Clinical Research Office. A partnership between Sheffield Teaching Hospitals NHS Foundation Trust and the University of Sheffield

General Surgery

Key Contacts

Name

Role

Mr Steven Brown

Research Lead

Mr Simon Boyes

Clinical Director

Sue Gregory

Operations Director

Simon Thurman
Service Manager
Dr Debby Hawkins

Directorate Research Coordinator

Luke Barron
Clinical Research Office Coordinator
(Portfolio & Non-Portfolio Studies)

Gaurika Kapoor
gaurika.kapoor@sth.nhs.uk

Clinical Research Office Coordinator (Industry-Sponsored Studies)


Introduction

The general surgical directorate is diverse with numerous subspecialities following different research agendas. There are 4 main subspecialities. The breast unit with a strong academic University presence, the endocrine unit, the upper gastrointestinal and hepatobiliary unit and the colorectal unit. Although superficially the unit would appear to have a small project funding income, the ratio of income to output is probably the highest in the Trust.

Research Strategy

Much of the clinical work in Breast Surgery focuses on the care of patients with a variety of forms of solid cancer and substantial numbers of these patients are recruited to portfolio studies as part of the National Cancer Research Network and may not be represented within the General Surgery portfolios.

The Academic Unit of Surgical Oncology (Professor M W R Reed, Miss L Wyld and Mr S Balasubramanian) has developed a strong programme of research in breast cancer, soft tissue sarcoma and the tumour microenvironment. The Unit comprises of a number of clinical surgeons and basic scientists working collaboratively on the above programmes. The main clinical focus in breast cancer is the management of older patients who where it is recognised there are inequalities both in terms of diagnosis and treatment. Professor Reed and Miss Wyld have developed a number of national portfolio studies in this area. Soft tissue sarcoma and endocrine oncology are developing areas of research, the latter strengthened by the appointment of Mr S Balasubramanian to a prestigious NIHR Clinical Lecturer Fellowship jointly between the STH Trust and the University of Sheffield.

The basic science programme involves research relating to the tumour microenvironment (angiogenesis and genomic instability) and the Unit has contributed to the highly successful breast cancer association consortium with publications in Nature, Nature Genetics and the JMCI.

The Academic Unit of Surgical Oncology has close links with NHS colleagues, jointly supervising research projects for surgical trainees.

Regarding the non-academic section of the general surgical directorate we have had to accept that within these areas there is minimal potential for portfolio studies and therefore limited access to project funding income available. Working within these confines demands novel mechanisms of funding. Sponsorship of clinical fellows is possible through Thornbury Hospital and collaboration with other academic units. For other research there is a strategy of keeping costs to a minimum. This may involve collaboration with other specialties or with other centres that have resources available. ‘Homegrown’ projects initiated through junior staff are encouraged and supported by the directorate.

Research Topics and Leaders

  • Breast Cancer - Prof Malcolm Reed, Miss Lynda Wyld
  • Tumour Microenvironment - Prof Malcolm Reed, Miss Lynda Wyld, Prof Nicola Brown, Prof Gillian Tozer, Prof Graham Pockley.
  • Endocrine Oncology - Mr Sabapathy Balasubramanian
  • Colorectal - Prof R Nelson, Prof Andrew Shorthouse, Mr Kevin Chapple, Mr Steven Brown

Topic 1: Breast Cancer/Soft Tissue Sarcoma

Research Direction

Management of breast cancer in older women and surgical choices in breast cancer.

Current And Recent Grants

  • NIHR Research for Patient Benefit - £228,299. Breast cancer screening in older women: who will benefit from screening and who will benefit? Wyld, Reef – 2007 – 2009
  • Yorkshire Cancer Research - £118,154. The relationship between vascular endothelial growth factor and tissue factor in breast cancer.
  • Yorkshire Cancer Research - £171,977. Variation in the apoptosis genes and susceptibility to common cancers. Cox, Reed – 2007-2010
  • Cancer Research UK - CTAAC £300k. BRESDEX – A decision support aid for patients with breast cancer. This is a collaborative project between the Universities of Sheffield, Cardiff and Oxford. It is a study to develop a decision support tool to aid women making a choice between mastectomy and wide local excision in the treatment of primary breast cancer.. Joint Principal Investigator and Co applicant - 2007 to 2010
  • Weston Park Cancer Appeal £133.383K. Molecular Characterisation of Soft Tissue Sarcomas. Principal Investigator - 2008 to 2010.
  • Sheffield Hospitals Charitable Trust – Grant Support £49,243K. Regulation of Angiogenesis initiation and regression in wound healing

Important Publications

  • Leonard R, Barrett-Lee P, Willett A, Gosney M, Reed MWR, Hammond P. National consultation on the effect of patient age on management decisions in breast cancer. Breast Cancer Consultation Group, August 2009
  • Ul-Hassan A, Sisley K, Hughes D, Hammond D, Robinson M, Reed M. Common genetic changes in leiomyosarcoma and GIST – implication for ATM involvement. International Journal of Experimental Pathology 2009; 90; 5: 549-57
  • Ahmed S, Thomas G, Ghoussaini M, Reed, MWR et al. Newly discovered breast cancer susceptibility loci on 3p24 and 17q23.2. Nature Genetics 2009; 41; 5: 585-90
  • Milne, RL, Benitez JB, Nevanlinna H, Reed MWR et al. Risk of estrogen receptor positive and negative breast cancer and SNP rs13387042 on 2q35. Journal of the National Cancer Institute 2009; 101 (14): 1012-1018
  • Shephard N, Abo R, Reed MWR, et al. A breast cancer risk haplotype in the caspase-8 gene. Cancer Research 2009; 69 (7): 2724-8
  • Reed MWR, Wyld L, Ellis P, Bliss J, Leonard R. Breast Cancer in Older Women: Trials and Tribulations. Clinical Oncology 2009; 21: 99-102
  • Reed MWR, Audisio RA, Wyld L. The role of surgery in the treatment of older women with breast cancer. Clinical Oncology 2009; 21: 103-110
  • Menakuru SR, Brown, NJ, Staton CA, Reed MWR. Angiogenesis in pre-malignant conditions. British Journal of Cancer 2008; 99: 1961-1966

Topic 2: Tumour Microenvironment

 

Topic 3: Endocrine Oncology


Research Direction

The strategy of the Endocrine Surgical Unit is to focus on research aimed at facilitating the early detection and treatment of rare endocrine tumours (affecting the thyroid, parathyroid, pancreas and adrenal glands). The unit undertakes both routine and complex endocrine surgery and receives tertiary referrals from across the region.

We have recently appointed a NIHR funded Senior Lecturer to provide an impetus to ongoing clinical and translational research. The focus of research will be in the following areas:

  • Identification of genetic and environmental factors predisposing to differentiated Thyroid Cancer
  • The role of Calcitonin screening for Medullary Thyroid Cancer
  • Exploration of the feasibility of Sentinel Lymph Node biopsy in Thyroid Cancer

Current And Recent Grants

  • NIHR Senior Clinical Lecturership funding for five years
  • Important Publications
  • Management of Retrosternal Goitre. Hardy RG, Bliss RD, Lennard TW, SP Balasubramanian, BJ Harrison. Annals of Royal College of Surgeons of England 2009; 91:8-11
  • Surgery for Adrenocortical Cancer. BJ Harrison. Annales d’Endocrinologie 2009; 70:195–6
  • Intraoperative Adjuncts in Surgery for Primary Hyperparathyroidism. BJ Harrison and F Triponez. Langenbecks Arch Surg 2009;394:799-809
  • Positional statement of the European Society of Endocrine Surgeons (ESES) on modern techniques in pHPT surgery. Bergenfelz AO, Hellman P, Harrison B, Sitges-Serra A, Dralle H. Langenbecks Arch Surg 2009;394:761-4
  • How is adrenocortical cancer being managed in the UK? Aspinall SR, Imisairi A, Bliss R, Scott-Coombes D, Harrison B, Lennard T. Ann R Coll Surg Engl 2009;91:489-93
  • What Steps Should be Considered in the Patient who has had a Negative Cervical Exploration for Primary Hyperparathyroidism? BJ Harrison. Clin Endocrinol (Oxf). 2009;71:624-7
  • Management of Medullary Thyroid Cancer. Journal of ENT Masterclass 2009; 2:22-5
  • Commentary on ‘Parathyroidectomy is safe and improves symptoms in elderly patients with PHPT’. BJ Harrison. Clin Endocrinol (Oxf) 2009; 71:766-7

Topic 4: Colorectal

Research Direction

The unit remains committed to producing Cochrane reviews on various topics within coloproctology. Over 5 topics are published or updated each year by Prof Nelson and Mr S Brown.
Cancer research collaboration is with the nutritional department with clinical fellows through Thornbury Hospital supervised by Mr S Brown and Mr K Chapple.
As a department we remain committed to multicentre trials (for instance on stents and chemotherapy) in collaboration with Western park Hospital.
Previous and ongoing research on colonoscopy techniques is in collaboration with the gastroenterology unit, whilst pelvic floor research is carried out using a clinical fellow sponsored through Thornbury and a trainee physiologist through the physiology lab and DeMontford University.
Collaborations through the Hallam University include projects on surgical devices and gloves through Prof AJ Shorthouse and Mr S Brown as well as bowel nerve pathology through IJAdam.
Regular research meetings with the junior staff encourage ‘homegrown’ projects and offer support and advice.
Current grant applications are ongoing through The Royal College of Surgeons, The Association of Coloproctology and the HTA.

Current And Recent Grants

  • Trustees grant (£49932) ‘Electrophysiology and immunohistochemical study of human intestinal afferent nerves’
  • Important Publications
  • Surgery for obstructed defecation: does the use of the Contour device (Trans-STARR) improve results? Wadhawan H, Shorthouse AJ, Surgeon C, Brown SR Colorectal Dis (In press)
  • Long-Term Failure and Function after Restorative Proctocolectomy - A Multi-Centre Study of Patients from the UK National Ileal Pouch Registry Tekkis PP, Lovegrove RE, Tilney HS, Smith JJ, Sagar PM, Shorthouse AJ, Mortensen NJ, Nicholls RJ. Colorectal Dis (In press)
  • Postoperative management after loop ileostomy closure: are we keeping patients in hospital too long? Baraza W, Wild J, Barber W, Brown S. Ann R Coll Surg Engl 2010 Jan;92(1):51-5