The impact of a communal multidisciplinary tumour board on medical education

Introduction: Numerous challenges hinder the development of multidisciplinary medical education in a resource-constrained environment. Communal tumour boards built through networking could be a suitable model for the effective management of diseases and enhancement of medical education. This study evaluated the impact of an integrated care pathway for patients with musculoskeletal tumours via multi-institutional networking in a metropolis. Methodology: Musculoskeletal tumours managed in different institutions in a large metropolis were included for discussion at monthly meetings, under the aegis of the Lagos Musculoskeletal Oncology Network (LAMON). The cases discussed were collated and presented by designated senior residents. The meetings ensured adherence to agreed national and international guidelines in the management of musculoskeletal tumours. Decisions about the treatment modalities were planned at the meetings. The impact on medical residency training was evaluated using the achievement of significant milestones by the residents supported by the network. Results: The tumour board network included health professionals from various specialist hospitals in the metropolis. Within the decade (2013–2022), 1,272 patients were reviewed of which 968 patients had definitive histological diagnoses. There was an improvement in limb salvage rate and disease outcome. The tumour board supported significant milestones in graduate medical training, including the completion of 4 residents’ fellowship dissertations, 22 conference presentations by residents, the publication of 12 articles by residents and the completion of an orthopaedic oncology subspecialty fellowship by 9 orthopaedic surgeons. Conclusion: The tumour board/network improved the outcome of musculoskeletal tumours over the study period. The network improved the education of medical doctors and increased the capacity for training newer instructors in a resource-limited environment. Perhaps with appropriate social and corporate support, communal tumour boards like LAMON may translate into a good model for multidisciplinary care of diseases and capacity building in resource-limited settings

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone