Surgery

About 80% of patients diagnosed with colorectal cancer undergo resection, usually through open surgery and conventional recovery. Many of our patients now benefit from the fact that this conventional approach has been challenged by the introduction of laparoscopic surgery and the Enhanced Recovery Programme (ERP) in order to reduce the risks of open surgery, operative stress and the hospital stay.

The major difference between ERP and more traditional care is a teamwork approach which aims to optimise the condition of the patient and their education, nutrition, pain control and early mobilisation.

Yeovil began applying ERP in 2002 in conjunction with a laparoscopic approach for managing colorectal cancer. Today, there is a well established team comprising surgeons, anaesthetists, theatre practitioners, dietitians, pain control nurses, colorectal and stoma therapists, physiotherapists and a programme facilitator.

Yeovil District Hospital is one of a handful of centres in England who are leading the way in providing training for the country’s keyhole surgeons for patients with bowel cancer. The South West Laparoscopic Colorectal Consortium (SWLCC) is managed at Yeovil and includes surgeons from across the region.

What our patients have to say

Susan McCormick, 64, from Sherborne
“I came into hospital on the Monday and was a bit apprehensive as I knew it was a major operation – I asked how long I would be in theatre and was told it would be four to five hours and I thought that is a long time! The surgeons and anaesthetists all spoke to me and I found them very reassuring and encouraging. They lived up to that reassurance because I was feeling quite well after the op – a bit of discomfort – but I had an epidural and had a cup of tea immediately after I had come round before I was even back on the ward! The anaesthetist Dr Kipling made me a cup of tea himself. I had soup and bread that evening on the ward, everyone looked after me very well and I was recovering well enough to come home on the Friday – which Mr Francis said was a record. They are a terrific team and they obviously work very well together and did a terrific job.”

Mrs Birdsall, 89, from Leigh
“I have spent 70 years of my life nursing, since I began during the Second World War, when I worked in both Army and Navy hospitals. Having so much experience of healthcare, I could have found myself being rather critical but I have to say that I found my treatment absolutely wonderful. Everyone was so caring and I have no complaints about anything – the pain control, in particular, was amazing. I can’t believe that it is only four weeks since my operation; I am nearly 90, I have other complications and I can’t expect miracles – but I feel fantastic, have had good post-operative care and hope to be back gardening soon! I am very grateful to YDH for everything which they have done.”

Nader Francis said
“This delightful lady was referred to me with a sigmoid cancer and has been using a wheelchair due to arthritic pain, which was thought to be due to polymyalgia rheumatica, but it is now clear that it was an unusual systematic effect of cancer. She also presented with a degree of slow heart rate (heart block). Due to all these challenges, many surgeons might be reluctant to actively treat this patient. However, Mrs Birdsall was keen to have surgery and I carried out a laparoscopic resection of her tumour. Through the Enhanced Recovery Programme, Mrs Birdsall made an amazing recovery and went home on day six following this operation. In addition, she now feels a remarkable improvement in her arthritic pain following her surgery. I reviewed her in clinic and she has been extremely well since. Her histology has confirmed an early cancer which has been cured by this operation.”

Mr Ivor Gay, 65, from Yeovil
“I was impressed with the speed of my treatment, from the time of my consultation with the surgeon until I was discharged. And I was surprised by how well I felt immediately after surgery – certainly 100% better than I had done three months earlier. I had had colitis for eight or nine years, for the last 18 months of which I felt awful and the relief was tremendous. I went down for my operation at eight in the morning, got back on the ward just in time for dinner and was walking 50 or 60 yards up the corridor the day after! My pain management was great and I felt no real pain during my entire stay in hospital. From the time when I saw the specialist in September, through to my meeting with the surgeon in October and my operation in November, I felt as if someone had rolled out the red carpet for me.”

Says Nader:
“Mr Gay has severe ulcerative colitis and underwent a laparoscopic total resection on the colon. Prior to surgery, he had cardiac surgery following a heart attack and he benefited from laparoscopic surgery and the Enhanced Recovery Programme. He went home five days following this major surgery and since the operation he has been extremely well and is back to full activity.”

The Enhanced Recovery Program (ERP) was first established in Yeovil in 2002. It is currently led by Mr Jonathan Ockrim and Mr Nader Francis, who perform routine laparoscopic colorectal resections and Mr Paul Porter in Orthopaedics. It is aimed at improving patients’ general health and wellbeing to accelerate recovery after surgery.

How does it work?

The programme involves a partnership between doctors, anaesthetists, nursing staff, dieticians, physiotherapists and occupational therapists, and promotes excellent nutritional support in the form of high-protein and high-calorie supplements before and after surgery. Research has shown that this reduces the risk of complications after surgery, and helps speed recovery.

Pre-operative clinics are also used to ensure that patients are properly prepared for surgery and that the necessary arrangements for their return home are already in place. The main focus here is patient education and motivation to ensure that patients have ownership of their recovery. Patients are encouraged to be active as soon as possible, often as early as the day of surgery, and the programme has seen patients recovering from surgery more quickly and being able to return home earlier than was previously the case. After discharge, patients are regularly reviewed to ensure their recovery continues without problems.

ERP has many benefits including shorter hospital stays.

With this successful and well-established programme, we have achieved a median length of stay of five days (compared to ten days nationally) for all elective colorectal resections with readmission rates are less than 10%. Although it has been shown that most patients with colorectal cancer benefit from ERP, older patients and/or those with complicated health problems seem to benefit most from this programme.

Yeovil is educating others to use ERP

Mr Nader Francis (a laparoscopic and colorectal surgeon at YDH) is delighted that the Trust is still leading the UK field in the Enhanced Recovery Programme and is able to deliver teaching and education programmes to other NHS trusts.

He says: “Combining the ERP and laparoscopic surgery, we are now able to embark on removing cancer form very elderly patients. Such patients often have substantial health problems and our techniques produce marked success. Seeing these patients doing so well after major surgery and regaining almost their full physical activities within such a very short period of time is a major step forward.”

The Pre-Assessment Clinic is located on level 6, Charlton Ward and aims to ensure that you are adequately prepared for your elective surgery. For more information about the pre-assessment clinic please click here.