Surgical collaboration: how three expert surgeons united to deliver pioneering surgery for advanced ovarian cancer 

“Mrs Davies diagnosis was very challenging and complex, she had an advanced, stage 4 ovarian cancer, which had spread to her lymph nodes. As well as a metastasis to the coeliac lymph node - which sits near the blood supply to the stomach – she also had a large metastasis in a thoracic node, which is in the chest cavity, close to the heart.” – says Mr Ahmad Sayasneh, consultant gynaecologist and gynaecological cancer surgeon at London Bridge Hospital, part of HCA Healthcare UK.

Mr Sayasneh explains how a unique team of surgeons were able to remove all of Mrs Davies cancer in a single, minimally invasive operation, significantly reducing her surgical recovery time and enabling her to move on to the next stage of her treatment without delay, which was critical to her longer-term outcomes. 

Their innovative approach not only demonstrated exceptional surgical skill and ingenuity, but also emphasised the importance of interdisciplinary collaboration in overcoming the challenges presented by complex cancer cases.

Mrs Davies diagnosis was discussed at a gynaecology multidisciplinary meeting (MDT) where Mr Sayasneh explored treatment options with a team of experts including consultant oncologists, radiologists, radiographers, pathologists, pharmacists, clinical nurse specialists, and many other healthcare professionals. The team agreed on a recommended treatment plan based on her individual diagnosis and personal circumstances. 

“As an MDT we agreed that a macroscopic clearance - surgically removing all visible disease, followed by a course of chemotherapy to chase any remaining cancer cells that we cannot physically see during the operation, was the best approach. Our goal was to find the best possible treatment that would prolong survivorship and provide Mrs Davies with the best quality of life. 

To minimise the amount of time she would need to recover from surgery, we also wanted to perform the operation using minimally invasive techniques. A faster recovery would mean she could start her chemotherapy without delay, which we knew could have a significant impact on her clinical outcomes”, he adds.

“Knowing what we needed to do was just one part of the puzzle. The extent of the primary cancer, and the distant and sensitive location of the metastasis - particularly the one close to the heart - meant that approaching these surgically would be difficult, and not something I could do alone. I would need the support of surgical colleagues with experience and expertise in other areas of the body”. 

Across HCA Healthcare UK we have experts in multiple medical specialties. Mr Sayasneh was able to draw on this network of surgical expertise to create a team who could perform this complex surgery in one operation. The surgical team brought together by Mr Sayasneh included himself, a specialist in complex gynaecological surgery, Mr Botha, an upper gastrointestinal surgeon with experience of performing minimal access surgery on the coeliac trunk, and Mrs Harrison-Phipps, a thoracic surgeon. 

“The benefit of being part of the HCA healthcare UK network is that not only do we have some of the best cancer specialists in the country, but have specialist colleagues in other disciplines, which means we can collaborate on these unique cases. We also have the right clinical environments to undertake complex care safely, with state-of-the-art operating theatres and intensive therapy units should we need them.

Between the three of us we had the experience and expertise to address the three distinct areas of disease as part of one minimally invasive operation. This meant Mrs Davies would have less surgical interventions, a quicker post-surgical recovery period, and move to the next phase of her treatment plan sooner.

As we were going to operate close to Mrs Davies heart, we also needed a specialist anaesthetist - a cardiothoracic anaesthetist - to administer a general anaesthetic. Again, we were fortunate to work with a specialist from within HCA UK”, he adds.

On the day of the surgery, three specialist surgeons gathered to perform a first of its kind cancer surgery. The plan was for Mr Sayasneh to begin the operation, removing the primary ovarian cancer and local spread through several small incisions in the abdomen. Mr Botha would then take over, removing the metastasis from the coeliac lymph node via the same incisions and, if possible, accessing the thoracic node laparoscopically. Should he not have been able to complete this, Mrs Harrison-Phipps was ready to access the chest node through a new incision in the chest.

“In many cases, a patient with a stage three or four ovarian cancer would receive open surgery, through one long incision in the abdomen. For Mrs Davies, traditional open surgery would have enabled us to remove the coeliac lymph node, but not the remote, chest lymph node. This would have required an additional incision to her chest, which we were aiming to avoid. 

We began surgery by making six small incisions in her abdomen, through which I was able to remove the primary ovarian cancer laparoscopically. This was challenging as the cancer had spread to the bowel wall, which required precise removal to avoid damage to the surrounding organs and tissues - whilst still managing to remove all visible disease. 

From the same incisions, Mr Botha, assisted by Mr Sayasneh, were able to access and remove the coeliac lymph node successfully. Then, what was most unique in this operation, was the way we accessed the lymph node in the chest. The plan was to access the thoracic node through a hole in the diaphragm where the oesophagus is. This would give us access to the chest node without the need for a chest incision, we could use the same abdominal access we used for the primary cancer and coeliac node. 

Whilst this looked possible on the scans, it wasn’t until we were in the operating theatre we would know for sure that this would be possible. Should we not have been able to access the thoracic node from the diaphragm, Mrs Harrison-Phipps, our expert thoracic surgeon, was on standby in theatre throughout, so we were assured that we could complete the surgery.”

“Fortunately, we were able to perform the entirety of Mrs Davies operation through just six small incisions in her abdomen, using minimally invasive techniques, no chest incisions were required. 

This was truly remarkable. Minimal access surgery minimised Mrs Davies risk of infection, significantly reduced her recovery time and, importantly, the time between surgery and beginning her chemotherapy. 

Had she been treated with conventional, open surgery, she would have been in hospital for 2-3 weeks, with more recovery time at home after that. In Mrs Davies case, she was home in just three days. This fast recovery from surgery gave her more confidence to start her chemotherapy, she felt ready. The surgery was a great success.”

At HCA Healthcare UK our experts are committed to advancing medicine and providing exceptional care. Mrs Davies case is testament to this approach, showcasing a commitment to using collaboration and advanced surgical techniques to improve patient outcomes.

“By successfully removing the primary and metastatic disease using minimal access surgical techniques, we were able to provide Mrs Davies with the best possible outcome, minimising her recovery time whilst maximising the thoroughness of cancer removal. She is making very good progress indeed with her first cycle of chemotherapy after surgery. This groundbreaking procedure not only represents a significant milestone in Mrs Davies's treatment, but also reinforces HCA Healthcare UK’s dedication to pushing the boundaries of medical innovation.”