Surgical research in cancer

Capacity issues in UK surgical research

Surgery is an important part of many cancer patients’ journeys, and the NCRI 2008–2013 strategic plan raised concerns about the UK’s capacity to undertake surgical research. Analysis of the NCRI’s Cancer Research Database showed a low overall volume of surgical research in cancer. This parallels the situation in surgery beyond cancer, as the Royal College of Surgeons of England (RCS England) found in their 2011 publication.

» RCS England report on overcoming barriers to innovation in surgery, 2011 (PDF)

NCRI has launched the Future of Surgery workshop series, bringing together experts to deal with challenging, cross-specialty topics and influence the future of surgery research in cancer. Five workshops will took place between May 2016 and March 2017, each will produce a report that brings together expert opinion and identifies potential next steps for surgery research in cancer. The first and second workshops were covered in editorials in The Lancet.

» The Lancet editorial, 1 October 2016, “How can registries and innovation improve surgical care?” (external website)

» The Lancet editorial, 14 May 2016, “The struggle for better research in surgery” (external website)

The workshops will not be one-way education from those speaking to those attending. Instead, they will take the form of expert working meetings, drawing on the expertise of all those attending to build consensus, identify gaps in knowledge, or propose ways that things could be done differently in surgery research in cancer. Workshop leads have now been appointed. The five workshop topics and dates are:

  1. 4 May 2016: Outcome measures in surgery studies, led by Mr Angus McNair.  Looking beyond overall survival, what are the key surgical endpoints? Powering studies to make endpoints statistically meaningful and change surgical practice.
    » “Trials are only as credible as their endpoints”: Defining the future outcomes surgical research
  2. 20 September 2016: Technology trials in surgery, led by Mr Stephen Price. Discussing the evidence required prior to introduction of new technologies into surgical practice. Ways to incentivise surgeons to evaluate new technologies.
    » “Technology Trials in Surgical Oncology”: What evidence is required prior to introduction of new technologies into surgical practice?
  3. 23 November 2016: Selecting patients for surgery, led by Ms Lynda Wyld. Algorithms to predict benefit and identify which patients will benefit from surgery. Frailty in cancer surgery – how can surgeons design and select tools for clinical application, and determining prevalence of frailty? Decision support tools for patients.
    » Selecting patients for surgery
  4. 17 January 2017: Extent of surgery, led by Mr Stuart McIntosh. Designing and delivering pre-surgical trials; Role of surgeons in window of opportunity studies; How to evaluate the extent of surgery in clinical trials
    » Extent of Surgery and peri-surgical trials
  5. 21 March 2017: Surgery for metastatic disease, co-led by Mr Prasanna Sooriakumaran & Mr Hassan Malik. Resection of metastatic disease; Surgery vs systemic therapy;Surgical and other loco-regional treatment of metastatic disease to lung, liver, bone and brain; Management of the primary tumour in the presence of metastatic disease; Imaging metastatic burden
    » Surgery for Metastatic Disease

The plan for each workshop has been overseen by the NCRI Future of Surgery steering committee, which includes senior research surgeons and an NCRI representative, to ensure it fits with the overall programme of events. NCRI Future of Surgery steering committee

  • Professor Richard Shaw
  • Professor Nigel Bundred
  • Mr Simon Bach
  • Mr Grant Stewart
  • Dr Seema Alexander
In 2012, NCRI produced a report summarising the setting for surgical cancer research activity in the UK, and identifying opportunities for action. Surgeons face a different set of challenges to other cancer researchers, such as difficulty taking time away from the operating theatre to do research, and limited exposure to academic leadership during training. As a result, the culture of research is weaker than in some other medical specialties that are involved in cancer treatment. Nonetheless, UK surgeons have delivered a number of large, landmark trials in cancer, and there are some very motivated surgical researchers taking on studies at present. The challenge is how to increase the number of active researchers in surgery, so that more trials can be delivered and the next generation of surgeons can acquire research skills. The report proposed a number of ideas to build momentum within the surgical community, and NCRI will be working with stakeholders to take these forward over the coming years.

» NCRI report on surgical research, 2012 (PDF)

NCRI has collated funding opportunities for surgeons to undertake research, in one easy-to-navigate document. Opportunities from our NCRI Partners, the Academy of Medical Sciences and the surgical Royal Colleges are included. Although the list is cancer focused, many opportunities are not exclusive to cancer. Funding is available for surgeons at all career stages to carry out both clinical and lab-based research.

» A surgeon’s guide to research funding, October 2013 (PDF)

NCRI organised a one-day meeting to bring surgeons from across the Clinical Studies Groups (CSGs) together in April 2014. Surgeons gave updates on surgery research and initiatives in their CSGs, which were set in wider context by talks from the Royal College of Surgeons, England, a clinical trials unit and a consumer representative. Surgeons held a concluding discussion at which they identified several cross-specialty topics that require progress and are exploring options for working together to advance these areas.

» Synopsis of NCRI surgeons’ working meeting, April 2014 (PDF)