Ongoing projects

A significant proportion of patients diagnosed with a rectal (final segment of the large intestine) cancer will present with a tumour that is unlikely to be completely removed with surgery alone. Many of these patients will be offered chemotherapy and radiotherapy prior to surgery. There is currently no reliable way to accurately predict which of these patients will respond to treatment, i.e. which cancers will shrink or completely disappear, or which will continue to grow despite treatment.

Surgery on the bowel often leads to postoperative ileus (POI) - a condition in which the bowel “goes to sleep”. In most patients, the bowel soon returns to normal, but in 12% of patients POI is prolonged. This delays recovery and increases the risk of vomiting, constipation, breathing difficulties, and blood clots in the legs and lungs. A new device, GammaCore®, aims to minimise the occurrence of POI by stimulating the nerves to the bowel and reducing the time taken for return of normal bowel function. It is easy to use, has no known serious side-effects and the device can be used at home or in hospital.

We are conducting work on a protein found in abundance in colorectal tumours (Nrf2) which could be used to test for tumours which are likely to be more sensitive to radiation treatment, or indeed manipulated to increase the sensitivity of tumours to radiation treatment

Our proposed research will use an established multi-disciplinary group called ENiGMA (Evaluating goaldirected management of fistulating perianal Crohn’s disease), made up of gastroenterologists, colorectal surgeons, specialist nurses and patients from 5 major teaching hospitals to establish a database of information about patients with fistulating perianal Crohn’s and to create a bank of tissue, faecal and blood samples to help improve understanding of the causes and potential ways of intervening to heal perianal Crohn’s fistulae.

There has been very little work assessing how surgeons make decisions on making a stoma for a patient and the work that has been done has focused on influencing patient factors (e.g. poor health, smoker). This unique work will provide insight into what decision-making tools each surgeon uses to make such an important and life-changing decision.

Rectal prolapse is a distressing condition where the bowel lining prolapses outside the anal canal. Only surgery can cure the problem and surgeons have invented many operations to do this. However, no-one knows which is best. A new operation called a laparoscopic ventral mesh rectopexy seems to be the best but surgeons are worried that the results are not as good as we think and that it may be dangerous if done wrong.

Bowel cancer may sometimes spread to other organs in the body, such as the liver or lungs. While chemotherapy may help prolong survival for these patients, the only possibility of long-term cure is if the cancer can be removed surgically. For many patients, this means facing surgery for the primary cancer in the bowel, surgery to remove part of the liver and also chemotherapy. We do not yet know what is the best way to treat these patients.

An anal fistula is very challenging to treat. It is associated with lower quality of life and problems such as incontinence. Treatment uses a combination of medications and operations. We would like to undertake a clinical trial to improve management, but think that we need more information before we can do this.

We hope that it may be possible from this study to identify mitochondrial genetic markers which could predict how patients will respond to chemoradiotherapy and allow us to tailor their treatment accordingly.