Surgical Oncology

Academic surgeons at the University of Birmingham promote a wide range of research including clinical trials and cohort studies aimed at improving healthcare both locally and worldwide. They are also involved with global surgical training. Current research includes CovidSurg – an initiative launched by the NIHR Global Health Research Unit on Global Surgery to understand the outcomes of COVID-19 infected patients who undergo surgery. 

Theme Lead

Research Groups

Spotlight on the significance of HPV and p16 as prognostic markers in throat cancer

A multinational team led by Hisham Mehanna has just published a paper evaluating the widespread medical practice of using p16 INK4A as a surrogate histology marker to predict whether throat cancers carry HPV infections. HPV-mediated oropharyngeal cancer is characterised by better treatment responsiveness and survival than HPV-unrelated oropharyngeal cancer. However, this new analysis including over 7500 patients revealed a high degree of discordance between these two markers. Furthermore, patients who were found to be p16-/HPV+ or p16+/HPV- had a signficantly worse prognosis than p16-/HPV- patients but a better prognosis than p16+/HPV+ patients. This study concludes that it is necessary to directly measure both p16 and HPV as histology samples in order to offer the best patient care. 

Lancet Oncology (2023). Mehanna H, M Taberna, C von Buchwald, S Tous, J Brooks, M Mena, . . . The HNCIG-EPIC group. Prognostic implications of p16 and HPV discordance in oropharyngeal cancer (HNCIG-EPIC-OPC): a multicentre, multinational, individual patient data analysis. 

Spotlight on abdominal surgery

Lancet 395:417-426 (2020). Bhangu A and Reinforcement of Closure of Stoma Site (ROCSS) Collaborative and West Midlands Research Collaborative. Prophylactic biological mesh reinforcement versus standard closure of stoma site (ROCSS): a multicentre, randomised controlled trial.

The introduction of a simple surgical procedure has led to a 40% drop in the rate of complications involving hernia associated with stoma following abdominal surgery.

In 25% of cases, the closure of abdominal stoma is associated with incisional hernia formation. In this randomised trial, a collagen mesh was inserted at the site of closure following removal of stoma. The reinforcement of the abdominal wall with a biological mesh led to a decrease in the occurrence of hernia from 25% to 15% during the two year follow-up period.

Related Centres

• The Birmingham Surgical Trials Consortium (BiSTC) works in partnership with the Cancer Research UK Clinical Trials Unit and the European Society of Coloproctology (ESCP) to promote surgical trials and the training of surgeons as trial investigators.
• Experimental Cancer Medicine Centre (ECMC)
  Birmingham Experimental Cancer Medicine Centre (ECMC) is one of eighteen adult centres across the UK and is led by Professor Gary Middleton. Jointly funded by Cancer Research UK and the National Institute for Health Research (NIHR), the ECMC Network seeks to accelerate the translation of discovery science into the clinic by promoting rational development and application of novel therapies, providing clinical networks for their evaluation, and supplying linked patient data and samples for future research. The current award period ends in 2022.
• NIHR Global Health Research Unit on Global Surgery 
  Our Global Surgery unit is core funded by the NIHR, led by the University of Birmingham, and supported by the University of Edinburgh and partners in Low and Middle Income Countries (LMIC). The Unit also works closely with the Royal College of Surgeons. The goal is to increase access to safe, affordable surgical and anaesthesia care in low and middle income countries. We work closely with research hubs in sub-Saharan Africa, the Indian sub-continent, South East Asia and Central America.
• West Midlands Research Collaborative (WMRC) 
  The West Midlands Research Collaborative (WMRC) is a surgical trainee-led group that aims to deliver high-quality, multicentre clinical research that has the potential to change clinical practice and improve patient care. 

Selected highlights from this research theme

Clin Otolaryngol  (2023). Mehanna H, B Carter, A Hartley, AK Abou-Foul, J Brooks, J Jones, . . . And Determin Study Management Group. Patient preference for commonly-used, head and neck cancer-specific quality of life questionnaires in the follow-up setting (Determin): A multi-centre randomised controlled trial and mixed methods study.

Lancet Oncology 24:239-251 (2023). Mehanna H, M Taberna, C von Buchwald, S Tous, J Brooks, M Mena, . . . The HNCIG-EPIC group. Prognostic implications of p16 and HPV discordance in oropharyngeal cancer (HNCIG-EPIC-OPC): a multicentre, multinational, individual patient data analysis.

Clin Otolaryngol Online doi: 10.1111/coa.13966 (2022). James TW, MJ Edwards, H Nieto, H Mehanna, P Pracy, C Jennings, . . . P Nankivell. An external validation of C-reactive protein reduction as a predictor of healing following laryngopharyngectomy.

Lancet 397:387-397 (2021). Bhangu A and Global Surgery Collaborative and National Institute for Health Research Global Health Research Unit on Global Surgery. Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries.

European Urology 80:12-15 (2021). Bryan RT, W Liu, SJ Pirrie, R Amir, J Gallagher, AI Hughes, . . . P Patel, ND James. Comparing an Imaging-guided Pathway with the Standard Pathway for Staging Muscle-invasive Bladder Cancer: Preliminary Data from the BladderPath Study.

Comput Med Imaging Graph 88:101853 (2021). Fouad S, G Landini, M Robinson, TH Song and H Mehanna. Human papilloma virus detection in oropharyngeal carcinomas with in situ hybridisation using hand crafted morphological features and deep central attention residual networks.

Oral Oncology 113:105112 (2021). Vreugdenhil M, C Fong, P Sanghera, A Hartley, J Dunn and H Mehanna. Hypofractionated chemoradiation for head and cancer: Data from the PET NECK trial.