Western Clinical School - Research in the Discipline of Surgery

Research Leader: A/Prof Manish Patel

Learn about this departments research groups and the projects they are working on.

Surgical Research at Westmead Hospital encompasses all specialties which our outlined below. Our research is administered by the Westmead Department of Surgery and Anaesthetics Research Committee (given below) who are very interested in developing collaborative research projects and supervising students for research higher degrees.

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.

For specific subspecialty research see below.

Urology

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 aimed at improving oncological and quality of life improvements 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.

For further information contact: A/Prof Manish Patel

Transplantation Surgery

Westmead hospital is home to the Federally funded National Pancreas Transplant Unit, one of two such units within Australia. As such much of our clinical research has focussed on Pancreas graft and patient outcomes. We have also supervised two PhD students over the last 3 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, in December.

Current clinical projects include the following:

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

Current Biomed Engineering collaboration:

  1. 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.
  2. Development of an automated pill dispenser to reduce drug non adherence.

Future Work

  1. 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.
  2. 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.

For further information contact: Prof Henry Pleass

Colorectal Surgery

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.

For further information contact: Dr James Toh

Head and Neck Surgery

Surgical Oncology /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 (MAR) 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.

For further information contact: Dr Muzib Abdul-Razak