TGIB Surgical Consultative Services

TGIB 手术咨询服务

• 批准号: 8938531
• 负责人: DAVID SCHRUMP
• 金额: $ 161.99万
• 依托单位: DIVISION OF BASIC SCIENCES - NCI
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/8938531
• 关键词: Abdomen; Accounting; Address; Administrator; Biopsy; Blood Vessels; Cessation of life; Chest; Chest wall structure; Chronic Granulomatous Disease; Clinical; Colectomy; Colorectal Cancer; Complex; Consult; Cytomegalovirus; Endocrine; Enrollment; Esophagectomy; Excision; Exposure to; Financial compensation; Hepatectomy; Human Resources; Immunocompromised Host; Infection; Innovative Therapy; Laboratory Research; Lung; Lung nodule; Malignant Neoplasms; Malignant neoplasm of lung; Mediastinal; Metastatic Neoplasm to the Lung; Mission; Multi-Drug Resistance; Mycobacterium Infections; Mycoses; National Heart, Lung, and Blood Institute; Neoplasm Metastasis; Neoplasms; Neutropenia; Obstruction; Operative Surgical Procedures; Patient Care; Patients; Pediatric Oncology; Perforation; Physicians; Pneumonectomy; Pneumothorax; Procedures; Protocols documentation; Regimen; Resistance; Resources; Rupture; Second Opinions; Services; Small Intestines; Surgical Oncology; Thoracic Surgeon; Thoracic Surgical Procedures; Thoracoplasty; Time; Translational Research; Transplantation Immunology; Typhlitis; Ulcer; United States; United States National Institutes of Health; indexing; lymph nodes; meetings; oncology; oncology program; operation; patient safety; reconstruction

The Thoracic and GI Surgery Services routinely handle referrals from the NCI Surgery Branch, Pediatric Oncology Branch, Endocrine Oncology Branch, Experimental Transplantation & Immunology Branch, as well as the National Heart, Lung, and Blood Institute, and other IC's. Thoracic Surgery volumes during the past 15 years have ranged from 150-175 cases annually, which have been covered by two thoracic surgeons. With only one thoracic surgeon currently at the NCI, approximately 150 cases are projected to be performed this year. The vast majority of cases performed on the Thoracic Surgery Service are high index procedures in patients who have already had multiple surgeries and/or chemotherapeutic regimens, or are severely immunocompromised. These procedures include extrapleural pneumonectomies, radical pleurectomies, mediastinal exenterations with major vascular resections/reconstructions, chest wall resections, complex pulmonary resections and thoracoplasties for primary lung cancers, pulmonary metastases and multidrug resistant resistant mycobacterial or fungal infections, and esophagectomies. Sixty percent of all cases performed in the Thoracic Surgery Section, TGIB are consult cases; additionally, there are approximately 200 consults annually that do not result in operations in the short term, such as management of pneumothoraces, indeterminant pulmonary nodules, and second opinions, that nevertheless consume Thoracic Surgery resources. The GI Surgery Service performs 150-200 procedures annually; nearly 75% of these procedures are consult cases. These procedures range from lymph node biopsies, to port insertions/removals to small bowel resections for obstructions or perforations, to colectomies and abdominal-perineal resections for colorectal cancers in immunocompromised hosts, as well as hepatectomies for metastases or chronic granulomatous disease. Approximately 100-150 additional consult cases such as ruptured appendices, typhlitis or perforated ulcers in patients with severe neutropenia or CMV infections are managed non-surgically, but still require substantial time commitments. Since there are no cardiothoracic surgery fellows at the NCI, and because most of the physicians (PGY-3) entering the Surgical Oncology Program have not had any exposure to Thoracic Surgery, the majority of complex thoracic cases require two Thoracic Surgery attendings to assure patient safety. Similarly, because there are no senior-level general surgery residents, many of the complex general surgery resections require two attendings. Collectively, consult activities significantly distract Thoracic and GI Surgery personnel from their primary academic mission, and are performed without appropriate compensation or institutional/academic recognition; no other services at the NIH have these burdens. Presently, our ability to meet the increasing demand for thoracic and general surgical support at the NIH is limited by insufficient personnel in the Thoracic and GI Surgery Sections as well as significant OR staffing issues that NIH administrators have yet to properly address.

胸部和胃肠道外科服务部门定期处理来自 NCI 外科分部、儿科肿瘤科、内分泌肿瘤科、实验移植和免疫学分部以及国家心肺血液研究所和其他 IC 的转诊。过去15年来，每年的胸外科手术量为150-175例，由两名胸外科医生负责。 NCI 目前只有一名胸外科医生，预计今年将完成大约 150 例手术。胸外科服务中进行的绝大多数病例都是高指数手术，对象是已经接受过多次手术和/或化疗方案或严重免疫功能低下的患者。这些手术包括胸膜外肺切除术、根治性胸膜切除术、纵隔廓清术及主要血管切除/重建术、胸壁切除术、针对原发性肺癌、肺转移瘤和多重耐药分枝杆菌或真菌感染的复杂肺切除术和胸廓成形术，以及食管切除术。 TGIB 胸外科执行的所有病例中有 60% 是会诊病例；此外，每年约有 200 次会诊在短期内不会导致手术，例如气胸、不确定性肺结节的治疗和第二意见，但仍消耗胸外科资源。胃肠道手术服务每年执行 150-200 例手术；其中近 75% 的程序是咨询案例。这些手术的范围包括淋巴结活检、端口插入/移除、针对梗阻或穿孔的小肠切除术、针对免疫功能低下宿主的结直肠癌的结肠切除术和腹会阴切除术，以及针对转移或慢性肉芽肿性疾病的肝切除术。大约 100-150 个额外咨询病例，例如严重中性粒细胞减少症或 CMV 感染患者的阑尾破裂、盲肠炎或溃疡穿孔，均采用非手术治疗，但仍需要投入大量时间。由于 NCI 没有心胸外科研究员，并且大多数进入肿瘤外科项目的医生 (PGY-3) 没有接触过胸外科，因此大多数复杂的胸外科病例需要两名胸外科主治医生来确保患者安全。同样，由于没有高级普外科住院医师，许多复杂的普外科切除手术需要两名主治医生。总的来说，咨询活动极大地分散了胸腔和胃肠外科人员的主要学术使命，并且在没有适当补偿或机构/学术认可的情况下进行； NIH 的其他服务机构没有这些负担。目前，我们满足 NIH 胸外科和普通外科支持日益增长的需求的能力受到胸外科和胃肠外科科室人员不足以及 NIH 管理人员尚未妥善解决的重大手术室人员配备问题的限制。