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.

COLORECTAL

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.

TRANSPLANT

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.