The Dukes’ Club Executive Committee Representatives Deadline for applications – 1st October 6pm

 

We are accepting applications for The Dukes’ Club for the following roles:

  • Abdominal Wall Representative
  • Advanced Cancer & Peritoneal Malignancy Representative
  • Association of Surgeons in Training (ASiT) Representative
  • Education & Training Representative
  • Emergency General Surgery Representative
  • JAG & Colonoscopy (Endoscopy) Representative
  • Inflammatory Bowel Disease & Intestinal Failure Representative
  • Research & Audit Representative
  • Robotics Representative
  • The Pelvic Floor Society Representative
  • Proctology Representative
  • Secretary
  • Webmaster and social media

The generic and specific responsibilities of each role are outlined in the role specific documents and Constitution found at https://www.thedukesclub.org.uk/about/constitution/

In brief, each role is held for 1 year and the successful applicant will be expected to engage with The Dukes’ Club and relevant ACPGBI/external organisation committees to further interests of colorectal trainees in the UK and Ireland.

Criteria

  • Training grade doctor
  • Dukes’ Club / ACPGBI Associate Member

To apply, please send the following details to president@thedukesclub.org.uk

  • Name, ACPGBI Membership number, contact details including email & phone number
  • 200-word anonymous personal This should include your vision for the role and may include skills, attributes, previous experience, etc.

Review Process

All applications will be reviewed centrally by the Dukes’ Club Secretary to ensure adherence to requirements. Applications will be anonymised by removal of all personal identifiers (name, email address, ACPGBI membership number). Anonymised applications will be put to an online vote of all current Dukes’ Club members from 2nd October – 8th October 2023. Successful applicants will be informed thereafter.

Clinical Fellow in Abdominoplastic Surgery

Wirral University Teaching Hospital and Whiston Hospital Trust

More information about this job 

Applications are invited for an exciting opportunity for a peri-CCT or overseas equivalent general surgery trainee to undertake the full time post of Clinical Fellow in Abdominoplastic Surgery within the General Surgery directorate at Wirral University Teaching Hospital and Whiston Hospital Trust.

This is a truly unique opportunity providing general surgery complex hernia experience along with sub specialist abdominal wall reconstruction experience with training from both a general surgical and plastic surgical perspective. The post will prepare the post holder to take up independent practice as a future consultant general surgeon with a subspecialty interest in complex abdominal wall surgery.

The post holder will also have an honorary contract at Whiston Hospital which will allow them to work in the regional plastic surgery unit to gain experience in plastic surgery of the abdominal wall.

This post is available from January 2022 for 12 months. It is are aimed at peri-/post-CCT trainees who have completed their general surgery training.

Applications from suitably qualified international trainees are also welcomed.

 

The post will commence in February 2023.

 

Informal enquiries may be made via switchboard 0151 678 5111 x2220 or email

Mr Ciaran Walsh, Consultant Colorectal Surgeon at ciaran.walsh@nhs.net

Or email

Mr Greg Simpson, Consultant Colorectal Surgeon at gregory.simpson4@nhs.net

Our Paper of the Month for August aims to summarise and analyse the outcomes associated with completion surgery and undertake a comparative analysis with primary rectal resections.


Completion total mesorectal excision after transanal local excision of early rectal cancer: a systematic review and meta-analysis
DOI: 10.1097/DCR.0000000000002407
Journal: Diseases of the Colon & Rectum Volume 65: 5 (2022)


What is known about this subject?

Rates of transanal excision (TAE) of early rectal cancers are increasing as a means of organ preservation in a select group of patients. Historically, these cT1-2 cN0 tumours were treated by rectal resection with total mesorectal excision (TME). However, TAE may offer benefits in terms of lower morbidity and equivalent oncological safety. Despite this, some tumours resected by TAE may reveal unfavourable, high-risk features or signs incomplete resection which necessitate completion TME surgery. In such cases there have been concerns raised regarding the impact of the inflammation and fibrosis caused by TAE on the quality of the subsequent completion TME. This systematic review and meta-analysis by Wyatt et al. looks to synthesis the evidence relating to completion TME following previous TAE. They also seek to compare primary TME with completion TME in this setting.

Design

Systematic Review and Meta-analysis

Study selection

Papers reporting the outcomes of patients undergoing completion TME following previous TAE for early rectal cancer. Indications for TAE were individually defined by each author group up to a maximum staging of T2N0. Studies reporting TAE by flexible endoscope, palliative procedures and case reports were excluded

Outcome measures

Primary – histopathological specimen quality, long-term survival, and recurrence rates.
Secondary – operative time, abdominoperineal excision of rectum (APER) rate, intraoperative blood loss, postoperative morbidity, conversion to open rates, length of stay, and 30-day mortality rates.

Search strategy

Databases included PubMed, Cochrane library, MEDLINE, and Embase from 1990
to April 2021.

Key results

  • Twenty-three studies (14 retrospective observational, 9 case-control, no RCTs) including 646 patients were eligible. 8 studies were included in the meta-analyses.
  • Most reported transanal endoscopic microsurgery (TEM), some reported TAMIS and some reported resection with a transanal retractor only.
  • Weighted average for time between TAE and completion TME was 6.8 weeks
  • Completion TME was associated with incomplete mesorectal specimens (risk ratio, 3.06; 95% CI, 1.41–6.62; p = 0.005) but there was no difference in the R1 resection rate.
  • Completion TME led to lower lymph node yields (standardized MD, –0.26; 95% CI, –0.47 to 0.06; p = 0.01)
  • Rates of APER were higher in the completion TME group but this was not significant (RR, 1.22; 95% CI, 0.97–1.55; p = 0.09)
  • Blood loss and operative time were higher in the completion TME group.
  • There was no significant difference in rates of intraoperative conversion to open, or in complication rates, or in 30-day mortality between primary and completion TME.
  • The weighted average of residual disease in completion TME specimens was 35% for 423 patients
  • No difference in local or systemic recurrence was found and there were no significant differences in 3- or 5- year survival between primary and completion TME.

Implications for colorectal practice?

With the increase in TAE for early rectal cancer and the increase in watch and wait programmes colorectal surgeons need to be prepared to undertake completion TME in the event of unfavourable TAE specimen characteristics. This paper provides evidence to suggest that whilst morbidity and survival might be comparable between primary and completion TME we need to be aware of the risk of reduced lymph node yield and incidence of an incomplete TME. The study is limited by the quality of the available literature, particularly the lack of randomised trials. This may reflect the low incidence of completion TME in this setting. Consequently, the conclusions relating to survival and recurrence should be treated with caution. Data relating to stoma rates between groups would also have been noteworthy. Nevertheless, patients should be counselled regarding the risks and benefits of organ preservation in early rectal cancer and should be informed of the outcomes relating to completion TME if this is later required.

Clinical Research Fellows

Imperial College, London.

The closing date is 11 August 2022

Apply for this job 

3 funded PhDs in colorectal surgery are coming up at Imperial College, London starting in April – projects in colorectal cancer, microbiome and pelvic floor.

On calls in general surgery at Charing Cross Hospital.

https://www.imperial.ac.uk/jobs/description/MED02852/clinical-research-fellow-x-3

 

For questions about the job, contact:

Ukraine Crisis

As events continue to unfold in the conflict in Ukraine, we would like to express our support for those affected by the crisis. Further information and support can be found at:

Our website’s Covid 19 section also has signposts to wellbeing support.

Senior Clinical Fellow – Colorectal

North Middlesex University Hospital NHS Trust

The closing date is 07 June 2022

Apply for this job 

Applications are invited for the post of Senior Colorectal Fellow for 12 months based in the North Middlesex University Hospital. This post has been approved by the Royal College of Surgeons and the Association of Coloproctology of Great Britain & Ireland as part of the RCS Senior Clinical Fellowship Scheme.

 

Main duties of the job

Applications are welcomed for a Senior Colorectal Fellow ST7+ (peri or post-CCT). This is a fixed-term post to start in October 2022.

For questions about the job, contact:

Lee Dvorkin

lee.dvorkin@nhs.net

07785522900

Applications are welcome for the post of a research fellow in the pelvic floor unit at St Mark’s Hospital, London.

St Mark’s Hospital is the only specialist GI hospital in the UK, with a world-renowned reputation for the management of complex GI disorders and research.  The successful applicant will be expected to work towards an MD (Res) or PhD via Imperial College, London. The post carries a salary and has a strong clinical component which will allow the fellow to also gain a thorough understanding of pelvic floor disorders and their management.  They will be supervised by Miss Carolynne Vaizey and Mr Gregory Thomas.

Please contact Mr Gregory Thomas for further information (gregorythomas1@nhs.net).

Our Paper of the Month for April looks at the largest study of pregnancy outcomes after stoma surgery for inflammatory bowel disease.


Pregnancy outcomes after stoma surgery for inflammatory bowel disease: The results of a retrospective multicentre audit
The PAPooSE Study Group
https://doi.org/10.1111/codi.16098
Journal: Colorectal Disease 2022;00:1-7


What is known about this subject?

Inflammatory bowel disease (IBD) affects up to 500,000 people in the UK. The diagnosis of IBD can frequently occur at a young age and those undergoing surgery can often require stoma formation – either temporary or permanent. There are data relating to the impact of IBD and stoma formation on fertility, but little information exists on the perinatal outcomes of women with a stoma. Potential problems cited in case reports include parastomal hernias, difficulties in attaching stoma appliances and obstructive symptoms. This study by the PAPooSE Group aims to capture data related to the obstetric, neonatal and stoma outcomes of pregnant women with an IBD related stoma.

Design

Retrospective audit conducted across 15 UK centres.

Study eligibility

Female patients with confirmed IBD who had a pregnancy with an existing stoma from 2014 -2020. Those with non IBD related stomas and previous stoma reversal were excluded.

Outcomes

  • Co-primary: Stoma complications and obstetric mode of delivery.
  • Secondary: Week of gestation, birth weight, and congenital abnormalities, IBD flare (change in medical therapy or high output stoma), incidence of intestinal obstruction, stoma prolapse, stoma herniation, and need for further stoma surgery.

Results

  • 82 pregnancies in 77 women were analysed of which 61% had Crohn’s and 35% had ulcerative colitis with 4% unclassified IBD.
  • Stoma types included Ileostomy in 72 (88%) and colostomy in 10 (12%) pregnancies.
  • Biologics were stopped in 20 of 29 cases at a mean of 25 weeks’ gestation. In 45 patients no medical therapy for IBD was required during pregnancy.
  • The overall cesarean section (CS) rate was 73% (n=58, 44 elective and 14 emergency). For reference, the population CS rate is 30.9% in the general IBD population and 29% in all national deliveries. In 19 elective CS, an IBD indication for CS was documented.
  • In 20 (24%) pregnancies, serious stoma-related complications occurred – all in ileostomies. Complications included stoma prolapse (11%, n=9), new parastomal hernia (4%, n=3), small bowel obstruction (9%, n=7).
  • Mean gestation was 37 weeks. 19% delivered before 37 weeks and 17% had a birth weight <2500g. Postpartum haemorrhage occurred in six (7.5%) cases, of which one required surgical intervention. Bladder injuries during CS occurred in three patients.
  • Complications relating to IBD occurred in 11 cases (13%) – IBD flare, perianal sepsis, high output stoma.

Implications for colorectal practice?

This audit is the largest study of pregnancy outcomes after stoma surgery for IBD. It has found that cesarean section rates are significantly higher than the general population and the non-stoma IBD population. However, the rate of emergency CS was similar to the general population. Interestingly, IBD was only documented as the reason in 19 of 44 elective CS. It would be interesting to understand the reason for the remainder. Complications of bladder injury at CS (5%) were also much higher than the population rate (0.1% to 0.3%). Stoma complication rates were also high in the perinatal period with an overall rate for 24%. The quantification of these risks has not previously reported and will provide important information for this patient group. The study is limited by its retrospective nature and its reliance on the accuracy of existing hospital records. However, the information provided will not only assist colorectal surgeons but also obstetric teams and specialist stoma care nurses during consultations with women at an early stage of their pregnancy. Ultimately this should lead improved patient-clinician decision-making around methods of delivery and perinatal care in this patient group.