Nicola Fearnhead, Chair of ACPGBI's Research and Audit Committee gives an update on their Delphi research programme, along with new trials, published research, NASBO and more.
Delphi research programme
Congratulations to the two Delphi research groups who have been awarded funding from the HTA: Neil Smart for CIPHER on parastomal hernias and Hugh Paterson for the LEGO trial assessing impact of intravenous lidocaine on postoperative ileus.
The ground-breaking patient engagement initiative ORACLE, funded by BDRF, has now been accepted for publication in Colorectal Disease: our thanks to Angus McNair for bringing this project to peer-reviewed publication.
Many thanks to all our members for their positive comments about the update in Edinburgh on the Delphi research programme. The Edinburgh Delphi on the impact of personality and situation on decision-making around anastomoses was clearly a hit – we never anticipated how oversubscribed a research event could be – and we hope to offer our members similar opportunities in the future.
The Rectal Biopsy Group (RRR) met in September to work on their BDRF-funded bid to set up a big biopsy protocol to allow prediction of response to radiotherapy.
The ENiGMA group in perianal Crohn’s disease have held really engaged patient consultations and collaborators meetings in September. Many ACPGBI members have signed up to contribute to a core outcome set in perianal Crohn’s fistula – do watch out for first round emails arriving in last week of October.
The RAPPORT trial in rectal prolapse surgery is preparing a funding bid and has a PPI exercise planned with patients in November 2016.
The Edinburgh meeting hosted a poster round consultation around the Delphi topics of resection of the primary cancer in the palliative setting and of timing of surgery in liver-limited metastatic disease. Both groups continue to make progress and are in discussion with the NCRI Colorectal Subgroup about how to take these important research areas forward.
Dale Vimalachandran’s BDRF-sponsored prospective study HiP of low Hartmann’s or inter-sphincteric APER for rectal cancers where no anastomosis is planned has opened and is now recruiting.
James Hernon’s PREPARE-ABC trial of exercise prehabilitation, funded by HTA, is due to launch on 21st November at RCS (Eng) and will open across multiple centres in 2017.
Jim Hill’s CREST2 trial of covered versus uncovered stents in palliation of malignant large bowel obstruction is set to launch at Birmingham Clinical Trials Unit on 28 November 2016.
Recently published research
Angus Watson presented the results of the eTHoS trial of stapled versus traditional haemorrhoidectomy at ESCP in Milan and the trial has since been reported in The Lancet. Both eTHoS and HubBLe have highlighted the need for assessment of new technologies early before widespread implementation, including cost analysis in resource-constrained healthcare systems worldwide.
Both trials showcase the talent of UK researchers in providing high quality evidence through well-designed trials. In particular, eTHoS selected a really elegant primary outcome that assessed both short and long-term impact on patients, and demonstrated a high level of consultant-delivered surgery, which no doubt contributed to the enviably low number of serious adverse events reported.
As surgeons and innovators, we shall need to balance the need to assess new technology while still encouraging investment from industry to support innovation to improve outcomes for our patients.
National Audit of Small Bowel Obstruction (NASBO)
The ACPGBI’s first prospective national audit will look at outcomes from both conservative and operative management of small bowel obstruction. The pilot study is already underway, and 110 centres have signed up so far to participate.
ACPGBI is indebted to Matt Lee, the SySURG and West Midlands Research Collaboratives for their engagement and leadership in this initiative. We have engaged multiple partners in ensuring the success of this initiative, and look forward to successful running of NASBO in 2017.
The deadline to enter cases in the Ileal Pouch Registry is 31 January 2017 if you want to have your institution’s data included in the Second Ileal Pouch Report planned for Summer 2017.
Work continues on the pouch module on SWORD and members should have access to this later this year. Watch this space.
Clinical outcome publication
Clinical Outcome Publication 2016 will take place on the ACPGBI website on 18 November 2016, and will include individual surgeon and Trust case numbers and 90-day mortality, and Trust case ascertainment and rate of major resection. Publication on NHS Choices will take place in early 2017.
Upcoming research events
The Society of Academic & Research Surgery (SARS) is holding a themed Peri-operative Care Day on Thursday 19th January 2017 at the Royal College of Surgeons in Ireland, Dublin.
The Colorectal Therapies Healthcare Technology Co-operative are holding a meeting on ‘Technologies Driving Precision Medicine ‘on 8 November 2016 at the Royal Armouries Museum in Leeds.
More info on 'Technologies Driving Precision Medicine' (1Mb)
Training researchers in the next generation
The Bowel Disease Research Foundation awarded a grant to the Student Audit and Research in Surgery (STARSurg) collaborative to develop a course for Generating Student Recruiters for Randomised Trials (GRANULE) with the aim to create a generation of early career surgeons who are better equipped to recognise equipoise, communicate uncertainty, and recruit patients to clinical trials. The first course was held earlier this year at the Royal College of Surgeons and was framed around real examples of trials in gastro-intestinal surgery, with 20 medical student delegates and a faculty of chief investigators and trial recruiters. All delegates completed online Good Clinical Practice certification prior to course entry.
The course offered unique training with simulated scenarios and trained actors to allow students to demonstrate their ability to communicate clinical equipoise, risks and benefits and to gain consent for participation in trials. Feedback from participants and faculty was overwhelmingly supportive. Perhaps the time is right to take this nationwide to deaneries and medical schools as a positive role model for encouraging research?