UGI - OESOPHAGO-GASTRIC CANCER
Training in Oesophago-Gastric cancer surgery is offered at 4 units within the region:
- Addenbrooke's Hospital - the unit performs 80-100 cancer resection a year, including minimally invasive, Hybrid, open oesophagectomy and D2 total Gastrectomy. Complex laparoscopic hiatal surgery and regional emergency complex benign OG cover. Twice weekly endoscopy list, including diagnostics and oesophageal EMR. Opportunities to engage in post graduate ward based and cadaveric training, research in conjunction with the GI surgical department and Cambridge University, and faculty opportunities on national training courses e.g. CCrISP.
- Norfolk and Norwich University Hospital (NNUH) - The department of Upper GI Surgery at the Norfolk and Norwich University Hospital provides the full range of upper GI specialty services for NNUH and the region as a whole. Minimally invasive cancer surgery, such as minimally invasive oesophagectomy and gastrectomy. Endoscopic mucosal resection for early oesophageal cancer and radiofrequency ablation of Barrett’s oesophagus with high grade and low grade dysplasia. Research opportunities in perioperative care in cancer surgery, oesophageal, gastric cancer surgery, and endoscopic treatments (RFA and EMR) for early cancer.
- Broomfield Hospital - innovative minimally invasive cancer unit with surgeons also providing training in EMR/ESD (endoscopic resection of early cancers) and HALO (radiofrequency ablation)
- Watford General Hospital - consultants perform cancer resectional surgery at Hammersmith Hospital
All units are tertiary centres taking referrals for the UGI cancer MDT from multiple hospitals within the surrounding geographical region. Excellent endoscopy training is delivered at each of these units to allow progression towards JAG accreditation in UGI endoscopy (diagnostic OGD). Formal research opportunities are available on request at Addenbrooke's Hospital and NNUH.
UGI - BARIATRIC/BENIGN
Training in Bariatric surgery is only offered at Luton and Dunstable Hospital. It is an established UK tertiary centre offering Bariatric and Metabolic Surgery including sleeve gastrectomy and gastric bypass procedures. Training at Luton and Dunstable Hospital includes involvement in MDTs and outpatient clinics as well as research/audit opportunities. This surgical rotation has historically always received great trainee feedback.
Benign UGI training is offered in almost every unit in the region. This includes endoscopy training, surgical training (e.g. anti-reflux surgery, cholecystectomies) and involvement in MDTs. Some units can offer more specialist training:
- West Suffolk Hospital and Norfolk and Norwich University Hospital (NNUH) - laparoscopic CBD explorations with laparoscopic ultrasonography or on table cholangiography
- Broomfield Hospital - robotic and complex revisional anti-reflux and hiatus hernia surgery. Also offer gastric pacemaker service for gastroparesis.
- Colchester General Hospital - experienced specialist laparoscopic UGI surgical unit
Training in Colorectal surgery is offered in all units within the region. This includes colorectal cancer resectional surgery (particularly laparoscopic) and benign/proctology surgery. Further specialist services are detailed below:
- Addenbrooke's Hospital - extensive specialist colorectal services including paediatric IBD surgery and pelvic extenterations/more radical cancer procedures. Busy unit with several training opportunities that attract fellows from around the world. minimally invasive procedures with the chance of introducing robotic surgery in the near future.
- Norfolk and Norwich University Hospital (NNUH) - one of the largest colorectal departments in the country. Offer training in extenterations, robotic resections and pelvic floor conditions. The unit manages patients with colorectal cancer and many benign colorectal disorders including inflammatory bowel disease and complicated diverticular disease. In addition to benign anorectal disorders including anal fistula and incontinence.
- Colchester Hospital - a large unit performs a wide range of benign and malignant resections in addition to procedures such as transanal total mesorectal excision surgery (TaTME). The unit performs as well laparoscopic surgery for complex and recurrent Crohn’s disease and surgery for Ulcerative Colitis including ileo-anal pouch surgery.
- Broomfield Hospital - performs cancer resectional and advanced pelvic floor surgery robotically. One consultant has a specialist interest in abdominal wall reconstruction and IBD.
- West Suffolk Hospital - one consultant specialist interest in pelvic floor surgery
Training in flexible sigmoidoscopy and colonoscopy varies from unit to unit, however most have training lists to facilitate training towards JAG accreditation. Approach the endoscopy lead early to establish learning objectives and attend a JAG accredited training course early in registrar training to start scoping. Most senior trainees with an interest in Colorectal Surgery train at Addenbrooke's Hospital, NNUH, Broomfield Hospital, Southend Hospital or Lister Hospital in their final two years.
The Department of Hepatopancreatobiliary (HPB) Surgery at Cambridge University Hospitals NHS Foundation Trust (CUH) provides a comprehensive tertiary service for the management of patients with HPB issues. The Department provides a full emergency and elective service to HPB patients. The unit performs 140 liver resections, 120 pancreatic resections and around 300 laparoscopic operations (mainly cholecystectomy, adrenalectomies, distal pancreatectomies, minimally invasive necrosectomies and liver resections) annually. Training in HPB cancer surgery is only offered at Addenbrooke's Hospital in the region. This busy unit provides training in:
- Open and laparosocpic major anatomical and non anatomical liver resections
- Pancreatic and complex biliary cancer surgery
- Benign pathology including minimally invasive necrosectomy in acute pancreatitis, chronic pancreatitis, benign hepatic lesions
- Laparoscopic adrenalectomy
- Cancer-specific MDTs
- Outpatient clinics
- Overlap with transplant surgery
There are numerous research opportunities within the unit with options for formal research on request. The HPB firm has strong academic links to the University of Cambridge and there are several opportunities for research and audit. Generally speaking, senior trainees with a HPB interest tend to be placed in this unit for surgical rotations during training.
Training in Transplant surgery is only offered at Addenbrooke's Hospital in the region.
The Cambridge Biomedical Campus hosts the largest and only comprehensive adult solid organ transplant programme in the UK.
All routinely performed organ transplants are carried out at either the Royal Papworth Hospital (heart and lung transplants) or Addenbrooke’s Hospital (kidney, pancreas, liver, intestine and multi-organ transplants).
The Addenbrooke’s team also provide a vascular access service for patients requiring dialysis, and is one of 2 national encapsulating peritoneal sclerosis (EPS) services.This internationally-renowned unit provides training in:
- Liver transplantation: Rapid out-patient and in-patient assessment pathway, follow-up (both for waitlisted patients and post-transplant patients) performed at referring centres in conjunction with the local hepatology team, median waiting time from listing to transplant <100 days, Highest 5-year patient survival (88.1%) of all UK liver units, world leading use of novel perfusion technology to assess and optimize donor livers before transplantation (normothermic regional perfusion and normothermic machine perfusion).
- Pancreas and kidney transplantation: Has the shortest waiting time in the UK from listing to receiving a transplant, patient survival and kidney survival following transplantation are amongst the best in the UK. Patients have the highest 5-year graft survival of all UK transplant units (91%). Highly active deceased donor kidney programme with access to pre-transplant biopsies of donor kidneys, and innovations in organ perfusion and preservation. Active living donor kidney transplant programme, with fully laparoscopic donor nephrectomy. ABO blood group incompatible transplants and high immunologic risk transplants are performed. Both patient survival and pancreas survival following transplantation are amongst the best in the UK. Patients have the highest 5-year pancreas graft survival of all UK transplant units (90%), and the highest patient survival 1, 5 and 10 years from listing.
- Multi-visceral transplantation including small bowel: Excellent 5 year patient survival following isolated intestinal transplant (80%), outreach clinics at intestinal failure centres throughout the UK, comprehensive multidisciplinary assessment and in-patient care (including transplant surgery, gastroenterology, hepatology, radiology and microbiology).
- Encapsulating peritoneal sclerosis (EPS): Cambridge is one of 2 national referral centres for surgery to treat EPS – most frequently caused by long-term peritoneal dialysis (PD). EPS occurs in a very small proportion of PD patients – often those who have had recurrent episodes of peritonitis or have received PD for more than 5 years.
- Organ retrieval training.
There are numerous research opportunities within the unit with options for formal research on request. Generally speaking, senior trainees (following ST6 ARCP) with a Transplant interest tend to be placed in this unit for surgical rotations during training.
Training in Breast surgery is offered by most units within the region. This includes breast cancer surgery (breast and axillary procedures), oncoplastics and benign surgery. Endocrine surgery training is variable and dependent on individual consultant surgeon practice. Units with specialist services offered include:
- Addenbrooke's Hospital - joint cases with Plastic surgeons for reconstruction following cancer resection (free flaps, rotational flaps and other oculoplastic procedures)
- Norfolk and Norwich University Hospital (NNUH) - busy breast unit with plastic surgery involvement. Perform endocrine surgery including thyroidectomies and parathyroidectomies.
- Broomfield Hospital - busy breast unit with large Plastics surgical department on site. One of the busiest DIEP surgical units in Europe. Also have a TIG fellowship in Breast surgery.
- West Suffolk Hospital - perform high numbers of endocrine and breast procedures including oculoplastic procedures (therapeutic mammoplasties/lipofilling/implant reconstruction)
Training in Vascular surgery has separated from General Surgery and has a different training curriculum. However, 6 months of training in Vascular Surgery is still required during ST3 or ST4. Most hospitals in the region provide vascular training with the largest departments at Addenbrooke's Hospital and NNUH. Trainees can re-apply for Vascular Surgery Training during General Surgery training but will be required to start at ST3/ST4 level on successful application. Hospitals providing Vascular Surgery offer:
- Arterial surgery - Aortic Aneurysms, peripheral arterial aneurysms, peripheral vascular disease (open/endovascular)
- Venous surgery - Varicose veins (endovenous/sclerotherapy/open), venous thrombosis
- Vascular access surgery - fistula surgery, vascular access lines/catheters/ports
- Other - endoscopic thoracic sympathectomy for hyperhidrosis, lymphatic surgery and thoracic outlet syndrome