Catch up TV

Series 4: Episode 4

Addenbrooke’s Hospital in Cambridge takes on some of the most challenging medical cases in the country. Its surgeons carry out operations that require such expertise, that they are only carried out here and a handful of other centres in the UK.\n\nOne such procedure is a pelvic exenteration, so complicated it requires two surgeons to perform and two days to complete. The surgeons - colorectal consultant Nicola Fearnhead and consultant urologist Alex Colquhoun - only do around 10 of these operations each year, where due to widespread cancer, all the organs in the pelvis need to be removed. It is such a massive, life-changing surgery that about 50% of people who need the procedure for otherwise terminal illness, decide not to have it.\n\nThis time their patient is 52-year-old Stuart, a father of two who has already had treatment for bowel cancer. However, the cancer has returned and the pelvic exenteration is his only chance for a cure. It will involve removing his rectum, bladder, prostate, surrounding lymph nodes as well as a large tumour on his kidney. The surgery is so radical it will leave him with no sexual function and needing two stomas; one for waste from his bowel and the other for urine.\n\nOn the first day of surgery Nicola and Alex concentrate on taking out the disease. They must operate deep within Stuart’s pelvis to separate out the cancer and affected organs from the surrounding tissue and blood vessels. It is high risk surgery because they need to operate near to the body’s biggest blood vessels - the aorta and inferior vena cava - and the major vessels that branch off them. Damaging any of these could cause a major bleed. \n\nBut even if they manage to clear the disease, they still need a second day to reconstruct and create the two stomas. The most difficult to create is for the urine produced by Stuart’s kidneys. Because his bladder will be removed, the drainage tubes from the kidneys – called ureters – need to be re-routed. This involves attaching these fragile tubes to a section of harvested bowel that will act as an outlet tube, which then has to be threaded through the abdominal wall to the surface without any kinks or distortions. Getting this reconstruction right is essential; if in the future urine has trouble leaving his body, Stuart could suffer from kidney failure.\n\nAnother ground breaking operation at Addenbrooke’s involves tackling one of the most serious forms of brain tumour. \n\nThe procedure uses a chemical – only available on the NHS since 2019 - that causes the cancer to glow bright pink under UV light and allows the surgeon to see and remove as much tumour as possible. It is an operation that neurosurgeon Alexis Joannides is performing on 30 -year-old Adam, a manufacturing operative who is expecting his first child with partner Tasha in just a few weeks.\n\nTwo months ago Adam started experiencing severe headaches that would not go away. Five weeks later, an optician’s appointment led to an immediate referral to A&E where doctors discovered the tumour. It turned out to be a glioblastoma, a particularly aggressive type of brain tumour that is life threatening. In order to give Adam the best prognosis, Alexis needs to take out as much as possible. \n\nTo achieve this, Adam will have a pink drink before surgery; a solution that contains the chemical 5 ALA which will cause the tumour cells to fluoresce pink under UV light in the operating theatre. This will allow Alexis to tell the difference between tumour and healthy brain and should assist in removing all the tumour. Research shows that when the pink drink is used, the whole tumour is successfully removed in 70% of cases, up from around 30% when the drink is not used.

Source: BBC 2