Start date: 2023
Award: £42,096
Status: Complete
What was the topic of this study?
Advanced bowel cancers are becoming increasingly common. Such tumours involve multiple organs in the pelvic area and have often been heavily pre-treated with radiotherapy or chemotherapy. Removing multiple organs (e.g. the bladder, rectum, anus, womb, and ovaries) due to advanced cancers is known as pelvic exenteration, and is often the only possibility of cure for these patients.
Exenteration surgery might also remove bone, nerves, blood vessels and pelvic floor muscles leaving behind a large empty space previously filled with these structures. This space can then fill with fluid, and other organs, such as the small intestine, that are not usually found in the pelvis. If the fluid becomes infected it can cause serious illness, wounds to breakdown, or result in abnormal links within the bowel resulting in intestinal failure. These processes form the empty pelvis syndrome, and nearly half of patients having a pelvic exenteration will suffer at least some problems due to it. Empty pelvis syndrome can cause serious long-term complications or even death.
Surgeons will often try to reconstruct and ‘fill’ the empty pelvis with tissues taken from elsewhere in the body or using biological implants. These techniques all have benefits and risks, but currently no one knows which technique is best. If the consequences of the empty pelvis syndrome were consistently reduced, then this surgery would become safer, and potentially more patients could benefit from these life-saving operations.
What were the aims of this study?
This project was carried out by an early career researcher and is supported by The PelvEx Collaborative. The PelvEx Collaborative is an international organisation of healthcare professionals from across five continents that provide specialist pelvic exenteration surgery. This research project had two parts. The first part was to define the empty pelvis syndrome and to agree a core outcome dataset to improve future research into the empty pelvis syndrome.
A core outcome dataset is an agreed, standardised set of end results that should always be collected in a specific area of healthcare research, this makes future research more consistent and improves its quality. You can watch a video here (https://www.youtube.com/watch?v=g1MZi2mzK1U&t=3s) that explains more about core outcome datasets. Patients are essential stakeholders in this research, and obtaining their perspective is vital. The first part of the project has been co-designed with patients and will include patient representatives and gather patient views by online voting and both virtual and face-to-face meetings.
The second part was to use the newly defined core outcome dataset to undertake an international study to better understand the impact this condition is having across the world through The PelvEx Collaborative. This included an assessment of techniques used to fill the pelvis, and produced the best quality evidence currently available to guide international exenteration teams on how to reduce complications from the empty pelvis syndrome.
The team published four papers during the project, and went on to receive a £254,131 from the National Institute of Health and Care Research to continue this work.
Read the papers:
Empty pelvis syndrome: PelvEx Collaborative guideline proposal
The empty pelvis syndrome: a core data set from the PelvEx collaborative
The research team
Mr Charles West, a Colorectal Surgery Research Fellow and PhD student at Southampton General Hospital, led this study.