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Enhanced recovery

Preoperative Assessment & Enhanced recovery Programme

When you and your consultant decide surgery is intended as part of your cancer treatment, we will also need to assess your fitness for surgery. Surgery on the gastrointestinal tract is considered major surgery and will routinely involve a period in the intensive care or high dependency setting post operatively. Surgery involves removing the organ containing the cancer and reconstruction of the digestive system.

For these reasons surgery involves a small but significant mortality risk (a risk of dying within the first 31 days) because of a complication arising from the surgery. The surgery you will have is only performed in a regional centre to minimise this risk but research has demonstrated that patient outcome is directly related to heart and lung fitness which is why preoperative fitness is so important.

For this reason all patients are assessed pre-operatively by our Bristol pre-operative Assessment team, located on A606 (POD). This team include experienced nurses and anaesthetists who can objectively assess patient's suitability for this type of surgery. This is done with an appointment to assess your medical history (previous medical conditions and operations, medications) and physiological tests to measure your heart and lung fitness

We also may recommend a period of Prehab (prehabilitation) please see our link for more information

Tests include

ECG - Electrocardiograph (leads attached to the chest with sticky pads to trace the activity of the heart)

ECHO cardiogram - an USS of the heart which can take detailed pictures of the structure and function of the heart

Stress ECHO cardiogram - a medication is given to mimic the effects of exercise on the heart whilst an USS of the heart is taken. This is done under supervision of a doctor.

CPET Cardiopulmonary exercise testing-  A physiological study where patients walk on a treadmill which is steadily inclined . This involves a breathing mask and heart monitors to record the amount of oxygen and carbon dioxide processed by your body. This gives the anaesthetist detailed information about how your body responds and copes with stress (like major surgery).

Some of the tests can be performed at your local hospital, but the pre-op appointment and tests such as the CPET can only be done at the BRI. This may involve a separate trip to Bristol which we appreciate may be inconvenient if you are travelling from outside Bristol, it is an essential part of your care and where possible we will try to combine appointments.

When you have been seen in POD you will be allocated a caseworker who will track your case and ensure things run smoothly. If you are unsure who to contact ring the main desk for POD and they will be able to assist you 0117 34 27598

The consultants and cancer coordinators (MDT coordinators) will then meet with the pre-op team to discuss your suitability for surgery. It may be that the tests indicate making a change to your current medication aiming to improve an existing medical condition such as angina, diabetes or high blood pressure. Occasionally, the team find that the surgery would be at very high risk to your life and they will arrange to meet with you in clinic to discuss this further with you. It is a good idea to bring any family members with you to this appointment who will be helpful in supporting your decision making. 

What is the Enhanced Recovery Programme?BRI banner

The Upper GI Cancer Service now has a well-established enhanced recovery programme.

The aim of this programme is to enable patients to return to full health as quickly as possible after surgery. 

The team are aiming to use an Enhanced Recovery Programme to optimise your nutrition, mobility and pain relief around the time of the operation. There is strong evidence that this will enable you to recover faster from your operation, with fewer complications. 

It involves all the staff caring for you (anaesthetists, nurses, dieticians, physiotherapists and surgeons) helping you to follow a clearly defined programme and most importantly requires your participation to make it work. Together we will use as many parts of the programme suitable for you to achieve the best recovery. 

This is based on the following principles:

  • The patient is in the best possible condition for surgery
  • The patient has the best possible management during and after their operation
  • The patient experiences the best post-operative rehabilitation 

We will talk to you about the operation beforehand, what to expect and how to aid your own recovery afterwards.  For major operations, this will include goals to aim for every day.  These are outlined in the patient diary (see patient information section).

The preoperative assessment team will discuss this with you and provide additional information.

When you are admitted to hospital you will meet our enhanced recovery nurse Trudy Reed, who is an experienced nurse practitioner who will guide you through the enhanced recovery programme.

You will be given information about prehab and a patient diary which you will need to keep with you whilst you are in hospital. This will give you a clear plan for each step of your recovery and set small achievable goals each day. The ward nurses and doctors will discuss your progress each day and work with you to achieve your goals.

You will be followed up closely in the first 7 days after discharge by phone by Trudy, after this period please contact your specialist nurse directly with any concerns or questions.  For any questions out of hours please contact ward A8000117 3427800who will be able to help you.

Further information about the national programme can be obtained here

Nutrition and Dietetic Services

Many people undergoing treatment to their digestive system find that eating and drinking can become difficult.  Our aim is to keep people well nourished to support them through their treatment.

If you feel at any point that you are finding it difficult to eat or drink or notice that you are losing weight without trying you may benefit from seeing a dietician for some support.

Dieticians can help by advising on ways of modifying your diet and on products that can support your needs.

There are dieticians available in many of the outpatient clinics you will attend and during any hospital stay.  Please raise any concerns you have with staff so they can make arrangements for you to meet a dietician.