Borthwick’s major surgery is the biggest upheaval of his reign in a tournament and is headlined by Fin Smith’s inclusion at fly-half and George Ford being axed from the 23 entirely. Also in are hooker Jamie George, lock Alex Coles, flanker Guy Pepper, scrum-half Ben Spencer, wings Cadan Murley and Tom Roebuck, plus centre Seb Atkinson and full-back Elliot Daly.

There are also three positional changes with Tommy Freeman switching from wing to centre, Tom Curry to openside flanker and Ben Earl to No.8.

Henry Pollock, Luke Cowan-Dickie and Ollie Chessum are demoted to the bench and Henry Arundell, Freddie Steward and Fraser Dingwall have been chopped from the 23 with Ford.

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Italian rugby is on a high; they have beaten the Scots and run Ireland close this tournament, and they are smelling blood and a first-ever win over England.

Borthwick said: “We know the challenge Italy will bring at the Stadio Olimpico, and we’ve selected a team we believe will deliver the level of performance we’re striving for.”

Earl will win his 50th cap, six years after his debut, and has been one of England’s most consistent performers in the last two years.

Borthwick added: “He’s an important leader within this group, someone who drives standards and brings energy every day. It’s a wonderful achievement and one he should be very proud of.”

Defeat in Rome would leave England, with France to come a week on Saturday in Paris, staring down the barrel of one win in five and their worst ever return in the Six Nations.

England will have a training camp in Verona between the two games.

England: Elliot Daly; Tom Roebuck, Tommy Freeman, Seb Atkinson, Cadan Murley; Fin Smith, Ben Spencer; Ellis Genge, Jamie George, Joe Heyes, Maro Itoje (capt), Alex Coles, Guy Pepper, Tom Curry, Ben Earl

Replacements: Luke Cowan-Dickie, Bevan Rodd, Trevor Davison, Ollie Chessum, Sam Underhill, Henry Pollock, Jack van Poortvliet, Marcus Smith