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.

胸腔和胃肠道手术服务通常会从NCI手术分支，小儿肿瘤科，内分泌肿瘤学分支，实验移植和免疫学分支以及国家心脏，肺和血液研究所以及其他IC的转诊中进行转诊。在过去的15年中，胸手术量的每年为150-175例，两名胸外科医师涵盖了。目前只有一名NCI的胸外科医生，预计今年将进行大约150例病例。在胸外科手术服务上进行的绝大多数病例是已经进行了多个手术和/或化学治疗方案或严重免疫功能低下的患者的高指数程序。 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.在胸腔手术部门进行的所有病例中，有60％是TGIB咨询案件；此外，每年大约有200次咨询不会在短期内进行操作，例如气胸管理，不确定的肺结核和第二意见，但仍会消耗胸外科手术资源。胃肠道手术服务每年执行150-200程序；这些程序中有将近75％是咨询案件。这些程序的范围从淋巴结活检，到端口插入/切除到障碍物或穿孔的小肠切除术，再到肠道癌症的结肠癌和腹部 - 腹膜切除术，用于免疫体现的宿主中的肠道癌，以及用于转移酶的肝切除术以及肝脏疾病的肝切除术。严重中性粒细胞减少或CMV感染的患者的附录，伤寒或穿孔性溃疡等大约100-150例咨询病例，但仍需要进行非表面处理，但仍需要大量时间承诺。由于NCI没有心胸外科手术研究员，并且由于大多数进入手术肿瘤学计划的医生（PGY-3）没有任何接触胸外科手术，因此大多数复杂的胸部胸部病例都需要两次胸外科手术来确保患者的安全。同样，由于没有高级一般手术居民，因此许多复杂的一般手术切除术需要两次参加。共同咨询活动会大大分散胸腔和胃肠道手术人员的主要学术任务，并在没有适当的赔偿或机构/学术认可的情况下进行； NIH没有其他服务负担这些负担。目前，我们满足NIH对胸腔和一般手术支持的需求不断增长的能力受到胸腔和胃肠道手术部分的不足以及NIH管理员尚未正确解决的重大或人员配备问题的限制。