Surgical research

RPA Institute of Academic Surgery 

Research leader: Dr Cherry Koh

In early 2014, an exciting development within academic surgery took place with the creation of the RPA Institute of Academic Surgery (IAS). Established by SLHD, in partnership with the University of Sydney, the IAS aims to promote academic surgery as well as best surgical practice and patient care through research, education and academic career development for surgeons.

To find out more visit the Institute of Academic Surgery website. 

Concord Colorectal Unit Research (CURe)

Research leader: Associate Professor Matthew Rickard 

The Concord colorectal unit is an international centre of excellence in the practice of colorectal surgery, in particular, the training of specialist surgeons in the full range of open, laparoscopic and robotic procedures and in the delivery of best practice care for both patients and their families, especially those suffering from large bowel cancer. 

This is empowered by the work of the Concord Colorectal Cancer Registry which has had a leading role in the investigation of the staging and reporting of colorectal cancer and in the development, standardisation, statistical verification and promulgation of the Australian Clinicopathological Staging Classification of CRC, one of six internationally recognised staging classifications endorsed by the NHMRC. 

This work together with numerous publications concerning the natural history, the influence of independent prognostic factors and the survival of patients treated for CRC is the basis for the Unit’s regular MDT meetings. They provide the milieu to discuss the complexities of individual patient care and the consideration for adjuvant therapy. In addition, the Registry remains a rich source of information for postgraduate research for both MD students and those advanced trainees wishing to undertake a PhD or higher doctorate studies.

The colorectal unit also undertakes extensive research in benign colorectal diseases, including inflammatory bowel disease and proctology.

Vascular Unit, Concord Hospital

Research leader: Associate Professor Sarah Aitken 

Our research focuses upon innovative vascular technology, vascular surgical outcomes (especially in older patients) and surgical education. We have current projects on endoanchors for EVAR, measuring vascular outcomes with data-linkage, patient-centred outcomes and experiences in vascular disease. Our unit works closely in collaboration with the Geriatrics unit at Concord Hospital, the Centre for Education and Research in Ageing and the Ageing and Alzheimers Association. Researchers within out unit have received grant funding from the Vascular Foundation, RACS college, Sydney Medical Foundation and the University of Sydney.

Research leader: Professor Guy Eslick

The Department of Surgery at Nepean Hospital conducts research in general surgery, the acute surgical unit, upper GI surgery, breast/endocrine surgery, orthopedic surgery, surgical education, surgical oncology, colorectal surgery, hepatobiliary surgery, and urological surgery.

The Whiteley-Martin Research Centre

The Whiteley-Martin Research Centre was opened in 2010 to conduct evidence-based surgical research into oesophageal and gastric cancer. Professor Michael Cox and Professor Guy Eslick are Co-Directors of The Whiteley-Martin Research Centre. 

Research interests include:

• simple and complex gallstone disease, including common bile duct stones
• hernia surgery
• acute pancreatitis
• emergency general surgery
• evidence-based surgery
• surgical oncology
• evidence-based methods - systematic reviews and meta-analysis
• cancer epidemiology including oesophageal cancer, gastric cancer, breast cancer, and thyroid cancer.

There is a strong focus in fundamental and translational research. Telehealth, surgical safety and quality are recent additions, with Nepean Hospital being one of the four pilot sites for the introduction of the American College of Surgeons (ACS) National Safety and Quality Improvement program (NSQIP).

Research leader: Dr Jonathon Parkinson

Surgical Education, Research and Training Institute (SERT)

Research is undertaken across a broad range of surgical specialties at Royal North Shore Hospital. Collectively, the surgeons of RNSH have formed the Surgical Education, Research and Training (SERT) Institute to formalise collaboration, pool resources and promote surgical academia on the RNSH campus. The key objectives of the SERT Institute are to:

• Promote the Surgical Education, Research and Training Activities on the RNSH campus.
• Strengthen the capacity of all RNSH surgical departments to undertake clinical and laboratory research, and accredited teaching activities.
• Provide an environment that allows surgeons to practice high quality, evidenced-based medicine.
• Create new academic career opportunities for surgeons.
• Provide a dedicated physical space at RNSH for surgeons to collaborate and interact.

Each of the surgical departments have provided an Academic Lead and through these leads the individual surgical departments are provided with resources to facilitate their individual research. 

The Kolling Insitute of Medical Research 

Royal North Shore Hospital has the luxury of being co-located with the Kolling Institute of Medical Research. The Kolling Institute was established in 1920 making it the oldest medical research institute in NSW. There is a strong focus on collaborative, translational research within the Kolling, and surgeons of various specialties contribute to a number of the groups within the Kolling Institute including the Bill Walsh Translational Cancer Research Laboratory, the Raymond Purves Bone and Joint Research Laboratory, the Cancer Genetics Laboratory and others.

Other research groups on the RNSH campus thatfocus on surgical research include: 

• The Institute of Bone and Joint Research 
• The Date Analysis and Surgical Outcomes (DASO) Unit 
• The Cancer Surgery Research Fondation
• RNSH Hand and Peripheral Nerve Sugery Research
• RNSH Vascular Surgery Research

Research leader: Associate Professor Manish Patel 

Research at the Westmead Department of Surgery ranges from laboratory based basic research, through to translational bench to bed-side research, clinical outcomes research and clinical trials. Research projects are available that would suit all students ranging from MD projects to Masters and PhDs. 

The department has also established a dedicated surgical trials centre to enable surgeons to deliver clinical studies to assess new surgical techniques and develop breakthroughs in treatment that will help deliver new and better care to hundreds of patients.

The Urological Cancer Outcomes Centre 

This research centre was established in 2010 with a grant from the NSW Cancer Institute. It aims to complete high quality clinical research to improve oncological and quality of life for patients with prostate, bladder and kidney cancer. This is achieved by completing research on a number of levels:

Epidemiological: 

Collaborations with the NSW Cancer Council have given access to population datasets (APDC/Cancer registry) and large cohort studies (45 and up) which allows investigation of patterns of care and cancer outcomes for patients in NSW.

Clinical outcomes:

Research from datasets collected from treated patients allows the investigation of oncological and quality of life outcomes from patients treated at Westmead. This then leads to quality improvement and investigational trials leading to improvement.

Clinical trials: 

The department of Urology places a strong emphasis on clinical trials. We currently have 7 surgical clinical trials open for urological cancers. 

Current major research projects:

1. Quality of life in patients with bladder cancer. A Cancer Australia Funded research project to develop a new instrument to measure quality of life. In collaboration with the Quality of Life Research Office- University of Sydney.
2. Incontinence after radical prostatectomy. We are one of the world leaders in research investigating the causes of incontinence after radical prostatectomy. This research is in collaboration with the Clinical research institute, Pusan University, Korea, MSKCC and numerous institutions globally.
3. Prostate cancer outcomes in Australia: Utilising multiple datasets, oncological outcomes and complications of various treatment strategies and quality of life outcomes are investigated ,with an aim for improved management strategies.
4. Bladder Cancer outcomes in Australia: Utilising multiple datasets, oncological outcomes and complications of various treatment strategies and quality of life outcomes are investigated ,with an aim for improved management strategies.

Transplantation Surgery 

Research leader: Professor Henry Pleass

Westmead hospital is home to the Federally funded National Pancreas Transplant Unit, one of only two such units in Australia. Much of our clinical research has focussed on pancreas graft and patient outcomes. We have also supervised two PhD students over the last three years, one full time and one part time, the former submitting their thesis on improving organ transplant outcomes through amelioration of the ischaemia reperfusion injury.

Current clinical projects include:

• Enteric leaks in the current pancreas Tx population.
• Non-adherence to medication, clinical outcomes and financial costs.
• Investigation of stakeholders attitudes to non-adherence and whether such patients should be re-grafted.
• The role of biopsy in determining graft use or discard, a systematic review.
• Review of deceased donor weight compared with recipient weight and liver transplant outcome.

Current biomedical engineering collaboration:

• Development of an insulating jacket to facilitate reduction in the warm ischaemic injury that occurs during the vascular anastomoses. Prototype developed, awaiting testing for insulating properties, prior to clinical pilot study.
• Development of an automated pill dispenser to reduce drug non adherence.

Future work:

• Building on the work completed by Ahmer Hameed as part of his PhD thesis, we plan to initiate normothermic machine perfusion into the clinical setting following ethics approval. A TGA approved normothermic machine perfusion device for Kidneys has been purchased and a project grant from the RACS for $100,000 has been awarded to cover the disposables for this study. Ideally another surgeon or surgical trainee who wishes to embark on a PhD, would be ideal for this first in Australia project. Collaborations with Dr Natasha Rogers and Prof Wayne Hawthorne are ongoing and the science behind machine preservation is largely unknown, particularly with respect to optimum pressures, temperature, duration of perfusion and additives to the circuit.
  
  
• Prof Wayne Hawthorne, based within both the Department of Surgery and WIMR is a world renown expert in both Pancreatic islet cell research, as well as islet xenograft research with an active and thriving laboratory and multiple funded projects ongoing.

Colorectal surgery 

Research leader: Dr James Toh

The academic colorectal unit at Westmead Hospital has numerous multi-centre collaborations with research groups in Australia, New Zealand and internationally, including with Korea University Anam Hospital.

Currently, our focus is on translational research into inflammatory bowel disease, colorectal cancer and diverticulitis, as well as clinical studies into the role of enhanced recovery after surgery (ERAS), bowel preparation and oral antibiotics and robotic rectal cancer surgery. The unit is part of the mucosal immunology group exploring the role of innate lymphoid cells in the aetiology of Crohn’s disease.

We recently published the largest cohort of inflammatory bowel disease patients in Australia with a focus on surgical management. We are also looking into the impact of microsatellite instability and Lynch syndrome in colorectal cancer, the immune landscape and role of checkpoint inhibitors in colon and rectal cancer.

As part of a multicentre trial, we are involved in the CAPP3 study on the role of aspirin in colorectal cancer. Our unit was recently awarded a CINSW grant to look at variations in colorectal cancer surgery. Westmead hospital is also involved in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) looking at improving the performance of surgical units based on a nationwide analysis. Our unit published the first NSQIP study outside of America on the role of mechanical bowel preparation and oral antibiotics in reducing surgical site infection, which we have now expanded into a quality improvement project in our district. Our unit is currently working on developing a risk calculator for morbidity and mortality for patients undergoing major colorectal procedures.

Head and neck surgery 

Research leader: Dr Muzib Abdul-Razak

Surgical oncology and head and neck have a collaborative approach to research with colleagues in cancer services, particularly radiation oncology. The areas of interest are Merkel Cell carcinoma, cutaneous squamous cell carcinoma and upper aerodigestive tract cancers particularly oral cancers. One of our surgeons is undertaking a PhD related to sentinel node biopsy of oral cancers.

We also work collaboratively with medical oncology at Westmead and Radiation Oncology at Prince of Wales sarcoma unit in projects relating to melanoma and sarcoma management.