Delighted to announce that today I joined the fantastic team @MTWnhs as a Consultant Colorectal & General Surgeon! Excited to get started at what is a very exciting time for our department, and overwhelmed by the support from my new colleagues across the board. Here’s to 2024!

Hypermutator cancers are defined by increased mutation rates. But do mutation rates evolve with time during tumour growth?⏱️ In this work @NatureGenet we show that hypermutator cancers use an unexpected set of genetic gear switches to adapt mutation rates to immune selection.

Really exciting news this morning that my oncology colleague Dr Vicky Kunene @uhbtrust dosed the first patient in the BioNTech BNT-122 mRNA vaccine trial for personalised therapy in colorectal cancer - @UHBResearch was the first site in UK to do this: bbc.co.uk/news/articles/cl77…

Totally agree. The days of taking someone off to theatre for complications of a hernia or severe abdo pain with no imaging are largely over. We need to be armed with as much info as we can safely obtain to deliver the best outcomes. Rarely that balance will mean an immediate op.

Yes, because it’s not what you get referred that should worry you, it’s what you don’t get referred and is sitting elsewhere, getting worse

Association between anaesthesia–surgery team sex diversity and major morbidity ➡️ doi.org/10.1093/bjs/znae097 In this population-based cohort study of 709 899 patients undergoing major inpatient operations, care in a hospital reaching a critical mass of over 35% female anaesthetists and surgeons was independently associated with 3% lower odds of 90-day major morbidity. Increasing team sex diversity to reach a critical mass of female anaesthetists and surgeons could contribute to improving patient outcomes. Great work by Julie Hallet, Rinku Sutradhar, Alana Flexman, Daniel I McIsaac, François M Carrier, Alexis F Turgeon, Colin McCartney, Wing C Chan, Natalie Coburn, Antoine Eskander, Angela Jerath, Pablo Perez d’Empaire, Gianni Lorello #SoMe4Surgery #MedTwitter #SurgEd #Surgery @RCPSGTrainees @aecirujanos @SEIQuirurgica @iss_sic #MedicalTechniques @BJSAcademy @young_bjs @BJSOpen @des_winter @evanscolorectal @robhinchliffe1 @bplwijn @ksoreide @MalinASund @nfmkok @TejedorPat @paulo_sutt @PVaughanShaw @JJEarnshaw @juliomayol

Important #surgicalresearch piece from @RealDanAshmore - survey on @nelanews leads on #malnutrition and #nutrition in #emlap Room for improvement, challenges identified, and need for primary data. @asgbi @ASGBI_MA @ACPGBI @Dukes_Club @BAPENUK doi.org/10.1111/jhn.13293

Just out in @JNCI_Now: innovative clinical trial design to test multiple radiotherapy research questions using master protocols including @CR_UK funded Leeds-led exemplars: the @PLATOtrial and CONCORDE @LcsmUk trials @LeedsCTRU @CRUKRadnetLeeds @UniversityLeeds @LeedsHospitals

Surgery for advanced neuroendocrine tumours of the small bowel: recommendations based on a consensus meeting of the European Society of Endocrine Surgeons (ESES) ➡️doi.org/10.1093/bjs/znae082 This paper provides evidence-based recommendations on the surgical management of locally advanced and metastatic small bowel neuroendocrine tumours, primary tumour resections in the setting of metastatic disease, and surgical indications for grade 3 small bowel neuroendocrine tumours and small bowel neuroendocrine carcinomas. The recommendations are the result of a working group of experts, created by the European Society of Endocrine Surgeons. The group addressed 11 relevant clinical questions regarding surgery for advanced disease, emphasizing and confirming the key role of the surgeon for advanced small bowel neuroendocrine tumours. Great work by Klaas Van Den Heede, Dirk-Jan van Beek, Sam Van Slycke, Inne Borel Rinkes, Olov Norlén, Peter Stålberg, Erik Nordenström #SoMe4Surgery #MedTwitter #SurgEd #Surgery @RCPSGTrainees @aecirujanos @SEIQuirurgica @iss_sic #MedicalTechniques @BJSAcademy @young_bjs @BJSOpen @des_winter @evanscolorectal @robhinchliffe1 @bplwijn @ksoreide @MalinASund @nfmkok @TejedorPat @paulo_sutt @PVaughanShaw @JJEarnshaw @juliomayol #endocrine @IfsoSecretariat

Important secondary analysis of the OPRA trial with a median f/u of 4 years. This provides important details from a landmark study, and can help guide patient counseling. Of note, it's not broken down to compare induction TNT to consolidation TNT. My analysis is long-winded, and the target audience is surgeons who offer organ preservation to patients with rectal cancer: Patients with a cCR at restaging: 98% offered organ preservation/watch-and-wait (WW), of which 22% experienced local regrowth. Patients with a sustained cCR had a 5% rate of distant metastases. Of the local regrowths, 93% underwent salvage TME and 7% underwent salvage local excision. For these patients, 33% developed recurrence (4% local, 22% distant, and 7% local distant). _______________________________________ Patients with a near-complete CR at restaging: 20 (17.5%) went straight to surgery, of which only 3 (16%) had a pathologic CR (pCR). Recurrence after upfront TME for near-cCR was 30% (15% local, 10% distant, 5% local distant). These numbers were small (n=3 for local recurrence) and should be interpreted with caution. Of the remaining 94 patients (82.5%) who underwent WW, 48 (51%) developed local regrowth. Salvage TME was performed in 34 patients (71% compared to 93% for cCRs). 2 of 34 TMEs (6%) had a pCR. For patients with a near-cCR who developed regrowth after WW, 33% developed recurrence (4% local, 21% distant, 8% local distant). Of the 46 patients (40%) with a near-cCR who remained in the WW program, 13% developed distant metastases (compared to 5% for cCRs). ______________________________________ Patients with an incomplete response at restaging: 88% were offered upfront TME, of which 4/51 (8%) had a pCR. For ICR and upfront TME, recurrence rate was 35% (3.5% local, 21% distant, 10.5% local distant). 8 patients with incomplete response were still enrolled in WW for different reasons, of which 5/8 (63%) developed local regrowth. All 5 underwent TME, and the local recurrence was 20% (1/5). Of the 3/8 that remained in WW without regrowth, 2/3 (66%) developed lung metastases. _______________________________________ Overall, the 3-year organ preservation rate was 77% for cCRs and 40% for near-cCRs. The median time to TME for near-cCRs was 1 year. 3-year DFS was 88% for cCR, 69% for near-cCR, and 56% for incomplete response. _____________________________ For patient counseling purposes: Of the 123 patients with a cCR who were offered WW, the local recurrence rate was 22% (0f which 93% underwent salvage TME) and the rate of distant metastasis was 10.5%. Of the 94 patients with a near-cCR who were offered WW, local recurrence rate was 51% (of which 71% underwent salvage TME) and the rate of distant metastasis was 15%. Of the 57 patients with incomplete response who were offered upfront TME, local recurrence was 14% and the rate of distant metastasis was 32%. @JohnRTMonsonMD @R_Perez_MD @ianmpaquette @JonVogel7 @jendavidsmd @KyleCologne @debby_keller @juliomayol @Neil_J_Smart @FergaljFleming @ScottRSteeleMD @JISBMD

"Hartmann’s procedure no longer has a role in colorectal surgery" is way too strong of a hypothesis. All retrospective data on HP vs protected anastomosis suffers from selection bias. RCTs never worked due to low accrual, which is ALSO selection bias, although appropriate, ie decisions at 2am that "this one is too sick for the trial."

Astonishing that it's taken a TV programme to get the truth about #PostOfficeScandal out to most people. I heard more than 3 years ago when it had already been going on for 20 years. I hope we never see such a blatant miscarriage of justice again. Maybe social media will stop it?

We got through about 10 minutes of #MrBatesVsThePostOffice and had to turn it off. An infuriating injustice, and we knew there would be no happy ending. Just awful.

Fascinating results from the EAGLE study, emphasizing the importance of quality improvement interventions in surgical procedures like right colectomy. Anastomotic leak remains a critical concern, and insights from such a widespread trial can be invaluable. For those seeking expansive explanations or related biomedical reviews, check out sciqst.com – a one-stop platform with AI capabilities to generate comprehensive biomedical literature reviews. It's a free resource that might offer deeper understanding of these findings. #Medicine #Surgery #Colectomy #QualityImprovement #Healthcare

More evidence that we have reached peak "surgical technique" dogma. We cannot improve the mechanics of anastomosis any further. Time to focus on biology patient factors.

Is 3hrs wait (and counting) on the side of the M25 the standard response for a breakdown in a dangerous location @TheAA_UK? Asking for… myself 🚙 💥 🥶 🥶

RT @MarkBagnallSurg: Beware workaholism! Make the time to live not just work. jamanetwork.com/journals/jam…

After an extensive 4 hour grilling, I’ve passed my #PhD. Thanks to my supervisors @rossdavenport, Prof Thiemermann & Dr Jordi L.Tremoleda for all their support. @CommsC4TS @QMULWHRI @QMULBartsTheLon @QMUL_DC

This week marks 20 years for me since matriculation. Choice of beverage has changed. Frission of excitement to see the newly refurbished Reynolds @icsmalumni unchanged. Cheers all!

Interesting study from GRECCAR group suggesting ESD provides better overall survival than TEM for early rectal cancer