1. Research Professor Andrew G Renehan PhD FRCS FRCS(GenSurg)
Peritoneal Tumour Service Patient Day
Christie 21st September 2016
Research
Professor Andrew G Renehan
PhD FRCS FRCS(GenSurg)
Colorectal & Peritoneal Oncology Centre, The Christie NHS Foundation Trust;
Division of Molecular & Clinical Cancer Sciences,
School of Medical Sciences, University of Manchester;
Manchester Academic Health Science Centre

2. Research framework Pseudomyxoma peritonei (PMP) Appendiceal cancers
Peritoneal metastases from colorectal cancer
Appendiceal
tumours

3. Complications & mortality: cyto +HIPEC for PMP
No. of pts
Complications (%)
Mortality (%)
Washington
501 40 2
Amsterdam
103 54 3
Winston-Salem
110 38 -
Regensburg 28 36 7
Milan 33
Lyon 27 44
Vancouver 11 56 18
Sydney 50 48 4
Manchester (2009)
118 9
Yan et al. Systematic review …… cyto + HIPEC .. PMP Ann Surg Oncol 2007

4. Manchester update analysis
Jan 2013 to Jun 2015
Prospective; monitored 3 monthly
N: 1105 major complex/major/ intermediate
304 major peritoneal operations
Grant Punnett
Lee
Malcomson

5. Manchester results: complications
Complication grade
Totals
(N: 304)
Grade 0
180 (59)
Grade 1
24 (8)
Grade 2
63 (21)
Grade 3
29 (9.5)
Grade 4
6 (2)
Grade 5
2 (0.7)
App Tumour
(N:230)
PMCR
(N:74)
140 40 19 5 47 16
20 (9)
9 (12)
3 (1)
3 (4)
1 (0.4)
1 (1)
12.5%
10.4%
17.6%

6. UK & Ire. Peritoneal Tumour Services
Reference treatment centres (appendiceal & PMCR)
Hampshire Hospitals NHS FT
The Christie NHS FT
Other treatment centres (PMCR only)
Mater Misericordiae University Hospital, Dublin
Ninewells Hospital and Medical School, Dundee
Good Hope Hospital, Birmingham

7. Study Aim IDEAL Framework
To develop a robust and reproducible framework in which to undertake a phase III trial in patients with PMCR suitable for CRS with or without HIPEC
IDEAL Framework
As CRS with HIPEC is a complex multi‐component intervention, we propose to address this agenda using the principles of the IDEAL framework
Idea
Development
Exploration
Assessment
Long-term Study

8. PMP: laboratory research
Andrew Renehan
Darren Roberts
Peter Stern

9. PMP: laboratory research
Bowel cancer
>50% Tumour
PMP
< 5% Tumour
PMP
cells
Mucin

10. Laser Capture Microscopy
Diseased Epithelium
Normal Epithelium

11. PMP: lab findings (1)

12. PMP: lab findings (2)

13. HIPEC
Oxaliplatin
0.14
0.22
0.37
0.61
1.0 50
100
Clinical
dose range

14. Future studies Cell line ‘high-through’ drug screens in PMP
Determine key driver genes in PMP
Characterise colorectal cancer with peritoneal metastases

15. Summary Prospective outcome analyses Trials (multi-step process)
Laboratory research

16. Acknowledgements The patients
The Christie Colorectal & Peritoneal Oncology team
O’Dwyer
Wilson
Selvasekar
Fulford
Aziz
Minicozzi
Deshpande
Kochhar
Mullin
Saunders
Braun
Mullamitha
Chakrabarty
Christie data team
Morrison
Punnett
Crichton
Fernandez de-Silva
Halstead
Butler
Brown
Tyrell
Secretaries
MDT coordinators
Anaesthetists
Theatre staff
Perfusionists
CCU staff
Ward staff
University of Manchester
Emsley
(statistics & methodology)
Science laboratory
Stern
Roberts
Brognard
Bowel Disease
Research Foundation
The patients