Royal Surrey research team looks to improve high-risk cancer surgery | News

A team of researchers at Royal Surrey has found that the use of minimally-invasive robotic surgical techniques in pelvic exenteration (PE) surgery, can cut the morbidity rate associated with this high-risk surgery, while achieving the same surgical outcome.

PE surgery is considered in certain cases of recurrent gynaecological cancers where other measures such as chemotherapy or radiotherapy have failed. Historically, this surgery is considered as a last resort due to its high morbidity rate, and is only applicable to a relatively small group of patients.

The team’s findings are detailed in a paper published recently in the European Journal of Obstetrics & Gynaecology and Reproductive Biology. The paper highlights the technical feasibility of minimal access PE as well as patient recovery and short-term outcomes, although long-term oncological outcome data remains unreported.

The paper was authored by an 11-person multi-disciplinary team. Ten members of the team are based at Royal Surrey. Rebecca Karkia, Anil Tailor, Patricia Ellis, Thumuluru Madhuri, Simon Butler-Manuel and Jayanta Chatterjee are from the Academic Department of Gynaecological Oncology, while Andrea Scala and James Read represent the Department of Colorectal Surgery, and Matthew Perry and Krishna Patil are from the Department of Urology. The team also includes Adam Blackburn from the Department of Plastic Surgery at Queen Victoria Hospital NHS Foundation Trust in West Sussex.

Professor Jayanta Chatterjee chairs the multi-disciplinary team, and co-authored the paper. “For decades PE has been carried out as an open surgical procedure,” he said. “The procedure invariably causes high blood losses, post-operative infections and other complications. Because of this, it is considered unsuitable for most patients, and often avoided due to the high morbidity.

“Our research has found that the risk of post-operative complications can be lowered by the use of robotic minimally-invasive techniques instead of the traditional open technique. Using the minimally-invasive technique leads to demonstrably quicker recovery times for patients, and much lower blood loss. Consequently, there is a reduction in post-operative complications and morbidity.

“That said, we are unable to make any definitive recommendations at this stage due to the fact that these are very rare procedures, and the number of cases is so small. But what we have shown is that minimally-invasive PE surgery is feasible and safe. We can say that we are very optimistic, because in this small first case series, we didn't find any major negatives.”

The findings demonstrate the value of Royal Surrey’s multi-disciplinary approach to cancer research.

“Royal Surrey’s position as a Centre for Cancer and Robotic surgical excellence means it is quite easy to discuss the cases across different disciplines, which is essential in order to conduct this kind of surgical research,” said Professor Chatterjee.

“Knowing that you have expertise in robotics surgery across colorectal, urology and gynae-oncology, with the addition of plastic surgery under one roof, is hugely beneficial to our patients. This multi-disciplinary working means, we can easily speak to each other, and our patients can see everyone in one place.”