Eligible patients and caregivers will provide written informed consent and complete baseline assessments. The recruiting clinician will contact the research team at The Christie National Health Service Foundation Trust who will manage the randomisation process using an online randomisation system. The person responsible for randomisation will have no involvement in the recruiting process. Participants will be randomised on a 1:1 basis to receive either surgery or no surgery as part of multimodality treatment. Once a patient has been randomised, both the clinical team and the patient will be made aware of the treatment allocation; given the nature of the intervention there will be no masking of patients, carers or clinical staff

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