centralisation of services at Preston was that junior surgeons will have undertaken a great many more oesophagectomies before becoming consultants than their more senior counterparts under the old system. So the centralisation improves specialist surgical techniques enormously.
The rate at which resections were done was about 40% of the oesophageal cancer diagnoses; nowadays it is closer to 20%. This is because the quality of the scanning has improved so markedly, and many more cases are detected where there has already been metastatic spread of the cancer to other parts of the body, and therefore undergoing the surgery is not going to provide a cure. When the current reorganisation of Bart's, UCH and Romford was being considered, each hospital did about 40 resections a year. This is a relatively low number, and certainly low by historical standards for maintaining surgical skills. The trend for developing specialist centres of excellence seems an obvious and clear strategy.
The steady rise in oesophageal adenocarcinoma over the past 30 years has been mirrored by an equivalent decrease in gastric adenocarcinoma.
The 5-year survival rate for Stage 1 oesophageal cancer is far higher now (around 70%) than for all stages (15%) so the initiatives for trying to promote earlier diagnosis are extremely important if the UK is to emulate the best outcomes in Europe. Very often diagnosis in the UK occurs too late for curative treatment.
The way in which doctors and patients give priorities to different issues is interesting. The surgeons tend to talk together about operating margins, mortality and so on; the patients being relatively more concerned about the reputation of the surgeon and quality of life afterwards.
Reorganisations in the NHS are often regarded with scepticism, if not cynicism by the public, but Prof Mughal is motivated by a very clear mission to improve the outcomes for patients, and he is a man who generates much loyalty, respect and affection.