Surgeons working 50 miles apart defy Covid to keep life-saving surgery going

A partnership forged between surgeons separated by more than 50 miles meant life-saving chest operations could continue throughout the pandemic.

Their unprecedented collaboration saw surgery for lung cancer resume safely just months after being forced to a halt when the virus took hold.

Main photo above: Morriston Hospital surgeons Pankaj Kumar and Ira Goldsmith

Established between specialists in Swansea and Cardiff, the South Wales Lung Cancer Collaboration has now gone on to win a major award.

And it augurs well for the future success of a multi-million-pound regional thoracic surgery centre, which is now in the detailed planning stage.

At the start of the pandemic outpatient appointments were cancelled across the UK, with theatre staff relocating to care for Covid patients on the wards and in intensive care.

Many had to self-isolate with the virus, or shield because of medical conditions.

There was also a tenfold risk of death or complications in patients who underwent surgery and contracted the virus, which can damage organs including the lungs and heart.

Surgery, by and large, came to a halt – including thoracic surgery, which did not take place at all in Swansea Bay during April and May 2020.

That was something clinicians like Ira Goldsmith, thoracic consultant surgeon at Morriston Hospital, never wanted to see.

“It’s all about patients and saving lives. Surgery is the best form of treatment for early stage lung cancer,” he said.

“If it is detected early, we can offer patients surgery that can cure them of their disease.

“But we were not able to do that. We had to send them for radiotherapy, which is the next best thing after surgery, or chemotherapy. But it was difficult to see because the outcomes are not as good.

“Those patients lost the chance of curative surgery. So for us it was a question of, how do we make sure others do not lose out? How do we ensure patients with a curable disease can come in for surgery?

“We also had patients with other conditions such as a collapsed lung requiring emergency surgery. How do we progress their surgery?

“For me as a surgeon when we stopped operating it was a huge blow. I can’t see my patients not having treatment. So I approached management and asked if we could look into how we could restore surgery.”

Cardiff and Vale University Health Board had also stopped surgery. However, it was able to relocate the cardiothoracic surgical service to Llandough Hospital, a green or Covid-free hospital, where operations on patients from the South East continued.

There was no such alternative in Swansea Bay, which also treats thoracic patients from Hywel Dda and Cwm Taf Morgannwg health board areas.

So another way had to be found, and it was decided to form a partnership between the two surgical teams.

This was supported by the health boards, the Welsh Health Specialised Services Committee (WHSSC), which commissions thoracic services, and by the Wales Cancer Network.

Right: at the Moondance Cancer Awards, where the collaboration won in the Working Together category

Pankaj Kumar, cardiothoracic consultant surgeon and Morriston’s Deputy Group Medical Director, was asked to develop the regional solution and lead the joint working collaborative.

“The goal was to ensure patients with lung cancer had equity of access to thoracic surgery across South Wales and the clinically most urgent cases could access surgery with the least delay,” he said.

Multidisciplinary teams from both sides met virtually on a regular basis and developed a patient tracker.

The tracker ensured all patients were assessed and prioritised for surgery, on an equal basis regardless of which health board provided their care.

Initially, all surgery was carried out at Llandough while a green pathway was created in parts of the Cardiac Centre in Morriston. Surgery restarted in Swansea in June 2020.

Based on Royal College of Surgeons guidance, patients with primary and metastatic lung cancer were prioritised to begin with. Over time, surgery for other serious chest conditions and injuries was restored.

The number of operations accelerated rapidly and is now almost back to pre-Covid levels.

Professor Goldsmith said: “For a partnership to come together so quickly and work well together is very unusual.

“It was quite a challenge to work across two health boards. It would be even in ordinary times, because everyone has different ways of working.

“But when people realised the enormity of the problem we were able to establish this very successful collaboration.

“There have been no Covid-19 related patient deaths and patients requiring surgery for the highest-priority conditions have received treatment in a safe and a timely manner.”

Morriston’s Directorate Manager for Cardiac Services, Dean Packman, added: “The collaboration has been a great example of what can be achieved through a combination of desire to improve access for patients and strong clinical leadership.”

Commissioners at WHSSC agreed, and encouraged the collaboration to put itself forward for the inaugural Moondance Cancer Awards.

It was Mr Kumar who nominated Professor Goldsmith and Mr Packman, along with Cardiff and Vale’s consultant thoracic surgeon Malgorzata Kornaszewska and Cardiac Services Directorate Manager Nick Gidman.

And they were the winners in the Working Together category. Judges described the collaboration as “a great example of what could be achieved when one kept the patient at the centre, and people were brave enough to step across boundaries to deliver services and care”.

While all involved were naturally delighted with the award, the collaboration’s success has longer-term significance.

There are plans for an Adult Thoracic Surgical Centre for South Wales, the third largest of its kind in the UK, at Morriston Hospital.

Expected to open in the next three to five years, it will provide a service for people living in the Swansea Bay, Hywel Dda, Cwm Taf Morgannwg, Aneurin Bevan, Powys and Cardiff and Vale health board areas.

It will operate on up to 20 per cent more patients. They would be treated as much as possible within their home health board area, only travelling to Morriston for pre-admission assessment and surgery.

Having this specialised service in one centre of excellence will, just like the lung cancer collaboration, ensure equity of access and service delivery and, more importantly, better patient outcomes.

Left: Mr Goldsmith with the award that he shared with colleagues from Swansea and Cardiff

Earlier this summer, the Welsh Government cleared the way for the next key stage, which is the development of detailed plans.

Professor Goldsmith said: “Thoracic surgery is particularly important. The big question for us was, how are we going to work with the surgeons and surgical team in Cardiff? Will they be compatible? Will they be willing to work with us?” he said.

“What this joint working showed is that, yes, we can do that. As a surgeon trying to make sure we have the single centre come here, and work in harmony and successfully, that was the biggest thing for me.”

Mr Kumar echoed those sentiments, saying: “From my perspective, the clinical teams from the two centres have worked very hard to deliver thoracic surgery that is patient-focused and patient-centred in the face of adversity brought on by Covid-19.

“We have developed a close and collaborative working platform across the health board boundaries that bodes well for the new regional thoracic surgery centre.”