Expertise in general, abdominal, laparoscopic and colorectal surgery

Rectal Cancer

Assessment and management of rectal cancer has become one of the most important areas for research and development in gastrointestinal surgery in recent years. Cancer of the rectum is different from that of the colon because its position deep in the pelvis means we can apply a range of investigations and treatments that are not applicable to colon cancers. Ultimately, this means that decision making is more complex and requires detailed knowledge and experience. Management of these patients tends to be tailored to each individuals needs based on the stage and location of the tumour, medical fitness, quality of life issues and how aggressively cure should be sought. Traditionally, surgery for rectal cancer involved a mutilating operating with a high mortality and recurrence rates of 50%. Steadily over the last two or three decades we have learnt to control recurrences with better surgical techniques and the addition of other treatment modalities such as radiotherapy and chemotherapy. However, this type of surgery remains challenging with a high complication rate. Today, as we increasingly deal with an ageing population with other medical problems, there is a balance to be struck between achieving cure at all costs and offering patients a small compromise in cure rates with a substantially increased quality of life. Certainly, some patients can be considered for organ preserving treatments.

My vision has been to seek out techniques that give the patient the best chance of organ preservation whilst balancing the risks of cancer recurrence. This means in addition to radical surgery, techniques such as local excision, transanal endoscopic microsurgery and neoadjuvant chemoradiotherapy with extended observation can be used. The concept that locally advanced rectal cancer can be cured outright by treatments other than radical surgery was driven by surgeons from Sao Paulo in Brazil. When I visited this centre in 2007, I was convinced that this approach alongside other therapies could result in better outcomes for patients. Their international meeting on rectal cancer, FICARE (Forum Internacional de Cancer do REto) is held every 2 years and I am fortunate enough to have been invited as faculty since its inception.

I am pictured above with my friend and colleague, Professor Angelita Habr-Gama at the FICARE 2011 meeting. The ICENI Centre in Colchester hosts its own international conference on rectal cancer management that has been a great success.

More recently, I have developed and introduced a new approach to operating on rectal cancer. This involves performing the most important part of the operation through the anal canal to gain better views of the anatomy and is part of the natural orifice surgery programme we are working on. Careful introduction of this technique has the potential to improve functional and cancer-related outcomes for patients. I have established a successful training course for senior colorectal surgeons who are interested in learning how to perform this surgery.