Surgical research in cancer

Surgery plays a prominent role in cancer care; achieving half of all long-term cures and providing the cornerstone of treatment for most solid malignancies. However, a previous report carried out by the NCRI highlighted a specific paucity of research in the field of cancer surgery with a recommendation that steps be taken to accelerate the development of surgical cancer research and support the sharing of research skills amongst surgeons using existing structures.

In response to this an advisory group was convened, comprising a surgical representative from each of the site-specific NCRI Clinical Studies Groups.  The role of this group was to prioritize themes for a series of five workshops with an overarching title “Future of Surgery” (see Table 1).

Table 1: Future of Surgery Workshops

1. “Trials are only as credible as their endpoints”: Defining the future outcomes of surgical research
2. “Technology trials in surgical oncology”: What evidence is required prior to introduction of new technologies into surgical practice?
3. “Selecting patients for surgery”: Decision making, informed choice, fitness and frailty stratification and measurement.
4. “Extent of surgery and peri-surgical ‘window-of-opportunity’ trials”
5. “Surgery for metastatic disease”

These themes represented trial paradigms and challenges unique to surgery. Each workshop developed a cross-cutting agenda that aimed to share existing skills and experience, but also identify gaps in knowledge. The workshops brought together key stakeholders including patients, publishers, charities, funders, and clinicians (including surgical trainees) and were conducted over 2016/17.

The following paper highlights the methodological challenges and priorities for research in surgical oncology that arose from these workshops.

» Future of Surgery – Report of the NCRI Series of five Workshops

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)

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)