Colorectal cancer
Bruce George is one of four specialist colorectal surgeons in the John Radcliffe Hospital. The unit treats approximately 300 new patients per year with cancer of the colon or rectum, making it one of the largest colorectal units in Europe. His specialist interest is in minimally invasive, transanal surgery for tumours of the rectum.

Recent publications:

• Bretagnol F, Rullier E, George B, Warren BF, Mortensen NJ.
  Local Therapy for Rectal Cancer: Still Controversial?
  Dis Colon Rectum. 2007 Feb 7;
  
  
• Box B, Lindsey I, Wheeler JM, Warren BF, Cunningham C, George BD, Mortensen NJ, Jones AC. Neoadjuvant therapy for rectal cancer: improved tumor response, local recurrence, and overall survival in nonanemic patients. Dis Colon Rectum. 2005 Jun;48(6):1153-60.
  
  
• Wheeler JM, Dodds E, Warren BF, Cunningham C, George BD, Jones AC, Mortensen NJ.
  Preoperative chemoradiotherapy and total mesorectal excision surgery for locally advanced rectal cancer: correlation with rectal cancer regression grade.
  Dis Colon Rectum. 2004 Dec;47(12):2025-31.
  
  

Inflammatory bowel disease
Bruce George has a particular interest in the management of anal Crohn's disease and inflammatory bowel disease in teenagers. He has set up a specific clinic at the John Radcliffe Hospital to treat patients Crohn's disease of the anus and co-ordinates a regular "teenager IBD" clinic with paediatric surgeon Mr Paul Johnson.

Recent publications:

• Hyder SA, Travis SP, Jewell DP, McC Mortensen NJ, George BD.
  Fistulating anal Crohn's disease: results of combined surgical and infliximab treatment.
  Dis Colon Rectum. 2006 Dec;49(12):1837-41.
  
  
• Fearnhead NS, Chowdhury R, Box B, George BD, Jewell DP, Mortensen NJ. Long-term follow-up of strictureplasty for Crohn's disease.
  Br J Surg. 2006 Apr;93(4):475-82.

Short bowel and complex abdominal fistulae
Over the last 5 years Bruce George has developed a particular interest in the management of intestinal failure and difficult abdominal fistulae. In conjunction with the Oxford total parenteral nutrition (TPN) team he regularly receives referrals from other hospitals of patients with difficult abdominal wall fistulae or intestinal failure.

Pelvic sarcoma and soft tissue tumours
Bruce George is the colorectal representative of the Oxford sarcoma and soft tissue tumour group. He is involved in surgical resection of complex pelvic tumours such as sarcomas, chordomas, neurofibromas and recurrent rectal carcimona. Rare tumours such as these benefit from detailed multidisciplinary assessment prior to consideration of major resectional surgery.

Common anal conditions
Bruce George is involved in the management of the common anal conditions such as haemorrhoids, anal fissure and fistula. The colorectal unit in Oxford regularly undertakes clinical trials or audit studies of these common conditions:

Anal Fistula
Comparison of conventional surgical treatment for anal fistula with the use of fibrin glue. This trial showed a significant benefit for fibrin glue in the treatment of complex (high) fistulas, but no benefit for the more common simple (low) fistula.
Recent publications:

• A randomised controlled trial of fibrin glue vs. conventional treatment for anal fistula. Lindsey I, Smilgin-Humphreys MM, Cunningham C, Mortensen NJ and George BD.
  Dis Colon Rectum 2002: 45; 1608-15.

Anal Fissure
The colorectal unit in Oxford has pioneered sphincter preserving approaches to anal fissure management. Standard first line treatment involves GTN ointment and bulking laxatives such as fybogel. Second line therapy usually involves botulinum therapy. Sphincter preserving surgery such as fissurectomy and botulinum or local flap repairs are used if conservative measures fail. Sphincter cutting procedures such lateral sphincterotomy are very rarely required.

Recent publications:

• Comparison of glycerine trinitrate (GTN) ointment with botulinum toxin (botox) with combination (GTN+botox) for the first line treatment of anal fissures. This trial is still recruiting.
  Botulinum toxin as second-line therapy for chronic anal fissure failing 0.2% glyceryl trinitrate.
  Lindsey I, Jones OM, Cunningham, George BD, Mortensen.
  Dis Colon Rectum 2003: 46; 361-6.
  
  
• Impotence following rectal surgery Impotence is a rare but important complication of rectal surgery. Comparison of viagra (sildenafil) with placebo showed a highly significant benefit of viagra in this group of patients.
  Randomised, double-blind, placebo-controlled trial of sildenafil (Viagra) for erectile dysfunction after rectal excision for cancer and inflammatory bowel disease. Lindsey I, George B, Kettlewell M and Mortensen N. Dis Colon Rectum 2002: 45: 727-32
  
  
• Jones OM, Ramalingam T, Merrie A, Cunningham C, George BD, Mortensen NJ, Lindsey I.
  Randomized clinical trial of botulinum toxin plus glyceryl trinitrate vs. botulinum toxin alone for medically resistant chronic anal fissure: overall poor healing rates.
  Dis Colon Rectum. 2006 Oct;49(10):1574-80.
  
  
• Jones OM, Ramalingam T, Lindsey I, Cunningham C, George BD, Mortensen NJ.
  Digital rectal examination of sphincter pressures in chronic anal fissure is unreliable.
  Dis Colon Rectum. 2005 Feb;48(2):349-52.