Our goal is to improve the survival of our patients, and our research program in this area includes developing risk prediction models which will allow us to provide more accurate information for our patients, and looking at the outcomes in the elderly patients to inform our treatment recommendations.

Bowel cancer is the second highest cause of cancer related deaths in the Australian community. Only lung cancer has a higher death rate.

The five year survival rate for bowel cancer in the period 2006-2010 was 66.2%. This rate had increased from 48% in the period 1982-1987. (Reference: Australian Government – Cancer Australia).

Our goal is to improve the survival of our patients, and our research program in this area includes developing risk prediction models which will allow us to provide more accurate information for our patients, and looking at the outcomes in the elderly patients to inform our treatment recommendations. 

Project 1: Who dies after bowel cancer surgery?

This project which investigates the circumstances in which patients die after bowel cancer surgery at the Cabrini and Alfred Hospitals.  Our data collection for this project is complete, and we have completed initial analysis. A poster was presented on this work at the Royal Australasian College of Surgeons conference in Singapore in May 2014.

Work has commenced on a paper to be submitted to the journal ‘Diseases of the Colon and Rectum’ on this important project, which will be completed in 2014.

Project 2: Mortality Risk Stratification Study

This project investigates the 30-day and 180-day mortality and risk factors for patients following bowel cancer surgery.  With the aid of data already received from St. John of God, WA (1800 patients) and Concord Hospital, NSW (2100 patients) we will use the 1500 patients on own Colorectal Surgery Database for analysis. 

The resultant data will be compared with the British (ACPGBI) bowel cancer postoperative mortality risk prediction model.

Data is currently being finalised, cleaned and checked for accuracy and completeness. The publications from this work are intended for high impact journals such as ‘Lancet Oncology’ or ‘Clinical Cancer Research’; as they will be the first large scale international comparative studies.

Project 3: Outcomes after resection of bowel cancer in high risk  patients

While 30 day outcomes after resection for bowel cancers are widely reported, longer term outcomes are not so well reported especially in high risk patients.  It is thought that high risk patients [American Society of Anaesthesiologists Class 4 (ASA4); defined as “Severe systemic disease that is a constant threat to life”] if they survive the initial 30 day post-operative period, usually survive the next 12 months following their surgery. We intend to identify what the real outcomes are. This will inform the discussions surgeons have with their patients who fit into the “high risk” groups.

A retrospective review of the database will be carried out and 6 and 12 month survival rates will be assessed.  

Project 4: Outcomes after resection of bowel cancer in patients with cancer stage 4 disease

This project will investigate the outcomes of patients who presented with cancer stage 4 disease (who have secondary metastases on presentation).  A retrospective review of patients on the database will be carried out examining mortality over 30 and 180 days post surgery as well as longer follow up periods.

We intend to identify what the real outcomes are. This will inform the discussions surgeons have with their patients who fit into the “high risk” groups.

Project 5: Outcomes after resection of bowel cancer in patients aged 85 and over.

This project will investigate the outcomes of patients who were aged 85 and over at the date of surgery.  With the ageing of our population this is an increasingly common scenario. The outcomes of surgery in this group of patients are unknown.

A retrospective review of patients on the database will be carried out examining mortality over 30 and 180 days post surgery as well as over longer follow up periods. This work will inform the discussions surgeons have with this group of patients in regards to what are the realistic outcomes of surgery are.

Other areas of interest include:

  • Using data collected from multiple Australian centers to re-examine a UK model for risk prediction of adverse treatment outcomes.
  • Assessment of the importance of tunour biomarkers, their influence on bowel cancer treatment outcomes and patient response to chemotherapy.