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.
Steering Committee: Richard Shaw (Chair), Grant Stewart, Simon Bach, Nigel Bundred
Workshop Chairs: Angus McNair, Stephen Price, Lynda Wyld, Sue Ward, Jenna Morgan, Stuart McIntosh, Prasanna Sooriakumaran, Hassan Malik
NCRI: Victoria Murphy, Seema Alexander
The following paper highlights the methodological challenges and priorities for research in surgical oncology that arose from these workshops.
NCRI report on challenges and opportunities in surgical cancer research
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.