Improving outcomes for patients following colorectal cancer surgery
Aims
Surgery to remove a portion of the bowel is a common treatment for colorectal cancer. A temporary stoma is often formed to divert the faecal contents to a ‘bag’ to allow bowel recovery and chemotherapy if necessary. It was not known what changes occurred in the bowel as a result of this surgery, or whether reversal success is impacted by the length of time the stoma was in place.
Overview
In early 2012, the Lancashire Teaching Hospitals Trust (LTHTR) research support team contacted me on behalf of a team of colorectal surgeons who wanted to utilise some tissue that would normally be discarded during stoma reversal surgery carried out in recovering colorectal cancer (CRC) patients. We gained pilot data from historic tissue samples and obtained a small amount of funding from the Research Design Service (RDS), to allow us to host a Public and Patient Involvement (PPI) event at LTHTR to gather feedback from patients who had experienced, or were due to undergo, this surgery. In 2014, we secured funding from Bowel Cancer Research to assess the impact of stoma formation on the ‘defunctioned’ bowel. This enabled us to gain additional tissue samples and recruit a PhD student. Further analysis, identified as of particular importance to patients, suggests that delaying stoma reversal surgery in CRC patients does not impact on success and that the changes seen in the bowel occur soon after stoma formation, with no ongoing atrophy or intestinal damage. We are currently seeking funding to complete this study and to support a clinical trial into whether we can improve the health of the bowel prior to reversal surgery.
Results and Outcomes
Tab Content: For Partners and Engagement
The initial idea for this project came from surgeons who were looking to utilise intestinal tissue that was being discarded following surgery and asking whether we could discover any insights into the physiological processes occurring through analysis of these tissues.
We assessed multiple features of the intestine from both ‘functioning’ and ‘defunctioned’ areas, including atrophy relating to function (such as cell division and cell death) and the microbiota. The microbiota (microbes that live within us) play an important role in maintaining gut health. We saw major differences in the function of these tissues, which we attribute, at least in part, to the dramatic depletion of the microbiota that we observed in absence of food, which could impact on the recovery of the intestine. Our research is important for the development of better ways to prepare the intestine for surgery. By ‘prepping’ the intestine we should be able to improve the success of surgery and reduce the number of patients who require a permanent stoma. Our collaboration enabled NHS surgeons to publish their research in a scientific journal (Beamish et al. 2017) and to gain competitive funding in an area of research that is not normally well funded.
Tab Content: For Academics
We were approached by an NHS research team on behalf of a team of surgeons who were looking to utilise intestinal tissue that was being discarded following surgery. We obtained NHS ethical consent to analyse these tissues and the microbiota from both functional and defunctioned intestine.
Our preliminary data enabled us to gain funding for a PhD studentship, which allowed us to assess multiple parameters in the functioning and defunctioned bowel, including atrophy, caused by a decrease in proliferation, and a reduction in the diversity of the microbiota. We hypothesised that the significant differences in the physiology and function of these tissues was due to depletion of the microbiota in absence of enteral nutrient, or food. In 2016, that PhD student won award for Best Oral (and Poster) Presentation following 2 years of ‘Runner Up’ Prizes at the annual Research Innovation Showcase at LTHTR and in 2017, we published the results of the initial study (Beamish et al. 2017) in Gut Microbes.
This research is important for the development of better ways to prepare the intestine for surgery and reduce the proportion of patients who require a permanent stoma, currently around 1 in 5. Funding applications to develop this study to improve the success of surgery, reduce complications and the number of patients who require a permanent stoma are ongoing.
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