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Vin Paleri featured in new season of "Super Surgeons"

ENT UK member Vin Paleri is featured as part of the Royal Marsden surgical team in season two of Channel 4's documentary "Super Surgeons: A Chance at Life." The show features pioneering and innovative surgical procedures to treat patients with advanced or difficult-to-treat cancers. The new series aired on Channel 4 on Tuesday,18 June, at 9 p.m. All four episodes are now available for streaming on Channel 4 On Demand.

Filming for this series began last summer and the new series follows some of the most complex and challenging cases tackled at The Royal Marsden.

Episode 2 features Professor Vin Paleri dealing with a complex tumour on Richard Sutton, a retired navy pilot. The tumour was an 18 cm recurrent epitheloid fibrosarcoma, extending from the mandible to just above the aortic arch and 360 degrees around the carotid artery. 

By following Rich through his cancer journey, the episode offers a poignant insight into a backstory that clinicians often get to see: the emotional toll caused by cancer recurrence, the roller coaster of decision-making for an operation which can have serious consequences (including 5% mortality), the stress borne by the family and the eventual rehabilitation and recovery for Rich. 

The filming hasn't held back when it comes to graphically showing the tumour resection, and demonstrates that with careful planning and multidisciplinary working, successful outcomes can be achieved even in such complex presentations.

The other operation featured in episode 2 includes a pelvic exenteration for a recurrent rectal cancer.  Other episodes demonstrate complex procedures in different primary sites, including the decision-making into an operation that had to be abandoned after open laparotomy.

Reflecting on the episode, Vin said:

I was initially reluctant for Rich's story to be filmed. Those of you who followed the previous series will be aware that two of my patients died before the series was telecast: one from tumour recurrence after salvage oropharyngectomy and the other from metastatic breast cancer, despite a successful head and neck salvage. Although ~70% of my surgical practice is salvage surgery for squamous cancer, our intraoperative mortality is under 1%. While a population dataset very clearly supports such surgical interventions as the benefits outweigh the risks, I was worried about the optics of another mortality for this series (we had quoted a 5% on-table mortality risk for Rich).

However, Rich was keen to be filmed, and the fact that he convinced me demonstrated shared decision-making in action: he wanted the world to know about the complex surgical procedures we undertake, the multidisciplinary working and advised us that even if things went wrong, there would be learning from the process. He persuaded me that he would accept the mortality risks associated with my non-filmed cohort rather than that from series 1! 

The procedure was technically difficult,  but on a sliding scale of difficulty, not far removed from some of the other complex presentations. As long as we achieved control of the carotid artery at its entry and exit points into the tumour, we were confident of complete resection and reconstruction. 

These are the cases where planning and close multidisciplinary working becomes crucial to success. My sarcoma oncology colleagues, who understand the biology of these rare tumours so well, were clear this was Rich's best option.  My vascular (Mr Colin Bicknell)  and cardiac surgery (Mr Mario Petrou) colleagues were immensely helpful in the decision making. We ran through multiple scenarios that could complicate the procedure and systematically plugged those points with strategies to sort on table. All this was the hard work. 

The operation itself, including the big bleed shown so graphically, was something we had rehearsed for. We weren't fully prepared for the gossamer thin carotid artery wall, but did eventually reconstruct the artery. The filming crew and their gear was something I was well used to during the previous series and posed no obstacles. I am glad we had a good outcome for Rich and he was able to share his story widely. I simply can't imagine the alternative outcome which would have been devastating. 

The main learning point for me is as follows: it is the team, the planning and the preparation that makes the operation happen. It is the postoperative support infrastructure and the rehabilitation specialists that make the intervention worthwhile. As my colorectal surgical colleague Mr Rasheed says, a more apt title for the series is "Super Teams", but it didn't meet with the approval of the production team as it simply wasn't catchy enough. Optics, after all, is everything.