Consultant Colorectal/General Surgeon (Advanced Colorectal Cancers)

Detailed job description and main responsibilities

We are seeking a highly skilled and experienced surgeon with expertise in pelvic exenteration to join our dynamic surgical team. 

It is an exciting period for the Liverpool University Hospitals NHS Trust, with a brand-new state of the art hospital functioning in full capacity since October 2022. The Trust is committed to innovative and technical developments within surgery, and this is demonstrated within the services we deliver. 

The position comes with full secretarial support, a shared office in our current building, and equitable support from the junior doctors and AHPs who form part of the wider colorectal team. We currently have 11 colorectal consultants, 6 ST places, 3 CST, 3 FY2 and 7 FY1 in colorectal, as well as 2 surgical assistants, a ward ANP and a team of 08 Colorectal Cancer Nurse Specialists. There are RCS-approved advanced robotic colorectal fellow and a North of England laparoscopic fellows (NLF) in the department. In addition, there are two international colorectal fellows attached to the unit every year. There is also a dedicated full-time surgical stoma team of five specialist nurses providing in-patient and out-patient stoma services across the Trust. There is a 7-day rota of dedicated colorectal consultant cover to look after the inpatients to avoid problems associated with multi-site working. This post is a replacement post to match the increase in demand in an advanced colorectal cancer work within the current Colorectal Unit. As well as a busy Specialist Colorectal practice there is an Emergency General Surgery rota covering acute admissions to the AUH and RLH site, and we provide emergency support for the Liverpool Women’s Hospital (LWH), Clatterbridge Cancer Centre (CCC) and Liverpool Heart and Chest Hospital (LHCH). There is an elective General Surgery component to the practise, including Day Case Surgery and short stay, which is performed on the AUH site. The successful applicant will be competent to perform colorectal cancer resections, either open or using minimally invasive techniques. The successful applicant is expected to operate advanced colorectal cancers though an interest in multi-visceral surgery is also desirable. It is expected that appointee will be a core member of colorectal MDTs and appropriate mentorship will be provided by a senior colleague. 

Our unit hosts a dedicated, high-volume MDT meeting every Thursday morning, reviewing approximately 300 patients annually. These complex cases are approached through a structured mentorship model, offering regular opportunities for dual operating alongside senior colleagues. The vision of our Complex Pelvic MDT is to expand surgical indications to include higher sacrectomy and procedures beyond total mesorectal excision (TME), enabling us to deliver truly comprehensive care for patients with advanced and recurrent pelvic disease.

LUHFT colorectal is one the largest unit for colorectal diseases in the country; we perform over 320 colorectal cancer resections in each year. We are a tertiary referral centre for complex Crohn’s and IBD cases including re-do resections. The unit perform approximately 10-15 new ileo-anal pouch surgeries per year and have a cohort of pouch patients under surveillance. We are the only ACPGBI regional accredited ileo-anal pouch centre in the Northwest. We provide a regional tertiary referral service for anal cancer, early rectal cancers, advance pelvic oncology, pelvic floor disease and complex polyps for the Merseyside and Cheshire population including the Isle of Mann.

Currently weekly colorectal MDT meetings occur every Tuesday morning and include regional MDTs of Small Early Rectal Cancer (SERC), Significant Polyp and Early Rectal Cancer (SPECC) and Anal Cancer followed by the wider Colorectal Cancer MDT. The Colorectal MDT meetings are supported by colorectal surgeons, gastroenterologists, oncologists, specialist Cancer Nurse Specialists and radiologists. There is a separate complex pelvic MDT every Thursday morning with Gynae-oncology, urology, colorectal surgeons interested in pelvic exenteration, plastic surgery and radiology. Patients with advanced metastatic colorectal cancers are discussed in Regional Advanced Colorectal MDT meetings which are based on the Royal Liverpool site. Oncology services are provided by Clatterbridge Cancer Centre NHS Foundation Trust.  

Colorectal cancer surgery is often demanding and require a team effort not only from multiple surgical specialities but also from anaesthetic, theatre scrub staff, post-operative nursing, stoma therapists, psychology, and discharge planning teams. RLH has been nominated as the site for elective colorectal cancer surgery including exenteration.

The LUHFT gastroenterology department is currently based on two sites (RLH and AUH) and provides a high standard of care, training, and research in benign and malignant gastroenterology disorders. There are further sub-specialities within gastroenterology including luminal endoscopy, nutrition and hepatology. The department provides advanced endoscopic therapeutic procedures including EMR, ESD, POEM, stents and EUS. In addition, to providing support to IBD and colorectal cancer MDT’s there are separate MDTs for nutrition, advanced cirrhosis and medical IBD. The Mersey School of Endoscopy is a national JAG accredited centre for endoscopic courses and training based in the RLH. We are an accredited centre for Bowel Cancer Screening and run the Merseyside and North Cheshire programme. The gastroenterology unit received many referrals for IBD patients from Merseyside, Cheshire, and Isle of Mann. The unit performs over 15,000 endoscopic procedures in a year and is one of the largest in the country with over 25 gastroenterology consultants including two Professors of gastroenterology and five advanced therapeutic endoscopists. 

There is a regional Neuro-Endocrine Tumour (NET) MDT which occurs weekly and is attended by gastroenterologist, oncologists, colorectal, liver, and pancreatic surgeons. If the successful candidate wished to be part of it, they would work closely under mentorship of Mr J Arthur Colorectal Consultant and in future, it is planned that two colorectal surgeons will provides support to the NET MDT.

Liverpool Women’s Hospital (LWH) is a tertiary unit and have accreditation for the regional gynae-oncology service. There is a weekly complex pelvic MDT meeting (Thursday morning) for advanced endometriosis patients who required multi-speciality input. The MDT involves a dedicated team of gynaecology surgeons, radiologists, urologists, colorectal surgeons, plastic surgeons’ experts and specialist complex pelvic speciality nurses. We perform joint advanced multi-visceral surgery mainly in Royal site. Formal proctoring will be offered to successful candidates of complex pelvic service. There is a Da Vinci robotic platform both in LWH and LUHFT and is used regularly for multi-visceral surgery.   

There is currently regular access to the Da Vinci robotic system for colorectal procedures, with three dedicated robotic theatre days each week, shared across several specialties. The colorectal team includes five consultants independently trained in robotic-assisted surgery. A well-established laparoscopic unit, supported by ample instrumentation and two highly experienced surgical assistant nurses, also underpins the service.

The Trust has well-advanced plans to expand its robotic surgery programme, including the acquisition of a second robotic system. It is anticipated that this will significantly increase access for colorectal surgery. However, until this expansion is realised, access to robotic theatre time for a new appointee may be limited. A candidate with robotic training will be supported but should be aware that independent access may be restricted in the interim, depending on progress with the Trust’s expansion plans. Mentoring and training opportunities in robotic surgery will be available as needed.

Within the department, straightforward mid and low rectal cancer resections (not requiring pelvic exenteration) are currently performed by a dedicated small group of surgeons, due to the relatively low case volume. All consultants are independently able to perform upper rectal cancer resections. This arrangement is reviewed annually, and the number of surgeons undertaking mid and low rectal cancer surgery may change in response to evolving service needs. Candidates should be aware of this structure and understand that opportunities to perform straightforward mid and low rectal resections may depend on future departmental review and workload distribution