The majority of my research has been in the colorectal cancer field. A precis of my Mastership of Surgery is appended below. At present I am conducting a number of clinical projects investigating conservative treatments for anal fissure, survival of the elderly age group following surgery for colorectal cancer and a new operation for pilonidal sinus. In addition I have piloted a new method of patient led follow up for colorectal cancer – all of which have been presented at National meetings and published in peer – reviewed articles (vide infra).
My present research is centered around cytokine expression of colorectal cancer cells in collaboration with the Kennedy Institute (see attached progress report). I continue to publish clinical studies.
My first book on Clinical Surgery with my co-author IJ Franklin is in in 2nd Edition Click Here
MASTERSHIP OF SURGERY (UNIVERSITY OF LONDON) – NOVEMBER 1988
“Histochemical changes at the resection margin and their relationship to
recurrent colorectal cancer
My MS thesis is based on the histochemical changes that occur in the colonic mucosa surrounding a carcinoma. Normal colonic mucosa (as shown by histochemical techniques) secretes mainly sulphomucin whilst surrounding a colonic tumour there is a change to predominant sialomucin secretion. This is called “Transitional mucosa” and may extend for up to 19 cm from the tumour.
Experimental models demonstrating sialomucin can be produced in response to trauma and repair. In a colonic cancer model sialomucin production occurred many weeks before the development of macroscopical tumour, in association with areas of histological dysplasia. Further work demonstrated that sialomucin was also associated with known pre-malignant conditions e.g. chronic ulcerative colitis and colonic polyps.
Detailed studies of 72 colonic cancer specimens demonstrated that sialomucin occurs in the resection margin in up to 20% of cases. This was found particularly so in association with more advanced cases. I found that if the sialomucin band extended more than 3 cms then there was a 70% chance that the tumour has penetrated other adjacent structures. If sialomucin could be demonstrated in the resection margin, therefore, this epiphenomenum might be of use as a “marker” of patients at increased risk of local recurrence.
A prospective multicentre trial between 9 hospitals investigated 358 patients who had a curative resection of their colonic carcinoma. The sialomucin status of their resection margins was known and after a median follow-up of 24 months, 71 patients developed a local recurrence. Multivariate statistical analysis (Cox Models) demonstrated that sialomucin at the resection margin was the most important prognostic variable for the development of local recurrence even above Duke’s staging and histological differentiation of the tumour. I suggested therefore that sialomucin may be of use as a marker of patients at increased risk of recurrence.
One of my former clinical interests was evaluating monoclonal antibodies and radioimmunoguided surgery in colorectal cancer . This technique has now been applied to sentinel node mapping in breast cancer. My large database for colorectal cancer (over 700 patients with prospective survival data) provides for continuing research output. Since joining Charing Cross I have developed a colorectal cancer basic science group in collaboration with The Kennedy Institue and Medical Oncology. I have started to receive small grants and with the pilot data hope to attract major grants to develop and expand this work.