Liver resection for metastatic uveal melanoma: experience from a supra-regional centre and review of literature.

Management of liver metastases from uveal melanoma (LMUM) requires multimodal approach. This study describes evolution of liver resection for LMUM, reviewing current literature and institutional outcomes. Records of patients referred to the Melanoma Multi-Disciplinary Team between February 2005 and August 2018 were reviewed. All publications describing surgery for LMUM were identified from PubMed, Embase, and Google Scholar. Thirty-one of 147 patients with LMUM underwent laparoscopic liver biopsy, and 29 (14 females) had liver resections. Nineteen liver resections were performed locally [7 major (≥3 seg), 14 laparoscopic] without major complications or mortality. Overall survival positively correlated with the time from uveal melanoma to LMUM (Spearman's rho rs = 0.859, P < 0.0001). Overall and recurrence-free survivals were comparable following R1 or R0 resections (OS 25 vs. 28 months, P = 0.404; RFS 13 vs. 6 months, P = 0.596). R1 resection cohort had longer lead-time (median 100 vs. 24 months, P = 0.0408). Eleven publications describing liver resection for LMUM were identified and included in the narrative review. Surgery for LMUM is safe and complements multidisciplinary management. Despite heterogeneity in literature, time from diagnosis of uveal melanoma to LMUM remains a key factor affecting survival after liver resection.

Educational Value of Surgical Multidisciplinary Team Meetings for Learning Non-Technical Skills - A Pilot Survey of Trainees From Two UK Deaneries.

OBJECTIVE: This prospective survey study aimed to identify trainee surgeons' views on the educational potential of multi-disciplinary team (MDT) meetings for learning non-technical skills and relevant issues around using MDT meetings as an educational instrument. DESIGN: An online survey questionnaire containing eight closed and three open-ended questions; was developed based on established educational theories. Responses were anonymous. SETTING: This survey study was designed as professional project for masters in medical education degree at Warwick University. The study received ethical approval from the Biomedical Science Research and Ethics Committee of Warwick University. PARTICIPANTS: Trainee surgeons and non-trainee junior surgical doctors within two regions (Health Education Kent Surrey and Sussex, Health Education Wessex) in the UK were invited through an email to take the survey with the help of regional heads of surgery and coordinators. RESULTS: Twenty eight (28) out of 420 invitees completed the survey. High internal consistency was observed for questionnaire (Cronbach's α = 0.924). 71.42% (20/28) respondents attended MDT at least once a week. 75.9% of participants indicated the importance of attendance to MDT meetings with any level of involvement; passive attendance considered the least important (5/28, 17.9%, p=0.005). Trainees felt included in the team by attendance to MDT meetings (Median score 5, p=0.027). MDT meetings were considered important for learning all domains of non-technical skills for surgeons taxonomy (cumulative mean score 2.4, p=001). Respondents considered MDT as a valuable tool for learning non-technical skills for surgeons on Miller's pyramid for learning (Cumulative mean 5.6, p=0.025). Free text answers indicated agreement to the learning opportunity provided by MDT meetings. Consistent suggestions of increasing trainee participation were obtained. CONCLUSION: Results indicate consistently positive views from trainees about the educational value of MDT meeting in general and for non-technical skills. Trainee participation, in the form of case-preparation, presentation, and discussion are recommended by respondents.