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Title: Optimising innovation in the surgical management of early colonic neoplasia
Author: Currie, Andrew
ISNI:       0000 0004 6495 7784
Awarding Body: Imperial College London
Current Institution: Imperial College London
Date of Award: 2016
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Aims and objectives: The aim of this thesis was to investigate the development of full-thickness laparoendoscopic excision (FLEX) as a surgical innovation in the management of early colonic neoplasia. The objectives were to (1) evaluate current approaches to surgical management, (2) explore challenges to surgical innovation and (3) evaluate novel surgical techniques in early colonic neoplasia. Methods: Objective 1: The impact of colon cancer stage on postoperative outcome was analysed using a prospective, international clinical dataset. A decision analysis model explored the potential patient impact of offering local excision to T1 colon cancer. A systematic review evaluted the quality of reporting of innovation in laparoendoscopic colonic excision. Objective 2: A systematic review of patient treatment preferences for management of colorectal cancer was undertaken. A Delphi consensus was formed on endpoints to measure in FLEX. The accuracy of CT colonography (CTC) to analyse local anatomy in early colonic malignancy was evaluated. Objective 3: Feasibility studies of sentinel node mapping for early colon cancer and FLEX for complex, benign polyps were undertaken. Results: The morbidity of colectomy is unaffected by stage of neoplasia. Local excisional approaches for T1 colon cancer could preserve quality-of-life, especially in elderly, comorbid groups. The current methods of reporting surgical innovation in laparoendoscopic surgery are deficient. Patients are prepared to trade survival to avoid surgical seqeulae. Consensus endpoints for FLEX focus on early safety-related outcomes. CTC can accurately assess local anatomical features that will be used in patient selection for FLEX. Sentinel node mapping is feasible in early colon cancer. FLEX is feasible for removal of complex, benign polyps in clinical practice. Conclusion: This thesis has shown that the FLEX technique can allow patients to avoid the morbidity of colectomy for complex, benign polyps and that structured reporting frameworks should guide future investigation of this surgical innovation.
Supervisor: Kennedy, Robin ; Faiz, Omar Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral