Across LHP’s region of Cheshire & Merseyside leading surgeons of many sub-specialities participate in an international research collaboration to establish best practice for cancer surgeries – for both patients and clinical staff – in the COVID-19 era.

The global project, COVIDSurg-Cancer, is a collaboration of more than 2,800 surgeons and anaesthetists from 115 countries delivering a set of studies to collect international data and efficiently inform clinical practice at a time when there is an urgent need to understand the impact of the COVID-19 pandemic on decision making and outcomes for cancer patients.

The NHS surgeon community in Cheshire & Mesreyside has been quick to respond to the many challenges presented by COVID-19 and the Liverpool Health Partner NHS Trusts such as Liverpool University Hospitals NHS Foundation Trust (the Royal and Aintree sites), The Walton Centre NHS Foundation Trust, Liverpool Heart and Chest NHS Foundation Trust have endorsed the study, with their surgeons contributing to its development.

Across LHP’s region of Cheshire & Merseyside there are a large number of patients with cancer requiring surgery on a daily basis, for many of these patients their surgery has currently been deferred or altered given the uncertainty surrounding the COVID-19 pandemic. The COVIDSurg-Cancer study will look at all aspect of cancer care including those patients who undergo surgery and importantly those that have their surgery deferred or adjusted due to the pandemic.

“At the current time there is little evidence to guide surgeons how best to manage their cancer patients, and this valuable project will provide this evidence in a timescale previously unseen in a project of this size”, explains Mr Dale Vimalachandran consultant colorectal surgeon at the Countess of Chester NHS Foundation Trust and the NIHR Surgery Specialty lead for the Northwest Coast.

Each surgical sub-specialty has its own specific challenges and particular questions that need to be addressed so within the CovidSurg-Cancer study sub-specialty specific modules have been developed and surgeons from both regions have been leading the way.

More specifically, surgeons from the Walton Centre  NHS Foundation Trust have developed a brain tumour module for the CovidSurg-Cancer study in conjunction with the Academic Committee of the Society of British Neurological Surgeons and the British Neurosurgery Trainees Research Collaborative. Professor Michael D Jenkinson, Consultant Neurosurgeon at The Walton Centre NHS Foundation Trust and Honorary Professor at the University of Liverpool, commented: “Delaying surgery for patients with brain tumours is not an option, and although surgery is often not curative, it does extend quality of life.  This study is open at The Walton Centre and will allow us to understand the risks of performing brain surgery during the COVID- 19 outbreak, and to determine which patients will get the most benefit.”

A related, neuro-oncology study has been led by Professor Jenkinson of the Walton Centre and his colleagues.  The COVIDNeuroOnc study has also been developed in Liverpool, in conjunction with the Academic Committee of the Society of British Neurological Surgeons and the British Neurosurgery Trainees Research Collaborative.  Professor Jenkinson said:

“Over a 3 month period we will understand how COVID-19 impacts decision making with regards to surgery, radiotherapy and chemotherapy and the impact of this on patient outcomes.”

At the Head and Neck (H&N) Centre , Aintree site of  Liverpool University Hospital Foundation NHS Trust surgeons are also recruiting to the study for their sub-specialty. Professor Richard Shaw and Mr Andrew Schache designed the H& N domain, leading a small international team of H & Nspecialists from the UK, New York, Spain & Australia. Professor Shaw explained: “There is a huge focus on Head & Neck, because H&N cancers present specific additional difficulties that highlight current challenges.”

“We hope that through this new Head& Neck part of the study the first data of which will be released 1^st May, will help us to answer questions such as; ‘Is it safe to operate on cancer in this environment for either patient or doctor?’ and, ‘How long is it reasonable to delay surgery whilst we wait for the ‘storm to pass’?” More information about the exemplar contributions of the H&N Centre to CovidSurg – Cancer can be found here: ttps://www.liverpool.ac.uk/health-and-life-sciences/research-departments/liverpool-head-and-neck-centre/

Lung cancer is one of the four most commonly occurring cancers globally and in the North West there is higher incidence of lung cancer than the rest of the UK. Michael Shackcloth, Thoracic/Lung Cancer surgeon at Liverpool Heart and Chest Hospital (LHCH) is actively contributing to the CovidSurg Cancer study for his subspecialty. Mr Shackcloth described the clinical need for evidence to inform best practice in the COVID-19 era: “In these difficult times, with potential increased risks of surgery, it is uncertain what the best treatment is for the patients.  From studies from elsewhere in the world, we know patients with COVID-19 have significantly poorer outcomes.  This is likely to be more so in lung cancer patients who have limited pulmonary reserve.  Should we delay cancer surgery till the risk of COVID-19 has decreased and risk the cancer growing and spreading, or operate now knowing there is an increased risk?”

“Colorectal cancer is another one of the four most common cancers, there remains a lot of uncertainty regarding whether to operate or whether this should be adopting a minimally invasive approach. Many surgeons are choosing to avoid joining bowel back together such that patients have stomas, which may be the right thing to do in the current crisis, but we just do not have the evidence to guide us. ” Mr Vimalachandran, who has been working with the colorectal module team to develop the data collection tool to answer these questions, added.

More information about the pioneering work within the CovidSurg-Cancer collaboration can be found here: https://globalsurg.org/cancercovidsurg/