Asteria An assessment of enteric nervous system

Lunchtime Posters LTP1 An assessment of the enteric nervous system and estroprogestinic receptors in obstructed defecation associated with rectal intussusception C. R. Asteria1, G. Bassotti2 & V. Villanacci3 1 Department of Surgery & Orthopedics, Surgery Unit Asola, Hospital ‘Carlo Poma’, Mantova, Italy, 2 Department of Clinical & Experimental Medicine, Gastroenterology & Hepatology Unit, University of Perugia, Perugia, Italy, 3Department of Human Pathology, 2nd Pathology Section, Spedali Civili, Brescia, Italy Aim: We investigated ENS abnormalities in patients with obstructed defecation (OD), undergoing surgery, together with the presence of estrogen receptors (ER) a, b, progesterone (PR) receptors, and compared the results with those obtained in controls. Method: Full-thickness rectal samples were obtained from 17 patients undergoing STARR for OD associated with rectal intussusception. Samples were analyzed by immunohistochemistry for enteric neurons, enteric glial cells, interstitial cells of Cajal (ICC), For ER and PR, data were compared with those obtained in 10 controls. Results: No differences between patients and controls were found for enteric neurons, whereas OD patients displayed a significant decrease of enteric glial cells in both the submucous (P = 0.0006) and the myenteric (P < 0.0001) plexus. ICC were significantly increased in patients in the submucosal surface (P < 0.0001) and the myenteric area (P < 0.0001). ER receptors were both present on ICC in patients and controls. ER a and PR were absent on enteric neurons and enteric glial cells in patients and controls, whereas ER b were present in all controls and in 69% of patients’ enteric neurons (P = 0.18) and in 12% of patients’ glial cells (P = 0.0001). Conclusion: Patients with OD associated to rectal intussusception display abnormalities of the ENS and of ER b.

LTP2 Percutaneous endoscopic caecostomy for antegrade colonic enema administration in severe constipation: a 2-year experience E. Duchalais, G. Meurette, E. Coron, S. Bruley des Varannes & P.-A. Lehur Institut des maladies de l’appareil digestif, Nantes, France Aim: This study evaluated percutaneous endoscopic caecostomy (PEC) placement as an alternative to the Malone surgical approach in the treatment of intractable constipation. Method: Between 2007 and 2010, 18 severely constipated patients underwent endoscopic placement of a ChaitTM caecostomy catheter to perform antegrade colonic enemas and they prospectively completed specific questionnaires to assess the frequency of enemas, benefits in terms of constipation (Kess) and their quality of life (GIQLI) after 6 months and yearly. Results: The catheter was successfully introduced in 16 patients (89%). Morbidity included superficial wound infection responsive to antibiotics (n = 1), leaks (n = 6) and local pain (n = 8). After a median follow-up of 25 months, nine patients (56%) still routinely perform ACE (median frequency: 1/day; volume: 1500 ml/enema). One and 2 years after PEC placement, the median Kess score improved respectively from 25 (baseline) to 17 (P < 0.01, n = 15) and 19 (P < 0.05, n = 11). One and 2 years after PEC placement, the median GIQLI score similarly increased from 64 (baseline) to 94 (P < 0.01, n = 15) and 76 (P = 0.2, n = 11) respectively. Conclusion: PEC has a low morbidity rate. After 2 years of follow-up, half of the patients experience significant functional and quality of life improvement, avoiding invasive surgical procedure.

LTP3 Sacral nerve stimulation (SNS) certitudes and issues about diagnosis, indications, implant procedures and follow up in bowel dysfunctions: results from the Italian Consensus Expert meeting E. Falletto1, D. Altomare2, G. Naldini3, E. Ganio4 & C. Ratto5 1 San Giovanni Hospital, Turin, Italy, 2University of Medicine, Bari, Italy, 3University Hospital, Pisa, Italy, 4Santa Rita Hospital, Vercelli, Italy, 5Catholic University, Rome, Italy Aim: This study presents the Italian clinical practice in SNS (44 Coloproctologists with around 1500 implants). Method: During May 2010, 26 physicians completed a questionnaire. A statement was considered as a ‘recommendation’ if reached 60% of agreement; in July 2010 the physicians met to discuss the dissenting opinions in order to reach consensus. Results: Patient selection: SNS is indicated in idiopathic faecal incontinence (FI) or with sphincter damage (< 180), not in gas incontinence alone and in severe chronic constipation (slow transit and pelvic floor dyssynergia). Pre-test evaluation: anorectal manometry, transanal US, bowel diary, severity and QoL scales are mandatory in FI; defecography, colonic transit time and colonoscopy in constipation. Change of bowel habits, pelvic floor rehabilitation and drug therapy must precede SNS. Implant procedure: tined lead, two-phase implant procedure, local anaesthesia and antibiotic prophylaxis are recommended. Intraoperative sensory-motor response and radioscopic control are important in lead positioning. Results: During follow up, patient satisfaction and symptoms improvement > 50% (based on bowel diary, severity and QoL scores (which are mandatory to evaluate the efficacy). There is consensus on standard stimulation parameters, but not in cases of unsatisfactory results when re-programming (also repeated) is recommended. Conclusion: Italian SNS experts are widely agreed on these procedures when they produce homogeneous results; when they do not, opinion is divided.

LTP4 What is the impact of PTNS on quality of life (QoL) in patients with faecal incontinence? A. Hotouras, M. Thaha, C. Bryant, M. Allison, C. Bhan, N. Williams & C. Chan Academic Surgical Unit, The Royal London Hospital, London, UK Aim: Faecal incontinence (FI) has a debilitating effect on Quality of Life (QoL). Percutaneous Tibial Nerve Stimulation (PTNS) is being increasingly used to treat FI. This prospective study aimed to evaluate the effect of PTNS on the QoL of patients with FI.

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Method: Patients with FI completed a validated questionnaire (Faecal Incontinence AQoL) prior to and on completion of 12 sessions of PTNS. The pre- and post-treatment scores for the four domains (lifestyle, coping, depression and embarrassment) were compared for any change using Spearman’s test. Results: Ninety-four patients (83F:8M) with a median age of 58 years (range 30–80 years) underwent PTNS. Fifty-two patients (55%) completed the questionnaire prior to treatment and 40 patients (43%) returned the questionnaire after treatment. The median AQol Lifestyle score increased from 2.25 (range 1.0–4.0) to 3.25 (1.1–4.0) following treatment (P < 0.05). The AQol Coping score increased from 1.55 (1.0–3.75) to 2.28 (1.22–4.00) following treatment (P = 0.000005). There were similar improvements in the AQol Depression score, increasing from 2.7 to 3.5 (P = 0.00002) and the AQol Embarrassment Score, increasing from 2.0 to 2.58 (P = 0.001) Conclusion: PTNS improves the quality of life in patients with FI. QoL changes in patients requiring ‘top up’ sessions need further evaluation.

LTP5 Malone antegrade continence enema procedure (ACE) – a long term follow up study ¨ jmyr-Joelsson2, M. Michanec1, B. Frenckner2 & J. Svensson2 B. Husberg1, M. O 1 The Karolinska Institute, CLINTEC at the division of Colorectal Surgery, The Karolinska Hospital, Stockholm, Sweden, 2The Karolinska Institute, Department of Women and Child Health at Astrid Lindgrens Childrens Hospital, The Karolinska Hospital, Stockholm, Sweden Aim: The aim was to evaluate the long-term functional results in a paediatric patient-group now reaching adulthood, who had been operated upon earlier with an ACE because of gastrointestinal functional disturbancies following surgery for inborn malformations or for intractable constipation. Method: Between 1994 and 2001, some 27 patients with functional GE-disturbances following surgery for anal atresia (15), Hirschsprung’s disease (2), myelomeningocele (8) and intractable constipation (2) were treated with ACE. Their ages at surgery were 5–21 years (mean 11 years) undergoing appendicostomy (21) and ileal/colonic conduit (8). Follow-up was performed in 2005 and 2011 through telephone interview and questionnaire about bowel function, rinsing technique and patient satisfaction. Results: In 2005, some 23 patients were still using ACE; 17 being fully continent and six having some leakage. 22/23 expressed satisfaction with one ‘fairly’ satisfied. The fistula was removed in four: three for lack of function and one owing to normalisation of bowel habits. In 2011, 21 patients, aged 16–36 years (mean 24 years), were contacted (six missing). A further four had had their fistula removed; two converted to enterostoma; two claiming no further need. The irrigation fistula was left in 13:11 expressing satisfaction; two ‘fairly’ satisfied. Conclusion: ACE is a minimally invasive method of providing control of bowel habit during adolescence, but it also has a longer perspective into adulthood.

LTP6 Long term outcome of sacral nerve stimulation for combined pelvic floor dysfunctions M. Lemma1, S. Giuratrabocchetta1, F. Cuccia1, M. Di Lena1, C. Ratto2, L. Donisi2, M. Rinaldi1 & D. F. Altomare1 1 University of Bari, Bari, Italy, 2Catholic University of Rome, Rome, Italy Aim: Various pelvic floor dysfunctions (PFD) are often associated. Sacral nerve stimulation (SNS) has been demonstrated to be effective in their treatment. The long-term outcome of patients with > 1 PFD, treated by SNS, are reviewed. Method: Eighty-one patients with at least two associated PFDs were treated by SNS in two centers. The severity of fecal and urinary incontinence, constipation, urinary retention and Qol were scored by appropriate questionnaires. A permanent implant was inserted in cases where there was a significant (> 50%) improvement of at least one PDF. Results: After SNS 45 patients (56%) improved significantly in at least one PDF, and 28 (35%) in 2. After a mean follow-up of 50 months the stimulator was removed in 11 pts (loss of efficacy), and one died leaving 33 (73%) patients for long-term follow-up. The number of episodes of fecal incontinence per month and Wexner’s score significantly decreased (7 vs 0, P = 0.0001 and 15.5 vs 8, P = 0.0001 respectively). The Urinary Incontinence score decreased significantly from 11 to 5 P = 0.0001, and the FIQL improved significantly from 57 to 89, P = 0.0001. However the SF36 Qol did not change significantly. Conclusion: The effects of SNS in the treatment of combined PFD are maintained in the long term in the majority of the patients.

LTP7 Colonic transit in obstructed defaecation syndrome (ODS): is motility abnormal in ODS? M. Rabie1,2, S. Mangam1 & D. Marzouk1 1 Queen Elizabeth The Queen Mother Hospital, Margate, Kent, UK, 2Ain Shams University, Cairo, Egypt Aim: We analyzed colonic transit in patients with ODS, who had failed conservative management and were scheduled for surgery, to understand the role of colonic motility in ODS and the possible effect of surgery. Method: Ninety-five (91F:4M) patients with severe ODS symptoms underwent anorectal physiology. Fifty-three patients with suspected slow transit underwent marker colonic transit studies, using a capsule containing 50 radio-opaque markers. Transit was calculated as the percentage of markers remaining after 100 hours. Transit studies were repeated postoperatively in patients with preoperative left sided slow transit and those with poor functional. Analysis of the presence and distribution of slow transit (> 20% of the markers retained) and the results of surgery was carried out. Results: Twenty-three (43.2%) of the 53 patients were found to have slow transit. Two patients (3.7%) had primary colonic inertia, 2 (3.7%) descending colonic slow transit, 13 (24.5%) rectal and sigmoid colonic slow transit and 6 (11.3%) had slow transit involving the descending colon, sigmoid colon and rectum. Eight patients had postoperative repeat studies, half of them still showed slow transit despite surgery.

 2011 The Authors Colorectal Disease  2011 The Association of Coloproctology of Great Britain and Ireland. 13 (Suppl. 6), 16–27

Lunchtime Posters Conclusion: Left sided slow transit is seen in 43.2% of ODS patients where there is clinical suspicion, representing 24% of all patients. It may not improve with surgery.

LTP8 Pouch design and long term functional outcome after ileal pouch-anal anastomosis T. Gardenbroek, C. Buskens, L. Bos, C. Ponsioen & W. Bemelman Academic Medical Centre, Amsterdam, The Netherlands Aim: Different designs for ileal pouch-anal anastomosis created after restorative proctocolectomy for patients with Ulcerative Colitis and familial adenomatous polyposis have been suggested, but whether one design is superior is still being discussed. This prospective cohort study evaluated the long term functional outcome for two different designs: J- or B-pouch. Method: The analysis included 278 patients from January 1999 to February 2010. Pouch function was evaluated by the Vaizey questionnaire, whereas general quality of life was measured with the SF36 questionnaire. Results: There were 189 patients in the J-pouch group and 89 in the B-pouch group. A total of 76% returned questionnaires were available for analysis after a median follow up of 32 months (range 1– 177). No differences were found in Vaizey and SF-36 scores between the two groups (P > 0.05). There was also no significant difference in stool frequency (22% of B-pouch patients had > 7 stools during day time and > 2 episodes at night versus 16% in the J-pouch group, P > 0.05). Conclusion: Both pouch designs are comparable in terms of the long term functional outcome. The B-pouch design does not result in decreased stool frequency. Therefore the simple J-pouch procedure is recommended.

LTP9 Single-port laparoscopic total proctocolectomy and ileal pouch-anal anastomosis (IPAA): a case-matched analysis D. Hahnloser & D. Dindo Division of Visceral Surgery, University Hospital Zurich, Zurich, Switzerland Aim: To describe our experience with Single-Port Laparoscopic Surgery (SPLS) for proctocolectomy and IPAA. Method: Five consecutive SPLS patients were matched (1:2) to laparoscopic patients (LAP) using four trocars controlling for age, gender and BMI. SPLS were performed with the use of a 5 mm camera and traditional laparoscopic instruments via a port placed at the planned ileostomy site. Results: There was no conversion in the SPLS group and one conversion to Pfannenstiel in the LAP group. There was no difference regarding age between SPLS and LAP (35 years vs 34 years, P = 0.7) or BMI (21.5 kg/m2 vs 22.1 kg/m2, P = 0.7). SPLS operations were shorter by 25 min (P = 0.2). SPLS patients had less pain at POD#2 (VAS 0.6 vs 3.7, P = 0.01) with no difference in analgesic use (P = 0.1). Interestingly, ileostomy output was higher in the SPLS group at POD#2 (1644 vs 525 ml, P = 0.03) and POD#3 (1714 vs 425 ml, P = 0.016). One small bowel obstruction occurred in each group (grade 1 and grade 3a) and one wound infection in LAP (grade 2). Hospital stay was comparable between the groups (7 days vs 10 days, P = 0.1). Conclusion: SPLS seems to be feasible and save for total proctocolectomy and IPAA.

LTP10 The prognostic impact of postoperative complications in patients with Crohn’s disease I. Iesalnieks1 & H. J. Schlitt1 1 Marienhospital Gelsenkirchen, Gelsenkirchen, Germany, 2University of Regensburg, Regensburg, Germany Aim: The prognostic impact of postoperative complications following bowel resection in patients with Crohn’s disease was analysed in the present study . Method: Patients undergoing intestinal resection for Crohn’s disease were included in this retrospective analysis. The term ‘intra-abdominal septic complication’ (IASC) was used for anastomotic leaks, intra-abdominal abscesses and intestinal fistula. ‘Surgical recurrence’ was defined as the need for repeat surgical therapy. Results: Three hundred and ninety-one patients with Crohn’s disease underwent 473 bowel resections. The mean follow-up time was 66 months. The incidence of postoperative IASC was significantly associated with the surgical recurrence rate (OR, 18.9). However, this prognostic impact was observed only in patients with the ileitis terminalis (P < 0.0001), but not in patients with ileocolitis and in patients with colitis. Seventeen patients died during the study period. Overall, the occurrence of postoperative IASC was associated with a higher probability of death from the disease-related conditions (9% vs 3%, P = 0.029), however this association was observed only in patients with terminal ileitis (10% vs 2%, P = 0.02), but not in patients with Crohn’s colitis or ileocolitis. Conclusion: Postoperative complications have a detrimental influence on the long-term outcome following intestinal resections in patients with isolated Crohn’s disease of the terminal ileum.

LTP11 One-stage colectomy of the descending colon without intraoperative colonic lavage in peritonitis and obstruction M. A. Ciga Lozano, F. Oteiza Martı´nez, L. F. Rico, P. A. Rubio, T. A. Force´n, M. De Miguel Valencia, M. De Miguel Velasco & H. Ortiz Hurtado Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain Aim: The surgical management of left colonic emergencies has evolved in the past few decades. Recently, there has been increasing interest in resection with primary anastomosis in selected cases. The aim of this study was to evaluate the differences in outcome in patients with peritonitis or obstruction treated by resection and primary anastomosis of the left colon without intraoperative colonic lavage. Method: Between January 2004 and December 2010, 148 consecutive patients underwent emergency operation for a distal colonic lesion. Resection and primary anastomosis of the left colon without intraoperative colonic lavage was performed in 37 patients with obstruction and in 40 with peritonitis. Main outcome measures were mortality, symptomatic anastomotic dehiscence and surgical site infection. Results: There was no mortality. No differences were found in symptomatic anastomotic dehiscence [2 (5.4%) obstruction vs 0 perforation; P = 0.439], or surgical site infection [2 (5.4%) obstruction vs 6 (15.0%) perforation; P = 0.265]. Conclusion: Resection without on-table lavage and primary anastomosis constitute the operation of choice for selected patients with left colonic emergency. Mortality, anastomotic dehiscence and surgical site infection are similar in patients with peritonitis or obstruction.

LTP12 The efficacy of non-operative management of acute diverticulitis F. O. Martı´nez, T. A. Force´n, M. A. Ciga Lozano, P. A. Rubio, A. V. Rodrı´guez, M. De Miguel Velasco & H. O. Hurtado Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain Aim: The purpose of this study was to evaluate the efficacy of non-operative management of acute diverticulitis. Method: A retrospective review was performed of an institutional review board-approved database of patients admitted with a diagnosis of acute diverticulitis from 2002 to 2010. All patients were diagnosed by CT scan. Primary end points were the success of non-operative management, the need for surgery during the initial admission and recurrences, further admissions and operations. Results: Five hundred twenty-three were diagnosed with diverticulitis. Sixty five (12.2%) diagnosed with generalized or feculent peritonitis were operated on. Of the remaining 458 patients, 106 were identified with complicated diverticulitis and 352 with uncomplicated diverticulitis. After discharge 30 patients were readmitted [18 (17%) complicated vs 12 (3.4%) uncomplicated (P = 0.001)]. Five of these complicated patients required urgent surgery for failed non-operative management. Recurrences were identified in 116 (25.6%) [29 (28.7%) complicated vs 87 (24.7%) uncomplicated (P = 0.417)]. Elective surgery was performed on 45 (9.6%) [15 (14.9%) complicated vs 30 (8%) uncomplicated (P = 0.037)]. Conclusion: Non-operative management of acute complicated diverticulitis is highly effective. However, further surgery is required more frequently.

LTP13 Are C-reactive protein levels necessary to diagnose acute appendicitis in children? J. Hodgkinson, Z. Shaker, E. Tan, O. Warren, Q. Irbil, S. Harris, Y. Mohsen & A. Prabhudesai Department of Colorectal Surgery, Hillingdon Hospital NHS Trust, Uxbridge, London, UK This abstract has already been published on the British Journal of Surgery website following presentation at ASGBI and has therefore not been published to avoid duplication.

LTP14 Preventing parastomal hernias: how critical is the trephine size? A. Hotouras1, M. Thaha1, N. Power2, C. Chan1 & N. Williams1 1 Academic Surgical Unit, The Royal London Hospital, London, UK, 2Department of Radiology, The Royal London Hospital, London, UK Aim: Parastomal herniation (PH) is the most common complication of stoma formation. The aim of this study was to assess the radiological incidence of PH in permanent colostomies and correlate it with the trephine size. Method: Patients who underwent Hartmann’s procedure or APER for malignancy (January 2004– December 2009) were identified from our departmental database. Follow up CT scans were reviewed by a single consultant radiologist. The maximal diameter of the trephine was measured and data analysed using the Mann–Whitney U test. Results: Forty-two patient records were retrieved and analysed. Radiologically, 24/42 (57.1%) had evidence of a PH. The median diameter of the trephine was 35.0 mm (range 25.0–58.0 mm, 95%CI 34.7–46.2 mm) in patients with parastomal hernias and 22.0 mm (range 7.0–36.0 mm, 95%CI 16.5– 26.5 mm) in patients without herniation (P < 0.0001). The median follow up was 26.0 months in patients with herniation as opposed to 16.0 months in patients without herniation (P < 0.1133). Conclusion: A significant proportion of patients with permanent colostomies develop PH within the first 2 years of stoma formation. PH is unlikely to develop with a trephine diameter £ 25 mm provided this is maintained with time. New techniques such as ‘Stapled Mesh Stoma A Reinforcement Technique’ (SMART) create a precise and rigid trephine, minimising the risk of herniation.

LTP15 A randomized controlled trial for single port laparoscopic surgery in acute appendicitis S.-H. Lee, B. M. Kang, S. I. Choi & B. S. Kim Kyung Hee University School of Medicine, Seoul, Korea Aim: We performed a randomized clinical trial to evaluate the safety and efficacy of single port laparoscopic surgery (SPLS) in acute appendicitis. This trial is registered with the clinical trial registry (ClinicalTrials.gov Identifier: NCT01007318). Method: Between December 2009 and November 2010, a total of 200 patients with radiologically diagnosed acute appendicitis were randomly allocated to either the single port or to conventional laparoscopic surgery (CLS). All data were analyzed by intent-to treatment. Results: The study groups were composed of 108 men and 76 women with a mean age of 30.7 years (range 7–71). There were no open conversions, but in 10.9% (10/92) multi-port operations were performed. Operation time was longer in SPLS group (43.7 min vs 29.6 min, P = 0.000). There was no difference between groups in the rate of intra-operative complications (P = 0.246). Postoperative pain scored by visual analogue scale 12, 24, and 36 hours after surgery was similar between SPLS and CLP groups, but more analgesics were used in SPLS group.(74.5 mg vs 51.6 mg, P = 0.028). Recovery of bowel function was slower in SPLS group in terms of time to first passage of flatus (27.5 hours vs 20.0 hours, P = 0.000) and time to sips.(27.5 hours vs 19.4 hours, P = 0.000). The postoperative complication rate and readmission rate were not different. Conclusion: The single port approach is safe and feasible in acute uncomplicated appendicitis.

LTP16 The management of enterocutaneous fistulae in the UK: are two hospitals enough? J. Murphy, C. Bhan & C. Chan Barts and The London School of Medicine and Dentistry, London, UK Aim: Enterocutaneous fistulae (ECF) comprise a complex entity requiring a multidisciplinary approach. It is suggested that ECF should only be managed in selected national centres. This study addressed the incidence of this condition to determine the need for specialist services in the UK.

 2011 The Authors Colorectal Disease  2011 The Association of Coloproctology of Great Britain and Ireland. 13 (Suppl. 6), 16–27

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Lunchtime Posters Method: Hospital Episode Statistics data were used to identify all the incident cases of ECF admitted to UK hospitals between 1998 and 2010. Results were stratified by gender, age, year of diagnosis, admission type, length of stay and bed days. Results: The number of incident cases requiring planned hospital admission increased from 835 patients in 1998, to 1758 in 2010 (P = 0.0001), a mean increase of 83.91 ± 59.48 patients per year. By contrast, emergency admissions over this time period remained relatively more stable with 488 cases in 1998 and 584 in 2010 (P = 0.0464), a mean increase of 8.73 ± 57.73. The rising incidence of this condition was due to increases in the adult rather than paediatric population (P < 0.0001). Conclusion: This study demonstrates that the incidence of hospitalisation for ECF in the UK has dramatically increased over the past decade. This has significant implications for service delivery, as clearly more than two specialist hospitals are now required in the UK to deal with this condition.

Method: Between January 2010 and March 2011 patients with potentially resectable stage IV colon cancer were submitted to preoperative Bevacizumab combined with cytotoxic chemotherapy. Pathological specimens of patients operated after post-chemio evaluation were studied and graded with Tumour Regression Grade (TRG; Mandard’s modified score) in order to analyze the histological response to chemotherapy. Results: After post-chemio evaluation 10 patients were submitted to surgery. Six had resection of the primary alone, four had both primary and the metastastatic disease resected synchronously. Analysis of the primaries revealed a TRG 4 in six cases, TRG 3 in one and a TRG2 in three. Conclusion: In patient with stage IV resectable colon cancer initial chemotherapy with Bevacizumab can obtain histological response in the primary tumour. Major or partial response were observed in 40% of cases. These initial data support the policy of initial chemotherapy for stage IV colon cancer and the need to verify the possible role of this approach in locally advanced primary colon cancer.

LTP17 Prospective comparison of quality of life outcomes in Chinese patients after curative laparoscopic versus open sphincter-preserving resection for rectal cancer S. Ng, W. Leung, C. Wong, D. Ngo, S. Hon, J. Li & J. Lee The Chinese University of Hong Kong, Shatin, Hong Kong

LTP21 Swedish patients operated with abdomino perineal resection (APR) for rectal cancer 2007–2009 M. Prytz, E. Angenete & E. Haglind Institute of Clinical sciences, University of Gothenburg, Gothenburg, Sweden

Aim: This prospective study was designed to compare quality of life (QoL) outcomes in Chinese patients after curative laparoscopic versus open surgery for rectal cancer. Method: Seventy-four (49 laparoscopic, 25 open) consecutive Chinese patients with rectal cancer undergoing curative sphincter-preserving resection between 7/2006 and 7/2008 were enrolled. The QoL outcomes were assessed longitudinally using the validated Chinese version of the EORTC QLQ-C30 and QLQ-CR38 questionnaires before surgery and at 4, 8, and 12 months after surgery. Results: The two groups of patients were comparable in terms of socio-demographic data and baseline mean QoL scores. There was no significant change from baseline in global QoL for the laparoscopic group at different time points, whereas the global QoL was worse than at baseline from 4 months onward but returned to baseline by 12 months for the open group. Compared with the open group, the laparoscopic group had significantly better physical, role, and cognitive functioning at 8 months, less micturitional problems at 4–8 months, and less male sexual problems from 8 months onward. Conclusion: Laparoscopic sphincter-preserving resection for rectal cancer is associated with better preservation of QoL and less micturitional and male sexual problems when compared with open surgery in Chinese patients.

Aim: As part of an ongoing study (APER) of Swedish rectal cancer patients operated with APR data on all patients operated 2007–2009 were collected from the Swedish Rectal Cancer Registry (SRCR). The primary aim of the ongoing study is to compare the oncological outcome 3 years after traditional and extralevator APR. We now present the basic characteristics of this population. Method: All patients with rectal cancer, operated with APR 2007–2009 and registered in SRCR were included. Demographic data and data on preoperative staging, neoadjuvant treatment, pathology reports and postoperative complications were collected. Results: One thousand three hundred and ninety-seven patients were included, 57% men 43% women. Median age at operation was 70 years. 81.3% received preoperative irradiation, (71% short term, 27.6% long term). 22.5% had preoperative chemotherapy. 5.2% had a laparoscopic operation. Stage distribution: 25% stage I, 24% stage II, 42% stage III, 13% stage IV. 3% had no remaining tumour. Overall postoperative complication rate was 43.3% and reoperation rate was 10.7%. Mortality within 30 days was 2.3%. Discussion: The data so far are only descriptive of this population. Further analysis with regard to the two different operation methods and with focus on local recurrence rate 3 years postoperatively will be of great interest.

LTP18 ‘It was an emergency’: no longer an excuse for poor stoma function M. Quinn1, E. Aitkens1, I. Robertson1, M. Spiers1, M. Thornton2 & A. Macdonald1 1 Monklands General Hospital, Lanarkshire, UK, 2Wishaw General Hospital, Lanarkshire, UK

LTP22 Survival after curative surgery for colorectal cancer in elderly patiens ASA I-II J. J. Arenal, C. Tinoco, M. A. Citores, C. Benito & M. Gonza´lez-Sagrado University Hospital Rı´o Hortega, Valladolid, Spain

Aim: A poorly constructed stoma affects cosmesis and alters patients’ quality of life. Historically, emergency stoma formation was linked with poor function. Across specialties, elective versus emergency stoma functional outcome was assessed. Method: A 10 year retrospective analysis of stoma formation was undertaken (data collected prospectively). Stomas were scored using a validated functional stoma scoring system [score: 0 (best)22 (worst)]. Data were analysed using SPSSv10, functional scores were expressed as median, and P < 0.05 = significant. Results: Seven hundred and seventy-eight patients were identified, 498 (64%) elective and 279 (36%) emergency procedures. No difference in score was seen between the elective and emergency groups (2.53 vs 2.49, P = 0.73). Pre-operative marking did not affect elective stoma scores. (2.38 vs 2.74 P = 0.21). However in an emergency setting, pre-operative marking was found to improve functional scores (2.05 vs 3.04 P = 0.03). Emergent stoma functional scores did not differ across specialties (2.44 vs 2.82, P = 0.28). There was a non-significant trend towards improved elective stoma function in the colorectal surgeon group (2.33 vs 3.28, P = 0.09). Conclusion: ‘It was an emergency’ is no longer an excuse for poor stoma formation. Although often performed at the end of a procedure, the formation of a good stoma is crucial and attention to detail must be paid. Wherever possible in the emergency setting, pre-operative marking should be undertaken.

Aim: One problem when analysing survival after curative surgery for colorectal cancer is the high prevalence of co-existing diseases in elderly patients. The aim of this study is to analyse 5-year survival in patients ASA I-II underwent curative surgery for colorectal cancer. Method: Seven hundred and ninety-nine patients operated on because stage I-III colorectal cancer, classified ASA I-II, selected from a cohort of 1830 patients operated between 1985–2006. Patients were divided in four age groups: Group 1, 274 cases aged < 65 years; Group 2, 268 patients aged 65– 74; Group 3, 205 patients aged 75–84; and Group 4, 52 patients ‡ 85 years of age. Analysed factors: Character of surgery (elective or not), tumour characteristics, mortality and survival. Results: No differences were found related to tumour characteristics except increase of right tumours in Group 4 (P = 0.0001) . Mortality was 0.7% in Group 1, 2.6% in Group 2, 6.3% in Group 3 and 5.8% in Group 4 (P = 0.003). 5-year cancer-related survival was 75% in Group 1, 74% in Group 2, 64% in Group 3, and 57 in Group 4 (P = 0.05). Conclusion: Curative surgery for colorectal cancer in oldest-old patients ASA I-II can be made with low surgical mortality and good rates of survival.

LTP19 Failure to rescue-surgical (FTR-S) a novel marker of surgical complication management in colorectal cancer patients A. M. Almoudaris1, E. M. Burns1, R. Mamidanna1, A. Bottle2, P. Aylin2, C. Vincent1 & O. Faiz1 1 Imperial College, London, UK, 2Dr Foster Unit, London, UK Aim: To assess whether variability exists in Failure To Rescue (FTR) rates after re-operations for serious surgical complications after colorectal cancer resections in England. Methods: Hospital Episodes Statistics (HES) was used to identify patients undergoing resection for colorectal cancer between 2000 and 2008 in England. Units were ranked into quintiles according to risk-adjusted mortality. Highest and lowest mortality quintiles were compared for- reoperation rates and FTR-Surgical (FTR-S) rates. We define FTR-S as the proportion of patients with an unplanned re-operation who die within the same admission. Results: One lakh forty-four thousand five hundred and forty-two patients undergoing resections for colorectal cancer in England were included. On ranking according to risk adjusted mortality, rates varied significantly between lowest and highest mortality quintiles (5.42% and 9.31%, P < 0.001). Lowest and highest mortality quintiles demonstrated equivalent adjusted re-operation rates (4.76% and 4.84%, P < 0.001). FTR-S rates were significantly higher at units within the worst mortality quintile (16.80% vs 11.10%, P < 0.002). Conclusion: Significant differences have been demonstrated between FTR-S rates which highlights variability in institutional capability to prevent death. This may represent differences in serious surgical complication management. FTR-S represents a potentially important, readily collectable marker of surgical complication management. This paradigm is likely to be applicable to other surgical specialities.

LTP20 Preoperative chemotherapy induces histological response in the primary in patients with Stage IV colon cancer A. Belli, F. Izzo, F. Tatangelo, F. Bianco, G. Nasti & G. Romano Department of Abdominal Oncology, National Cancer Institute ‘G. Pascale’, Naples, Italy Aim: Preoperative chemotherapy has been recently proposed as initial treatment of resectable metastatic (stage IV) colon cancer. This approach offers the possibility to analyze the histological effects of neoadjuvant chemotherapy on the primary tumour an aspect rarely investigated.

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LTP23 Preliminary results of reconstruction of the pelvic floor after abdominoperineal resection (APR) for rectal cancer with a biological mesh P. Armenda´riz, H. Ortiz, M. De Miguel, M. A. Ciga & F. Oteiza Hospital Virgen del Camino, Pamplona, Spain Aim: The aim of the study was to compare perineal wound and pelvic complications in two groups of patients operated on abdominoperineal resection with excision of pelvic floor and reconstruction with and without a biological mesh. Method: From January 2008 to January 2011, thirty three consecutive patients had extended APR. In last eleven patients (group 1) reconstruction of the pelvic floor was performed by using an absorbable biological mesh (Permacol) and in remaining twenty-two patients reconstruction was carried out without mesh. Postoperative adverse effect was collected in a prospective database. Results: There were no differences in demographics or TNM status between both groups. Perineal wound infection was observed in eight patients (one in group 1 and 7 in group 2). One patient in group 1 and four in group 2 presented delayed perineal healing and the same figures was observed in pelvic abscess. The overall number of pelvic or perineal complications (Delayed healing, infection or abscess) was 2 (2/11 patients) in Permacol group and 10 (10/22) in the other group. Conclusion: Our preliminary result suggest the use of a biological mesh for pelvic floor reconstruction is related with a decrease of perineal and pelvic complications after APR.

LTP24 Prono versus supine abdomino perineal resection in low rectal cancer P. Armenda´riz, H. Ortiz, E. Garcı´a-Granero, M. De Miguel, B. Flor & P. Esclaped Hospital Virgen del Camino, Pamplona, Spain Aim: This study assessed the short-term clinical and pathological endpoints of the extralevator technique performed in a supine or in a prone perineal approach. Method: The present study includes all patients undergoing APE in two hospitals of the Spanish’s Rectal Cancer Project. From February 2008 two hospitals changed from a supine (S-APE) to a prone perineal approach (P-APE) performing extralevator APE. Data were collected in a database and included surgical perforation (IOP) and CRM involvement. Eighty-eight patients were included in the study. In the first period 32 patients were operated in a supine position (S-APE). In the second period 56 patients were operated in a prone position (P-APE).

 2011 The Authors Colorectal Disease  2011 The Association of Coloproctology of Great Britain and Ireland. 13 (Suppl. 6), 16–27

Lunchtime Posters Results: There were no differences in surgical adverse effects, T and N stages or the plane of resection of the mesorectum between both groups. Nine specimens showed an IOP (10.22%), three in group S-APE versus six in group P-APE (P = 0.576). The CRM was affected in seven (22, 58%) patients in group S-APE versus six (10.71%) in group P-APE (P = 0.121). Conclusion: Our data suggest that P-APE has a similar result than S-APE when both are performed with the same oncological criteria.

LTP25 The effect of colonoscopic tattooing on lymph node retrieval and sentinal node mapping S. Bartels1, E. van der Zaag2, H. Peters2, P. Tanis1, C. Buskens1 & W. Bemelman1 1 Academic Medical Center, Amsterdam, The Netherlands, 2Gelre Ziekenhuizen, Apeldoorn, The Netherlands Aim: In colorectal cancer (CRC) colonoscopic tattooing with Indian ink is performed to mark the tumor site before surgery. It can also serve an additional role as sentinel lymph node (SN) mapping. Aim of this study was to determine if colonoscopic tattooing leads to a higher lymph node (LN) yield per specimen and determine its accuracy as a SN procedure. Method: In a consecutive series of 95 tattooed cases between 2005 and 2009, all LNs were microscopically examined for the presence of carbon-particles. A series of 211 patients that underwent elective resection for CRC in the same time period without tattooing served as controls. Results: A significantly higher LN yield was observed in patients with pre-operative tattooing, median (interquartile range) 15 (10–20) vs 12 (9–16), (P = 0.012). Carbon-particles were detected in 71% of tattooed patients with an average of 5 positive LNs per case. If pre-operative tattooing was used for SN mapping, the overall accuracy of predicting LN status was 94%. In the 24 N1 cases there were four false negative procedures (sensitivity 83%). Conclusion: After tattooing of CRC LN yield was significantly higher than in a control group, and it can be used as a SN procedure with acceptable accuracy rates.

LTP26 Who benefits from adjuvant chemotherapy after neoadjuvant chemoradiation and surgery for locally advanced rectal cancer? M. Maas1, P. Nelemans2, V. Valentini3, C. Crane4, C. Capirci5, C. Ro¨del6, J. Guillem7, L.-J. Kuo8, R. Glynne-Jones9, J. Garcı´a-Aguilar10, J. Sua´rez11, F. Calvo12, S. Pucciarelli13, S. Biondo14, G. Theodoropoulos15, R. Beets-Tan1 & G. Beets1 1 Maastricht University Medical Centre, Maastricht, The Netherlands, 2Maastricht University, Maastricht, The Netherlands, 3Catholic University Rome, Rome, Italy, 4MD Anderson Cancer Center, Texas, USA, 5State Hospital, Rovigo, Italy, 6University Hospital Frankfurt, Frankfurt, Germany, 7Memorial Sloan Kettering Cancer Center, New York, USA, 8Taipei University Hospital, Taipei, Taiwan, 9Mount Vernon Hospital, London, UK, 10City of Hope Comprehensive Cancer Center, Chicago, USA, 11Hospital de Navarra, Navarra, Spain, 12University Hospital Gregorio Maran˜on, Madrid, Spain, 13University of Padova, Padova, Italy, 14Bellvitge University Hospital, Barcelona, Spain, 15Hippocration General Hospital, Athens, Greece Aim: The aim was to evaluate whether the effect of adjuvant chemotherapy (aCT) depends on the response after CRT for rectal cancer and to identify which patients benefit from aCT after CRT. Method: A pooled analysis of individual patient data was performed. Patients were categorised into three response groups: pCR (ypT0N0), ypT1-2 tumour and ypT3-4 tumour. Relapse-free survival (RFS) was compared between patients who did and did not receive aCT within the three response groups with Kaplan–Meier survival curves and multivariable Cox regression analyses. Results: Three thousand three hundred and thirteen patients were included of which 1723 (52%) received aCT. Eight hundred and ninety-eight patients had a pCR, 966 had a ypT1-2 tumour and 1302 had a ypT3-4 tumour. Median follow-up was 51 months. 5-year RFS with aCT was 90%, 85%, 62% (for pCR, ypT1-2, ypT3-4, respectively) versus 90%, 84% and 60% without aCT (for pCR, ypT1-2, ypT3-4, respectively). Corresponding hazard ratios were 1.30 (95%CI 0.71-2.37) for pCR, 0.62 (95%CI 0.40–0.95) for ypT1-2 and 0.83 (95%CI 0.64– 1.07) for ypT3-4 tumours. Conclusion: Patients with a pCR after CRT do not benefit from aCT, while patients with residual tumour do benefit from aCT. Therefore, it can be considered to omit aCT in patients with a pCR after CRT, while patients with a residual tumour after CRT should receive aCT.

LTP27 Short-term outcomes following the extralevator approach to abdominoperineal resection for low rectal cancer Z. Bell, P. Loughlin, R. Gilliland, K. McCallion & I. McAllister Ulster Hospital, Dundonald, Belfast, UK Aim: Extralevator abdominoperineal resection (APR) is currently suggested to be an oncologically superior surgical approach for low rectal cancer. This study compared early short-term results for this procedure with those obtained by a conventional operation. Methods: Clinical and pathological data were collected retrospectively on 93 consecutive standard APRs performed by five colorectal surgeons between 2004 and 2011. These were compared with the first 23 extralevator excisions carried out by two of the surgeons who adopted the new technique during the study period. Results: Patients were more likely to have involvement of the circumferential margin (CRM) if the tumour was pT3 (P = 0.02), pT4 (P = 0.001) or pN2 (P < 0.001). However, extralevator APR resulted in a reduction in CRM involvement (from 27.2% to 13%; P = 0.19) and intra-operative perforation (from 15.2% to 0%; P = 0.07) compared with standard surgery. Extralevator excision was also associated with a significant increase in perineal wound complications (from 16.3% to 26%; P = 0.045) Conclusion: This study supports current evidence that rates of IOP and CRM for low rectal cancer surgery can be improved by an extralevator approach. Indeed, although statistical significance was not achieved with the small sample size, CRM involvement was halved in this patient cohort.

LTP28 Natural course of untreated colorectal cancer A. Bhattacharjee, M. Khonje, M. Ashrafi, H. Shaker & A. Ramesh University Hospital of South Manchester, Manchester, UK Aim: The natural history of untreated colorectal cancer is poorly understood.

Method: Casenotes were reviewed for 67 patients with untreated colorectal cancer between 2005 and 2010. Data was collected on demographics, reasons for not having treatment, complications of untreated cancer and survival. Results: Mean age was 82 years (range 49–100). Twenty-six (39%) patients had two or more major co-morbidities. Five patients had dementia. Twenty-nine patients (43%) had scan-confirmed metastases, 26 (39%) were metastases-free and staging was unknown in 12 (18%). Reasons for not having treatment included being unfit (n = 24), advanced disease (n = 13), both of the latter (n = 13) or refusal of treatment (n = 17). Major complications (perforation, obstruction, bleeding) were seen in 27 (40%) patients and minor complications (low-grade bleeding) were seen in 10 (15%). Survival ranged from 1 to 63 months (mean 9.5). Forty-one patients (61%) survived < 6 months. Fourteen (21%) survived 12 months or more. Survival was not influenced by age, co-morbidities, tumour site or presence of metastases. Conclusion: Approximately 60% of untreated colorectal cancer patients will die within 6 months of diagnosis; however the remainder of patients survive a mean of 20 months. Complications of untreated colorectal cancer need to be considered when deciding to manage patients conservatively.

LTP29 Neoadjuvant long course CCRT significantly increases distant free survival among pathological stage III rectal cancer patients as compared to short course RT alone J.-M. Chiang, P. S. Hsieh, N. M. Tsang, W. Yang, C. Y. Yeh & J. S. Chen Chang Gung Memorial Hospital, Taipei, Taiwan Aim: Both neoadjuvant short course radiotherapy and long course radiotherapy with concurrent chemotherapy have been used for locally advanced rectal cancer. However, selection of patients between these treatments remained unclear. Method: Patients diagnosed as locally advanced mid and low third rectal adenocarcinoma and received short course or long course radiotherapy then followed by curative surgery were included. Clinical variants, survival, local recurrence and distant metastasis rate were compared. Results: Tumor location (63.4% vs 81.0% for low rectum, P = 0.049) was the only difference between short course and long course subgroups. The 5 years overall survival (89.3% vs 62.2%, P = 0.009) is better in the short course group for subgroup without lymph node metastasis. In contrast, subgroup with lymph node metastasis, better 5 years diseases free survival (27.8% vs 64.7%, P = 0.018) and metastasis free survival (26.8% vs 76.5%, P = 0.003) were noted in the long course CCRT group. However, there was no significant difference for local recurrence (83.0% vs 87.5%, P = 0.557). Conclusion: To achieve better disease free survival, long course CCRT was suggested for patients with suspected lymph node metastasis. However, for patients without clinical evidence of lymph node metastasis, short course RT would be recommended.

LTP30 The added value of diffusion weighted MRI in the local staging in advanced colorectal pelvic cancer P. A. Georgiou1,2, P. P. Tekkis1,2, U. Patel3, A. Antoniou1,2, A. W. Darzi2,4, D. Cunningham5, D.-M. Koh3 & G. Brown3 1 Department of Surgery and Cancer, Chelsea and Westminster Campus, Imperial College, London, UK, 2Department of Colorectal Surgery, The Royal Marsden NHS Foundation Trust, London, UK, 3 Department of Radiology, The Royal Marsden NHS Foundation Trust, London, UK, 4Department of Surgery and Cancer, St Mary’s Campus, Imperial College, London, UK, 5Department of Oncology, The Royal Marsden NHS Foundation Trust, London, UK Aim: To assess the diagnostic accuracy and added value of diffusion weighted Magnetic Resonance Imaging (DW-MRI) in detecting colorectal tumour invasion into seven intrapelvic compartments for planning exenterative pelvic surgery. Method: Thirty-three consecutive patients were preoperatively staged using DW-MRI to undergo exenterative surgery for locally advanced primary (n = 12) and recurrent (n = 21) colorectal pelvic cancer. Two blinded radiologists reported tumour invasion. Diagnostic accuracy values were calculated. Interobserver agreement was assessed using Cohen’s Kappa (j) coefficient for each compartment. Results: The sensitivity of DW-MRI when used alone was low for all the compartments except the central (92%). Its specificity was very high for all the compartment (‡ 89.5%). DW-MRI the diagnostic accuracy for the lateral compartment improved by 3%. The interobserver agreement was either good or very good (j ‡ 0.669; P < 0001). Conclusion: DW-MRI was weak in detecting tumour invasion within all the compartments except the central. It was accurate though in predicting the absence of disease within any of the compartments. DW-MRI improved the overall accuracy of MRI within the lateral compartment.

LTP31 The single port laparoscopic surgery can be performed safely and appropriately in colon cancer. The analysis of the pilot prospective randomized trials S.-H. Lee, B. M. Kang, S. J. Park & K. Y. Lee Kyung Hee University School of Medicine, Seoul, Korea Aim: The aim of this study were to identify the safety and efficacy of the single port laparoscopic surgery (SPLS) in patients with colon cancers in a prospective randomized clinical trials. (ClinicalTrials.gov Identifier: NCT01203969). Method: Between June 2010 and April 2011, total 62 patients were randomly allocated to either the SPLS or conventional laparoscopic surgery (CLS) at Kyung Hee University Hospitals, Seoul, South Korea. The primary endpoints were related to safety and pathologic adequacies such as the number of harvested lymph node and length of resection margin. Data was analyzed according to intention-totreat principle. Results: Total 62 patients was composed of 35 men and 27 women with mean age of 63.0 years (range 3882). The types of operation and operation time (SPLS 135 min vs CLS 131 min; P = 0.134) and EBL (94.8 ml vs 43.7 ml, P = 0.073) were similar. Conversion to multi-port laparoscopic surgery was occurred in 6 (19.4%) patients of SPLS group (open conversoin two cases). Number of harvested lymph nodes, length of proximal and distal resection margins were not statistically different between two groups. Postoperative complication (P = 0.661) and postoperative recovery of bowel function were similar in both groups. Conclusion: SPLS for colon cancer could be performed safely. SPLS for colon cancer is feasible to follow the oncologic principles.

 2011 The Authors Colorectal Disease  2011 The Association of Coloproctology of Great Britain and Ireland. 13 (Suppl. 6), 16–27

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Lunchtime Posters LTP32 Long-term functional results and quality of life after transanal endoscopic microsurgery M. E. Allaix, F. Rebecchi, M. Mistrangelo, C. Giaccone & M. Morino Digestive and Colorectal Surgery, Centre of Minimal Invasive Surgery, University of Turin, Molinette Hospital, Chief Prof. M. Morino, Turin, Italy Aim: The aim of this study was to assess long-term clinical and instrumental outcomes after TEM for extraperitoneal rectal cancer. Method: Pre- and postoperative assessment of anorectal function was based on clinical scores and manometry. Results: Between January 2000 and July 2005, 93 patients undergoing TEM completed the study protocol at 60 months. Mean Wexner score for continence was higher than the baseline value at 3 months, began to decline within 12 months, and then returned to the preoperative value at 60 months. Urgency was reported by 65%, 30%, and 5% of patients at 3, 12 and 60 months, respectively (P < 0.05). An improvement in the FIQL, EORTC QLQ-C30, EORTC QLQ-CR38 and the EuroQol EQ-5D, EQ-VAS scores was noted at 12 and 60 months. Postoperative manometry values at 3 months were significantly lower than at baseline (P < 0.05) but returned to preoperative values at 12 months. Tumor size (> 4 cm) was the only factor that significantly (P = 0.008) affected the rectal sensitivity threshold, the urge to defecate threshold, and the maximum tolerable volume at 3 months. Conclusion: TEM did not have a long-term effect on anorectal function or on QoL. Lower anal resting pressure at early follow-up was not associated with defecation problems in preoperatively continent patients.

LTP33 Anal cancer: differences between HIV+ and HIV) patients M. Mistrangelo1, I. D. Conte2, P. Cassoni3, R. Senetta3, F. H. Munoz4, G. Fora5, E. Milanesi5, P. Racca5, M. E. Allaix1 & M. Morino1 1 Digestive and Coloproctological Surgical Department and Centre of Minimally Invasive Surgery, University of Turin, Dir. Prof. M. Morino, Turin, Italy, 2Infectious Diseases Department, University of Turin, Dir. Prof. G. Di Perri, Turin, Italy, 3Department of Biomedical Sciences and Human Oncology, University of Turin, Molinette Hospital, Chief Prof. G. Bussolati., Turin, Italy, 4Department of Radiotherapy, University of Turin, Dir. Prof. U. Ricardi, Turin, Italy, 5Department of Oncology, Molinette Hospital, Dir Dott L. Ciuffreda, Turin, Italy Aim: Anal cancer is a rare disease. MSM and patients HIV+ present a increased incidence. Combined radiochemotherapy is the treatment of choice. Morbidity isn’t negligible. Method: Eighty-one patients (49 F and 32 M) affected by anal cancer were observed. Eighteen patients (22.2%) were HIV+. Three of these patients presented a multifocal neoplasm. All patients, except 8 with T1 lesions of the anal verge were treated with combined radiochemotherapy treatment. Inguinal metastases, detected with PET-CT and Sentinel lymph node biopsy are similar in the two groups (28.5% in HIV+ vs 25% in HIV)). Results: Toxicity related to chemoradiation treatment occurred in 21 HIV) patients (33.3%) vs 5 HIV+ patients (27.7%). Mucositis, Diarrhea, neutropenia and piastrinopenia were the more frequent complications. In HIV- group 1 patient died during the treatment for complications. Post-treatment recurrence occurred in 5 HIV+ patients (27.7%) vs 15 of HIV) patients (23.8%). Conclusion: In HIV+ patients anal cancer could be multifocal. Radiochemotherapy for anal cancer is well tolerated both in HIV) and HIV+ patients. Morbidity is comparable in the two groups, so no differences in the standard treatment must be done. Recurrences are similar. A CD4+ count < 200 is a relative controindication to standard treatment.

LTP34 Local therapy for high-risk T1 rectal cancer N. Saito, Y. Nishizawa, M. Sugito, M. Ito, A. Kobayashi, A. Kohyama, H. Nishigori, T. Oogara, Y. Sato, S. Murata & M. Yokota National Cancer Center Hospital East, Kashiwa, Chiba, Japan Aim: The aim of this study is to examine the oncologic outcomes of local excision (LE), LE plus chemoradiotherapy (CRT), and major surgery for high-risk T1 tumors in distal rectum. Method: High-risk T1 tumors were defined according to NCCN Guidelines. Ninety-eight patients with high-risk T1 lesions were treated by LE, LE plus CRT, or major surgery between 1994 and 2008. Thirty-four patients were treated with LE alone, 23 with LE adjuvant CRT (45Gy, 5-Fu), whereas 41 with major surgery, Kaplan-Meier curves were used to estimate the primary outcomes. Results: With a median follow-up of 8.3 years, 7-year overall survival rates (OS) were 93% for major surgery, 91%for LE plus CRT, and 84% for LE. Local recurrence-free survival (LFS) was 92% for LE plus CRT and 64% for LE (P = 0.04). Disease-free survival (DFS) was 97% for major surgery, 92% for LE plus CRT, and 66% for LE.(LE vs LE plus CRT: P = 0.06, LE vs major surgery: P = 0.002) Conclusion: Major surgery and LE plus CRT showed better DFS and LFS than LE. There were no significant differences in OS, DFS, and LFS between major surgery and LE plus CRT. LE alone for high-risk T1 rectal cancer is associated with high recurrence.

LTP35 Presence of apopotis in diagnostic biopsies predicts complete response (TRG1) following preoperative chemo-radiotherapy in rectal carcinomas R. Senetta1, M. Mistrangelo2, P. Racca3, R. Spadi3, L. Chiusa1, M. Morino2, F. H. Munoz4, U. Ricardi4, M. E. Allaix2, S. Sandrucci2 & P. Cassoni1 1 Department of Biomedical Sciences and Human Oncology, University of Turin, Molinette Hospital, Chief Pr of. G. Bussolati., Turin, Italy, 2Digestive and Coloproctological Surgical Department and Centre of Minimally Invasive Surgery, University of Turin, Dir. Prof. M. Morino, Turin, Italy, 3 Oncological Centre for Gastrointestinal Neoplasms, University of Turin, Molinette Hospital, Italy, Chief Dr. Racca, Turin, Italy, 4Department of Radiotherapy, University of Turin, Dir. Prof. U. Ricardi, Turin, Italy Aim: Although preoperative chemo-radiotherapy (CT-RT) has been used as a major treatment modality to improve local control and survival of rectal cancer, response to CT-RT differs among patients. Method: Twenty-nine rectal cancer patients were studied between January 2006 and December 2010. Biopsy specimens were obtained before preoperative CT-RT. Response was determined by histopathologic examination of surgically resected specimens and classified as complete (TRG1) or partial/absent response (TRG 2-5). On biopsies, we valuated tumor grade, number of mitosis/3HPF, presence of apoptosis, inflammatory infiltrate and presence of desmoplasia. Immunohistochemical analysis with antibodies raised against caveolin-1 and YKL-40 was performed. These parameters were correlated to TRG of the surgical specimens.

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Results: Only apoptosis proved to be predictive of complete CT-RT response. Presence of apoptotic bodies on the biopsy specimens proved to significantly correlate to complete response (P = 0.043, v2: 2.978), determined as TRG1: 83% of partial or non-responders (Mandard’s TRG 2-4) had no apoptosis on biopsies. 67% of patients with conspicuous apoptosis on the diagnostic biopsy were complete responders (TRG1). Absence of YKL-40 staining is correlated to complete response as well. Conclusion: Apoptosis-inducing genes seem to play a key role in predicting response to RT. The absence of YKL-40 staining seems to be related to complete tumor response.

LTP36 For rectal cancer after chemoradiation don’t ‘watch and wait’ – ‘resect then reflect’ F. Smith, K. Sheahan, D. Gibbons, J. Hyland, R. O’Connell & D. Winter St Vincent’s University Hospital, Dublin, Ireland Aim: Central to the ‘watch and wait’ concept for rectal cancer after chemoradiotherapy (CRT) is an individual’s ability to identify a complete pathological response (pCR). The aim of this study was to identify whether inter-observer variability existed in this approach. Method: A slideshow containing digital photographs of the endoluminal aspects of 100 rectal cancers resected following CRT was compiled. The tumours were staged: ypT0 (n = 20), ypT1 (n = 8), ypT2 (n = 18), ypT3 (n = 49) and ypT4 (n = 5). All photographs were anonymised, randomised then independently and blindly reviewed by six senior colorectal specialists; surgeons (n = 4) and pathologists (n = 2). Each indicated the tumours they felt had undergone pCR and those amenable to transanal resection (surgeons only). Results: Average sensitivity, specificity, positive and negative predictive values for pCR identification were 61.5% (range 39–80%), 90% (range 75–100%), 71% (range 44–100%) and 92% (range 85– 98%) respectively. On average 49% (range 31–77%) of all lesions were deemed to be transanally resectable. Of these, pCR would have been accurately predicted in 72% (range 50–85%). Conclusion: Visual assessment of pCR is subject to inter-observer variation and error. In contrast, the majority of tumours with pCR could potentially be identified with transanal excision making selection for non-operative treatment safer.

LTP37 The impact of primary language in patients with permanent stoma after colorectal cancer surgery F. Zehra1, O. Faiz2, B. Jalaludin1 & J. Warusavitarne1,3 1 University of New South Wales Australia, Kensington, New South Wales, Australia, 2Imperial College London, London, UK, 3St Mark’s Hospital, Watford Road Harrow, Middlesex HA1 3UJ, UK Aim: This study aims to determine the impact of primary language spoken on the effects of stoma on QOL. Method: Two hundred and forty patients with a permanent stoma were identified from the Sydney South West Area Cancer Registry. Seventy-two patients met the inclusion criteria and 54 (72%) responded to the survey. We grouped permanent stoma patients into English speaking and nonEnglish speaking country of birth. SF12 and stoma quality of life (SQOL) questionnaires were administered. Results: There were no differences in the overall SF 12 in English versus non-English speaking groups (PCS P = 0.121, MCS P = 0.280). Language spoken was strongly associated with work/social impairment (P = 0.000), stoma function (P = 0.039) and sexuality/body image (P = 0.005). Conclusion: Primary spoken language does not impact on overall QOL of patients with permanent stoma. However, stoma patients from non-English speaking backgrounds have poorer body image perception and greater social impairment. This study highlights the importance of primary language spoken on the social functioning in patients with a permanent stoma.

LTP38 Treatment for rectal cancer is associated with long term rectal functional impairment with no impact on quality of life F. Zehra1, O. Faiz2, B. Jalaludin1 & J. Warusavitarne1,3 1 University of New South Wales, Kensington, New South Wales, Australia, 2Imperial College, London, UK, 3St Mark’s Hospital, Watford Road Harrow, UK Aim: To determine the long term rectal function after treatment for rectal cancer and its impact on QOL compared with case-matched colon controls. Method: Patients with primary rectal cancer more than 2 years after treatment, without distant metastases, recurrence or stoma were eligible. Controls were patients who had treatment for colon cancer. The SF-12 and the faecal incontinence severity index (FISI) were utilised. Results: One hundred and eighty-six patients with rectal cancer (70%) and 175 patients with colon cancer (44%) responded. 66 (35.4%) rectal cancer patients received radiotherapy. Patients treated for rectal cancer experienced significantly more faecal incontinence compared to age-matched colon cancer patients but the QOL was similar. In rectal cancer patients faecal incontinence was worse if RT was added to surgery. QOL was no different in the two groups. Conclusion: Treatment for rectal cancer is associated with increased faecal incontinence and this is exacerbated by adding RT. The rectal functional impairment associated with treatment for rectal cancer does not appear to impact on QOL.

LTP39 The Role of MRI in planning exenterative pelvic surgery for advanced colorectal cancer P. A. Georgiou1,2, G. Brown3, V. A. Constantinides1, A. Antoniou1,2, R. Goldin1, A. W. Darzi2,5, D. Cunningham6, R. J. Nicholls1 & P. P. Tekkis1,2 1 Department of Surgery and Cancer, Chelsea and Westminster Campus, Imperial College, London, UK, 2Department of Colorectal Surgery, The Royal Marsden Foundation NHS Trust, London, UK, 3 Department of Radiolofy, The Royal Marsden NHS Foundation Trust, London, UK, 4Department of Pathology, St Mary’s Hospital, London, UK, 5Department of Surgery and Cancer, St Mary’s Campus, Imperial College, London, UK, 6Department of Oncology, The Royal Marsden NHS Foundation Trust, London, UK Aim: To assess the diagnostic accuracy of Magnetic Resonance Imaging (MRI) in detecting colorectal tumour invasion according to seven intrapelvic compartments for planning exenterative pelvic surgery.

 2011 The Authors Colorectal Disease  2011 The Association of Coloproctology of Great Britain and Ireland. 13 (Suppl. 6), 16–27

Lunchtime Posters Method: Sixty-three consecutive patients underwent preoperative MRI planning for exenterative surgery, defined as operative excision beyond conventional mesenteric planes for locally advanced (n = 23) and recurrent (n = 41) pelvic colorectal cancer. Two blinded radiologists reported tumour invasion for each of the seven anatomic surgical resection compartments. Diagnostic accuracy values were calculated and Univariate Cox regression analysis was used to calculate the risk for death and recurrence. Overall interobserver agreement was assessed using Cohen’s Kappa coefficient (j). Results: The sensitivity of MRI was ‡ 93.3% in all except for the lateral compartment where it was 89.3%. Its specificity for the posterior (82.2%), anterior compartment below (86.4%) the peritoneal reflection compartments was lower compared to the rest of the compartments. The agreement between the two radiologists was either good or very good (j > 0.72). MRI diagnosis of tumour invasion within the anterior compartment above the peritoneal reflection was associated with poorer survival (P = 0.012). Conclusion: MRI is highly accurate in predicting tumour invasion according to compartments and it should always be used to stage patients with advanced colorectal pelvic cancer.

LTP40 Prefer anal swab over standard anoscopy for HIV-positive patients! C. Couffon1,2, C. Dupin1,2, S. Henno1,2, S. Minjolle1,2, I. Berkelmans1,2 & L. Siproudhis1,2 1 CHU Rennes, Rennes, France, 2Univ-Rennes1, Rennes, France Aim: To assess anal oncogenic HPV and anal cytology in HIV-positive cohort (HIV+). Method: Anoscopy was performed in 78 HIV+ (M/F:69/9; age: 48 ± 11 years) and swab samples were collected for cytology and HPV DNA testing. Results: Intra-anal lesions were observed in 8 (10.3%): five condylomas and three irregular mucosal patterns. Abnormal cytology was encountered in 41 (52.6%): high-grade squamous intraepithelial lesions in 8 (HGSIL:10.3%), low-grade squamous intraepithelial lesions in 21 (LGSIL:26.9%), atypical squamous cell of undetermined significance in12 (ASCUS:15.4%). HPV DNA positive patterns were detected in 55 (73.3%). Within the same subject, 24, 26 & 11 had < 2, 2–4 & > 4 different HPV subtypes respectively. HPV 16, 33, 51, 52, 58, 66, 70 were significantly associated with abnormal cytology. Mean number of subtypes significantly increased with the level of abnormal cytology (normal cytology: 1.2 ± 2; ASCUS: 2.3 ± 2; LSIL: 3.8 ± 2.5; HSIL: 4.1 ± 2.6). Conclusion: Despite normal anoscopy in 90%, both abnormal cytology and oncogenic HPV DNA were observed in, at least, half of the population study. Moreover co-infections were correlated with intraepithelial lesion. This may impact the follow-up of HIV-positive patients, with emphasis on both cytology & HPV testing.

LTP41 PPH versus HEEA for haemorrhoidopexy in III degree haemorrhoids: which one fits better? Preliminary data of a prospective randomized trial S. Giuratrabocchetta1, G. Pecorella2, A. Stazi3, G. Tegon4 & D. F. Altomare1 1 University of Bari, Bari, Italy, 2University of Catania, Catania, Italy, 3St Anna Hospital, Pomezia, Italy, 4Colorectal Unit, Treviso, Italy Aim: To assess in new stapler device in the treatment of haemorrhoids. Method: One hundred and one patients (50 males, mean age 42) with third-degree haemorrhoids were randomly allotted to stapled haemorrhoidopexy with PPH 03 stapler (Ethicon EndoSurgery) (49 patients) or with HEEA stapler (Covidien) (49 patients) in four referral centers. The number of haemostatic overstitches on the stapled suture and the area of the resected mucosa (in cm2) were recorded. Any postoperative bleeding within 30-days were also recorded. Results: The mean area of the resected mucosa was significantly larger in HEEA than PPH patients (38 ± 16.5 vs 30 ± 9.4 cm2, P < 0.005). The mean number of haemostatic points in the HEEA group was significantly lower than the PPH group (1.3 ± 1.5 vs 3.5 ± 2.15, P < 0.0001). Postoperative bleeding occurred in two PPH patients but never after HEEA. Conclusion: Preliminary data suggests that the HEEA stapler has better haemostatic properties compared with PPH and allows resection of a larger quantity of mucosal prolapsed with potential benefits over the recurrence rate.

LTP42 ‘Pit-picking’ surgery for primary pilonidal sinus I. Iesalnieks, S. Deimel, S. Denecke & C. Zu¨lke Marienhospital Gelsenkirchen, Gelsenkirchen, Germany Aim: To assess the role of ‘pit-picking’ in the management of primary pilonidal sinus. Method: Only patients with small primary pilonidal disease were selected for this method. The technique of ‘pit-picking’ was to remove all primary pits in the midline by excising a border of skin of < 1 mm. An incision of 1 cm parallel to one side of the cleft opened the chronic abscess cavity. A total excision of the pilonidal sinus was avoided. The surgery was performed under local anesthesia in all but one case. Results: One hundred and fifty-three patients (126 males) underwent 158 ‘pit-picking’ surgery between 6/2007 and 11/2010. Follow-up information was available in 144 patients of whom disease recurrence developed in 22 patients (15%) and five patients needed two procedures to achieve healing. Factors associated with failure of ‘pit-picking’ surgery were: male sex, BMI > 25 kg/m2, smoking and disease duration of < 6 months. The presence of an acute abscess did not influence the outcome of surgery. Conclusion: Most patients with primary pilonidal disease can be treated successfully by a ‘pitpicking’ procedure reserving larger excisional surgery for those developing a recurrence.

LTP43 Preoperative staging of rectal lesions using 3D endorectal ultrasound in patients referred for transanal endoscopic microsurgery or transanal local excision L. B. Johnson, A. Zawadzki & M. Stark Malmo¨ University Hospital, Malmo¨, Sweden Aim: To determine whether experienced ultrasound examiners using 3D high frequency endorectal ultrasound can discriminate between adenoma (pT0) and invasive rectal cancer (pT1, pT2, pT3). Method: Between 2004 and 2011, 224 consecutive patients were referred for local excision and underwent preoperative 3D endorectal ultrasound examination. Lesions where staged according to

uT0, uT1, uT2 and uT3 staging. The 3D ultrasound staging was compared with the histopathological staging made on the basis of the diagnoses in the excised specimens. Results: Two hundred and nineteen patients were included. Five patients underwent preoperative radiotherapy and one patient had a lymphoma and were excluded. The histopathological diagnoses were as follows: invasive rectal cancer in 63 patients and adenoma in 156 patients. The sensitivity of 3D endorectal ultrasound with regard to invasive cancer was 70% (44/63), specificity 96% (151/156), positive predictive value 90% (44/49), negative predictive value 89% (151/170), and accurancy 86% (188/219). Conclusion: In patients with rectal lesions assessed as suitable for local excision, 3D endorectal ultrasound can distinguish between rectal tumours confined to the mucosa and tumours penetrating into the submucosa or deeper with an accuracy that is probably clinically acceptable.

LTP44 Long term efficacy of dextranomer in stabilized hyaluronic acid (Solesta) for treatment of fecal incontinence (FI) F. La Torre 1st College of Medicine SAPIENZA Rome University, Rome, Italy Aim: To evaluate the efficacy and safety of Solesta in the treatment of FI as measured by proportion of responders at 24 months after last treatment. Method: Data was collected from diaries over a 28 day period. One hundred and fifteen subjects were treated with Solesta at 15 centers throughout Europe and Canada. Results: At 24 months follow-up, 63.0% of subjects experienced ‡ 50% reduction in total number of FI episodes. The median number of FI episodes declined by 69%. Both solid and liquid stool episodes were improved significantly. The average number of incontinence-free days increased from baseline of 15 to 22. The number of controlled bowel emptying when the subject had to hurry, decreased from 14 to 6 over 24 months. All values P < 0.0001. The most common adverse events were proctalgia (10%) and pyrexia (5.2%). The majority of these were mild to moderate, self limiting and occurred prior to 6 months post injection. Conclusion: Solesta is safe, effective and durable over a 24 month period with a majority of subjects experiencing significant improvement in multiple symptoms associated with FI.

LTP45 Long-term outcome of patients born with anorectal malformation G. Meurette1, J. Podevin1, V. Wyart1, G. Podevin2 & P.-A. Lehur1 1 Institut des maladies de l’appareil digestif, Nantes, France, 2Service de Chirurgie pe´diatrique, Angers, France Aim: To assess the complaints and evaluate the social integration of ARM in adult patients from a referral centre 3 years after a nation-wide registry launch. Method: Two hundred and ten patients, of whom 70 were older than 18 years (mean age 28 ± 9), enrolled in the registry and answered a specific questionnaire for social and professional outcome. Past medical history (ie. hospitalisation and surgical procedures) were reviewed and anorectal function was assessed. Results: In 45, ARM was a low grade type. Fifty patients (71%) suffered severe anorectal complaints (incontinence: 51% – severe constipation: 20%). Functional outcome was not correlated to ARM grade. A surgical procedure was required in 31 (artificial bowel sphincter 10, antegrade colonic irrigation 10, prolapse resection 10, sacral nerve stimulation 1) and seven underwent a stoma formation. The rate of postgraduate patients was higher than in general population (30% vs 16%). Unemployement rate was 13%. Physical working jobs were less represented among the patients (7% vs 22%). Conclusion: ARM leads to significant complaints in adulthood that influence the social insertion and well-being. Most of them require additional significant surgical procedures.

LTP46 Outcome of temporary stoma closure in patients with Crohn’s disease I. Iesalnieks1 & H. J. Schlitt2 1 Marienhospital Gelsenkirchen, Gelsenkirchen, Germany, 2University of Regensburg, Regensburg, Germany Aim: To assess the outcome after closure of temporary stoma in patients with Crohn’s disease. Method: The ‘recurrence’ was defined as a need for surgery which served as an indication for stoma creation. Results: Eighty-seven stoma closures were analyzed. Indications for stoma creation were: perianal fistula (n = 16), postoperative complications after intestinal resection (34), bowel resection without restoration of intestinal continuity (29) and covering stoma for intestinal anastomosis (8). Twenty seven patients had a loop-stoma and 60 patients an end-stoma. The time between stoma creation and the closure was median 4.7 months and it was longest in patients with stoma due to anal fistula (8.6 months, P < 0.05). Postoperative complications occurred in 10 patients. Recurrence rate was 27% and it was highest if stoma was created for the treatment of anal fistula (82% vs 15–25%, P = 0.00015). The risk to be a stoma-carrier again at the end of the study was highest in patients with anal fistula (22% vs 0%, P = 0.002). Conclusion: Most patients with a temporary stoma created to treat perianal fistulae will undergo further fistula surgery or will need a new stoma after they underwent a stoma closure.

LTP47 Functional outcome of laparoscopic resection rectopexy in obstructed defaecation syndrome M. Rabie1,2, S. Mangam1 & D. Marzouk1,2 1 Queen Elizabeth The Queen Mother Hospital, Margate, Kent, UK, 2Ain Shams University, Cairo, Egypt Aim: To assess the role of laparoscopic resection rectopexy (LRR) in the treatment of patients with obstructed defaecation syndrome (ODS). Method: Sixty-seven ODS patients (64F: 3M) with a mean age of 55.4 (27–88) who failed conservative treatment underwent LRR between February 2005 and March 2011. Patients’ data were collected in a custom made ODS Database and analysed, including clinical, anorectal physiology, operative findings and postoperative bowel function. Results: All patients had internal rectal intussusception. Also present were 53 rectocoeles (79%), 49 sigmoidocoeles (73%) and 40 enterocoeles (60%). Adhesiolysis was required in 50 patients (75%), cul-

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Lunchtime Posters de-plasty in 29 (43%), colposacropexy in 4 (6%) uterine suspension in 1 (1.5%), and loop ileostomy in 10 (15%). Complications included one anastomotic leak, one postoperative intestinal obstruction and one anastomotic bleed. There was no mortality. Functional outcome was assessed at a median of 23.4 months (6–81). ODS score decreased from 16 preoperatively to seven postoperatively (P < 0.01). Subjectively, 65% of patients had complete or significant improvement in their symptoms. 16% had moderate improvement while 19% felt that their improvement was minimal. Conclusion: LRR appears to be an effective surgical treatment for ODS.

score ()3.2 ± 6.1, P = 0.001). However, 52 (55%) patients remained incontinent: 52 (55%) reported urge incontinence and 31 (33%) had a passive leakage. Neither physiological nor anatomical data were associated with some level of improvement. In contrast, patient age, symptom duration before surgery and faecal incontinence score were significantly higher in patients suffering from post-operative incontinence. Conclusion: Despite some decrease of incontinence in two thirds of patients who underwent surgery for RP, the level of improvement remains low for more than half of them.

LTP48 Sexual health in patients undergoing sacral nerve stimulation (SNS) for faecal incontinence C. Smart, A. Jadav, E. Kiff & K. Telford University Hospital South Manchester, Manchester, UK

LTP52 Differences in tissue degeneration between preoperative chemotherapy and preoperative chemoradiotherapy for colorectal cancer Y. Nishizawa1, S. Fujii2, N. Saito2, M. Ito2, K. Nakajima2, M. Sugito2, A. Kobayashi2 & Y. Nishizawa2 1 Institute for Frontier Medical Sciences, Kyoto University, Kyoto, Japan, 2National Cancer Center Hospital East, Chiba, Japan

Aim: To assess sexual health in patients undergoing SNS for faecal incontinence (FI). Method: Seventeen female patients (mean age 58 years, range 34–74) undergoing SNS completed female sexual function index (FSFI total 36, £ 26 = dysfunction), female sexual distress scale (FSDS total 52, ‡ 11 = dysfunction), Manchester health questionnaire (MHQ) and Vaisey incontinence score. Results: Median MHQ (681) and Vaisey (15) scores were high. Overall FSFI was poor (74% £ 26, median 7.4) and FSDS was high (74% ‡ 11, median 20). FI was equal (MHQ 681/682. P = 0.8) in relationship (n = 11) versus non-relationship groups but FSFI was significantly higher (20.3 vs 5.3 P = 0.03). However there was no difference in sexual distress (19 vs 22.5 P = 0.8) despite improved sexual function. MHQ correlated with FSFI (rs )0.41) and FSDS (+0.32) but was not statistically significant (P = 0.2). Conclusion: FI appears to adversely affect sexual health. Sexual function can be maintained in a relationship but sexual distress remains high despite this. Sexual health is not purely function dependent and surgical treatments, including SNS, may improve distress without having to improve function in patients not in a relationship.

Aim: To examine differences in the effects of preoperative CRT and chemotherapy on tissue degeneration of patients with colorectal cancer. Method: Seventy-six patients, including 68 with rectal cancer who underwent internal sphincteric resection (ISR) with (n = 47, CRT group) or without (n = 21, control group) preoperative CRT, and eight with colorectal cancer who received preoperative FOLFOX treatment. Peripheral nerve degeneration was evaluated histopathologically, based on karyopyknosis, disparity of the nucleus, denucleation, vacuolar or acidophilic degeneration of the cytoplasm, and adventitial neuronal changes. Results: The incidence of neural degeneration was significantly higher in the CRT group than the control group, and the incidences of karyopyknosis, adventitial neuron changes, and denucleation were significantly higher in the CRT group than the FOLFOX group. There were no differences in any items of neural degeneration between the FOLFOX and control groups. Conclusion: CRT induced marked neural degeneration around the rectal tumor. FOLFOX treatment produced mild neural degeneration similar to that in the control group.

LTP49 Laparoscopic low ventral rectocolpopexy for symptomatic rectogenital prolapse A. Lauretta, R. Bellomo, F. Galanti & A. Infantino Santa Maria dei Battuti Hospital, San Vito al Tagliamento, Italy

LTP53 Percutaneous tibial nerve stimulation for faecal incontinence in a community setting A. Pascariello1, S. Bennett2, A. Khan2, P. Russell2, I. Tomasi1 & P. Giordano1 1 Whipps Cross University Hospital, London, UK, 2Ching Way Medical Centre, London, UK

Aim: To describe a modified laparoscopic ventral rectocolpopexy, a laparoscopic low ventral rectocolpopexy: (LLVR) adopted in our unit to manage combined rectogenital prolapse. Method: Between November 2006 and August 2010 all patients with symptomatic rectal prolapse associated with genital prolapse and or enterocele underwent LLVR. Technique: (1) a peritoneal incision inverted J shaped is made over the sacral hollow and is extended caudally along the rectum. (2) Anteriorly the Douglas pouch is opened and the posterior vaginal fornix or vault is exposed. (3) A polypropylene mesh is fixed to the sacral hollow and sutured to the anterior rectal wall. The distal end of the mesh is sutured to the vaginal fornix or vault. Results: A total of 52 patients underwent LLVR. All patients had concomitant enterocele and or genital prolapse. The mean operating time was 95 ± 35 min. Conversion to laparotomy was never needed. The mean hospital stay was 5 days. No mortality was recorded and the morbidity rate was 9.6%. The recurrence rate of prolapse was 6.1%. Conclusion: Laparoscopic low ventral rectocolpopexy is safe with very low morbidity. In the medium term it provides good results for prolapse and associated symptoms.

Aim: To assess the efficacy of percutaneous Tibial Nerve Stimulation (pTNS) delivered in a community setting. Method: Patients with faecal incontinence (FI) who failed to respond to conservative management were offered pTNS treatment within a community clinic setting. FI severity was assessed using the Cleveland Clinic Incontinence Score (CCIC) before and after treatment. Quality of life was assessed according to the MOS-SF36. Results: Thirty-one patients (30 F; average age 61 years) were offered pTNS. All patients completed the 6 weeks treatment course. 25 (80%) patients reported a variable degree of improvement. The median CCIC improved significantly (13.56 vs 10.88, P = 0.003). All individual scores of CCIC but one improved significantly: gas (3.19 vs 2.75, P = 0.014), liquid (2.56 vs 2.00, P = 0.023), solid (2.00 vs 1.60, P = 0.164), wears pad (3.20 vs 2.60, P = 0.033), lifestyle (3.23 vs 2.15, P = 0.003). There were no differences in pre and post treatment MOS-SF36 scores. At 3 months six patients with initial response deteriorated and were offered maintenance treatment. Conclusion: pTNS is an effective and very well tolerated treatment for patients with FI that can be successfully and safely delivered in the community settings.

LTP50 Is a nurse led functional service an effective first line treatment in management of functional bowel disorders? K. Stackhouse, K. Gill & N. Cruickshank Sandwell and West Birmigham NHS Trust, West Midlands, UK Aim: To assess the clinical outcomes of a nurse led conservative management programme for patients with functional bowel problems. Method: One hundred and five patients [median age 53 (16–87)] with functional bowel problems [faecal incontinence (FI) (52%), obstructive defaecation(10%), rectal evacuatory dysfunction(24%) and slow transit constipation(14%)] were referred to the specialist nurse led service over a 9 month period. Outcome variables were assessed using pre and post intervention using self reporting symptoms, Wexner incontinence score, KESS constipation score and health related QOL measures. Results: One hundred and five patients completed treatment out of which 92 (88%) reported improvement. Self reported FI episodes decreased in all patients [pre: median 7 (1–20) to post: median 0 (0–7)]. Wexner scores for FI improved [pre: median 10 (5–20) to post: median 5 (2–13) P < 0.01] and the number of successful bowel movements increased [pre: median 9 (6–15) to post: median 5 (3– 6) P < 0.01]. No patients have reported a relapse in their symptoms at 6 months. Conclusion: Patients with functional bowel disorders appear to benefit from nurse delivered management programmes, at least in the short term. Conservative management with a dedicated functional bowel nurse specialist should be offered as first line treatment.

LTP51 Incontinence in full-thickness rectal prolapse: which level of improvement after laparoscopic surgery? V. Desfourneaux1,2, D. Cunin1,2, P. Y. Bouteloup3, B. Meunier1,2, A. Ropert1,2 & L. Siproudhis1,2 1 CHU, Rennes, France, 2Univ-rennes1, Rennes, France, 3CHP, Saint Gre´goire, France Aim: To assess the level of improvement in continence after rectopexy for full thickness rectal prolapse (RP). Method: Ninety-four patients (mean age 55 ± 16 years, 87 women) underwent laparoscopic rectopexy to treat RP between 2003 and 2009. Symptomatic and functional data were collected prospectively before and after surgery by self-administered questionnaires including CCIS, Kess and GIQLI questionnaires. Incontinence was considered when the CCIS remained ‡ 5 after surgery. Results: After a mean follow-up of 37 months after surgery 87% of patients rated good to excellent results. The continence was improved in 62 patients (66%) with a significant decreased incontinence

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LTP54 Proportion and distribution of myofibroblasts in patients with rectal prolapse E. Smyth1, O. Jones2, C. Cunningham2, J. Urban1 & I. Lindsey2 1 University of Oxford, Oxford, UK, 2Churchill Hospital, Oxford, UK Aim: To evaluate the occurence of myofibroblasts in the pelvic connective tissues of patients with rectal prolapse. Method: Pelvic floor tissue samples were collected and histologically processed. Immunohistochemistry was performed using anti smooth muscle actin antibody. The proportion and distribution of myofibroblasts was determined. Results: Forty-three samples were collected (controls n = 6, male n = 10, nulliparous women n = 7, multiparous women n = 20). The proportion of myofibroblasts were: controls (n = 6) Mean 79.7, nulliparous women (n = 68.7) Mean 68.7, males (n = 10) Mean 50.8* and multiparous women (n = 20) Mean 36.8*. *Sample vs Control P < 0.005 Conclusion: Males and multiparous women with rectal prolapse have reduced myofibroblasts in their pelvic connective tissues and this may contribute to the development of rectal prolapse.

LTP55 Pathology and therapeutic results of 537 cases of neurogenic intrapelvic syndrome M. Takano, S. Ogata, R. Nozaki, S. Hisano, Y. Saiki, M. Fukunaga, S. Takano, M. Tanaka, Y. Nakamura, G. Sakata & K. Yamada Coloproctology Center, Takano Hospital, Kumamoto, Japan Aim: There are cases with tender induration along the pudendal nerve which exhibit disorders such as anal pain, incontinence, defecatory disturbances, abdominal symptoms, and lumbar spine symptoms. The phenomenon is understood to be caused by combined dysfunctions of the sacral nerve and the intrapelvic splanchnic nerve, which led us to label this syndrome, ‘Neurogenic Intrapelvic Syndrome’. The anal pain is characterized as typical chronic pain which can bring on depression or anxiety. Method: A total of 537 cases were examined from 2001 to 2005. For treating disorders of this syndrome, nerve block was mainly used for anal pain, biofeedback therapy for incontinence and defecatory disturbances, pharmacological treatment for motility of the digestive tract, and physical and kinetic therapies for nerve dysfunctions and spinal disorders. Moreover, counselling was used for certain mental disorders that may accompany this syndrome.

 2011 The Authors Colorectal Disease  2011 The Association of Coloproctology of Great Britain and Ireland. 13 (Suppl. 6), 16–27

Lunchtime Posters Results: As a result of a combination of these therapeutic methods, there was a 74% improvement in anal pain, 83% in incontinence, 78% in defecatory disturbances, 82% in abdominal symptoms, and 60% in lumbar spine symptoms. Conclusion: Significant results were achieved through a combination of the therapeutic methods directed at each disorder of this syndrome.

LTP56 Overlapping sphincter repair. Three-year functional and electrophysiological follow-up in patients with and without post-operative sphincter electrostimulation M. Romaniszyn, K. Gronostaj, P. Walega, P. Richter & W. Nowak III Department of Surgery, Jagiellonian University Collegium Medicum, Krakow, Poland Aim: The aim of this study was to assess functional and electrophysiological results of transanal sphincter electrostimulation after overlapping sphincter repair in a 3-year follow-up. Method: Out of 29 patients who in 2005–2008 underwent overlapping sphincter repair due to anal sphincter rupture (post partum or after accidents) 18 were selected and divided into two groups: one had transanal electrostimulation introduced (10 patients), the second (eight patients) was the control. Each patient had manometric and electromyographic examination performed before and after operation, and then after 3-year follow-up. Results: Compared to control group, electrostimulation in post-operative period significantly improved squeeze anal pressures with no significant influence on resting anal pressures. Electromyography showed increase in amplitude of motoric unit action potentials, but without statistical significance. Patients with pathological findings in electromyographic examination preoperatively achieved poorer functional results after sphincter repair, compared to patients with proper external sphincter innervation. Conclusion: Post-operative transanal electrostimulation of the repaired sphincter may enhance functional results of treatment. The long-term efficacy must however be assessed in further randomized studies, with bigger groups of patients.

LTP57 Platelet derived growth factors in the treatment of Crohn’s disease anal fistula first results E. Espin, A. Calero, L. M. Jimenez, M. Marti, F. Vallribera, J. L. Sanchez, L. Salgado & M. Armengol Hospital Valle de Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain Aim: Growth factors derived from platelets (PDGF) are used in some surgical procedures. We have treated a series of patients with anal fistula due to Crohn’s disease before starting a randomized trial to prove its feasibility. Method: Prospective study from November 2009 to January 2011. Five patients with a diagnosis of Crohn’s disease have been treated with PDGF. Results: All five patients were females, and all patients were previously treated with infliximab. Four fistulas were classified as high and one as low (according to MRI and operative findings). Mean age was 38 years (R: 31–47). Mean follow-up: 10 months (8–16). Four patients were treated with a combination of plug and PDGF, and a fifth was treated with a fistulotomy plus PDGF. Success was obtained in four cases (80%). One patient treated with a plug + PDGF never showed cure and was considered as a fistula persistence. Conclusion: The use of PDGF is safe and easy to perform. Its real impact in the treatment of anal fistula should be evaluated in a prospective randomized. This study will start in our hospital in June 2011.

LTP58 Quality of life and obstetrical outcome of women with severe ano-perineal Crohn’s disease managed with minimally invasive medico-surgical approach G. Meurette, J. Norca, E. Abet, A. Bourreille & P.-A. Lehur Institut des maladies de l’appareil digestif, Nantes, France Aim: Emerging management for severe ano-perineal Crohn’s disease (APCD) includes immunomodulatory medications and less aggressive surgical management. The aim of this study was to assess the outcome of female patients in terms of perineal well-being, fertility, obstetrical outcome and quality of life. Method: Systematic Combined medical (anti-TNF medications) and minimally invasive surgical protocol (drainage and seton, plug and fibrin glue) was applied to 26 female patients between 2004 and 2010. The patients underwent systematic assessment of disease activity (PCDAI) and Quality of life (IBDQ) scores, fertility, pregnancy and delivery modalities. Results: The mean follow-up period was 48 months, Mean age was 40 (24–74). The perineal lesions included 23 complex fistulas (anorectal and rectovaginal) and three multiple fissures and ulcerations. The management required a mean 19 ± 5 medico-surgical consultations, 2 ± 1 GA/patient. Induction regimen of infliximab and maintenance were dispensed respectively for 61% and 46% of the patients. Mean PCDAI and IBDQ scores were respectively 9 (4–15) and 167 (117–224). Among the whole group 9 (58%) of the patients achieved pregnancy with uneventful delivery. Conclusion: In our study, combined management of APCD achieved acceptable quality of life and perineal comfort for pregnancy and delivery when expected.

LTP59 Safety, feasibility, and short-term outcomes of single port laparoscopy colorectal surgery: a single institutional case-matched study S. Gaujoux, L. Maggiori, F. Bretagnol, M. Ferron & Y. Panis Colorectal Surgery, Beaujon Hospital, Clichy, France Aim: Benefits of Single Port Laparoscopy (SPL) in colorectal surgery, as compared to multiport laparoscopy (ML), still need to be assessed. This case-matched study aimed to compare SPL to ML for colorectal surgery. Method: From July 2009 to July 2010, SPL colorectal resections were matched on main predictive postoperative morbidity risk factors, in a 1 to 2 fashion, with patient having the same procedure for the same indication by ML. Results: Twenty-five SPL were matched with 50 ML patients. Median age was 56 (32–69) years and median. Body Mass Index was 22.6 (21–25). SPL was performed for benign tumor (n = 9),

inflammatory bowel disease (n = 8), diverticulitis (n = 4), adenocarcinoma (n = 3) or sigmoid volvulus (n = 1). Procedures included right (n = 13), left (n = 7), and subtotal colectomy (n = 2), and rectal resection (n = 3). Conversion to ML was needed in one case (4%). SPL was associated with a significantly shorter median operative time (130 in SPL vs 180 min in ML group, P = 0.04) and hospital stay (6 days vs 7 days, P = 0.005). Postoperative morbidity rates were similar (4% vs 16%, P = 0.25). Conclusion: This study suggested safety of SPL colorectal resection in selected patients without increased morbidity, and with shorter hospital stay, as compared to ML.

LTP60 Predictors of severity in ischaemic colitis S. O’Neill, K. Elder, S. Harrison & S. Yalamarthi Queen Margaret Hospital, Dunfermline, UK Aim: The aim of this study was to identify patient characteristics that predict severity in biopsy confirmed Ischaemic Colitis (IC). Method: A retrospective study of consecutive patients admitted with IC over a 5-year period was performed. A strict inclusion criteria including: supporting histopathology, exclusion of previous inflammatory bowel disease, absence of recent antibiotics or negative stool sampling with testing for clostridium difficile was adhered to in every case. Patients were divided by outcomes into a severe IC group including those that needed surgery or suffered mortality and a non-severe IC group that included patients managed medically with good evolution during their index admission. Patient characteristics were analysed to identify statistically significant predictors of severity. Results: Thirty-two patients (11 male, 21 female, mean age 72.5) were included. Medical management was adopted in 23 patients with a single mortality (4.3%). Nine patients were managed surgically (22.2% mortality), giving an overall mortality of 9.4% and a severe IC group consisting of 10 patients. Statistically significant prognostic predictors of severity included: right sided IC (P = 0.0002), guarding (P = 0.001), lack of rectal bleeding (P = 0.005) and chronic constipation (P = 0.02). Conclusion: Right sided IC, guarding, lack of rectal bleeding and chronic constipation are factors associated with severe IC.

LTP61 Evaluation on safety and efficacy of an enhanced recovery after surgery (ERAS) protocol to colorectal cancer patients in Japan H. Ota, Y. Maeura, Y. Fujie, K. Shimizu, Y. Toyoda, H. Fukunaga & W. Endoh Osaka Saiseikai Senri Hospital, Osaka, Japan Aim: An enhanced recovery after surgery (ERAS) protocol is a comprehensive practical program which integrates a range of perioperative interventions proven to maintain physiological function and facilitate postoperative recovery. Unlike European countries and the US, ERAS protocol has not been prevailed yet at all in Japan. Our ERAS protocol was initially introduced into colorectal surgery patients in February 2008, and has been implemented as a clinical pathway since October 2008. Method: We evaluated 96 ERAS pathway patients of colorectal cancer until August 2010, undergoing laparoscopic surgery, whose ASA (American society of Anesthesiologists) class was I or II. Results: Median age (range) and median postoperative day (POD) (range) of the first flatus, the first defecation, resumption of oral feeding, and length of postoperative hospital stay were 70 (35–88), 1 (1–4), 2 (1–5), 1 (1–6), 11 (7–61). These data showed significant shorter duration compared with conventional pathway applied patient of ASA I or II, n = 52 in 2007 (P < 0.05). There was no difference in readmission rate, reoperation rate, mortality rate and morbidity rate between the ERAS and conventional pathway groups (P > 0.05). The accomplishment rate of the ERAS pathway was 88.5%. Conclusion: In this study our ERAS protocol for elective laparoscopic colorectal cancer surgery was safe, feasible and efficient.

LTP62 Colorectal complications of end-stage renal failure and renal transplantation: a review C. N. Parnaby1, E. J. Barrow1, S. B. Edirimanne2, N. R. Parrott3, F. A. Frizelle2 & A. J. Watson1 1 Raigmore Hospital, Inverness, UK, 2Christchurch Hospital, Christchurch, New Zealand, 3Manchester Royal Infirmary, Manchester, UK Aim: End-stage renal failure (ESRF) and renal transplant recipients (RTR) are thought to be associated with an increased risk of developing colorectal complications. Method: A review of the literature was performed to assess the prevalence and outcome in benign and malignant colorectal disease. Results: No prospective randomized studies were identified. Benign complications included: diverticulitis, infective colitis, colonic bleeding and colonic perforation. There was insufficient evidence to associate diverticular disease with adult polycystic kidney disease. Three population based studies have shown up to a twofold increased incidence of colonic cancer but not rectal cancer for RTR. Bowel cancer screening by faecal occult blood testing for RTR appears justified, however evidence suggests that consideration of starting screening at a younger age may be worthwhile because of an increased risk of developing colonic cancer. Two population based studies have shown a twofold and 10 fold increased incidence of anal cancer for RTR. Conclusion: Despite the lack of high level evidence, ESRF and renal transplant were associated with colorectal complications that could result in morbidity and mortality. Bowel screening in this patient group appears justified. Effectiveness of screening for anal cancer in RTR remains unclear.

LTP63 Transvaginal symptomatic rectocele repair with biological mesh V. Pla, M. D. Ruiz, J. Martin, D. Moro, P. Arago & F. Checa Sagunto Hospital, Sagunto/Valencia, Spain Aim: Different surgical methods were used to correct symptomatic rectocele in our Department according with surgeon preferences. The aim of this study was to assess if the implementation of a standardized rectocele repair technique reduces morbidity and improves our results. Method: Prospective study of 20 patients undergoing, between 2006 and 2010, transvaginal longitudinal midline fascial plication reinforced with biological mesh for the repair of symptomatic rectocele without medical management response. Patients with intussusception or enterocele were

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Lunchtime Posters excluded. Morbidity, recurrence and clinical outcome have been analysed and compared with our group of patients previously operated with several techniques (n = 51). Results: The mean age was 61 (44–77) years. The median follow-up was 16 (6–61) months. There were 15% mild wound early complications and two patients (10%) had dyspareunia as a late complication. There was no mesh erosions or recurrences. The 80% of patients have corrected their presenting symptoms. Compared with the control group significant differences were observed in late morbidity (10% vs 36%, P = 0.033) and recurrence (0% vs 15% P = 0.048). Conclusion: Transvaginal rectocele repair reinforced with biological mesh as a standardized technique can improve clinical outcomes and reduce late morbidity.

Index was 17 (SD 5.2, range 5–29). Three patients (8%) died of multi-organ failure after persistent sepsis. Twenty patients (58%) developed other complications. Eight patients (20%) needed emergency laparotomy; in six patients (15%) a temporary stoma was created. Three patients (8%) experienced recurrent diverticulitis attacks. Conclusion: Laparoscopic lavage for perforated diverticulitis is associated with a high morbidity and a high rate of secondary emergency laparotomy. Yet with this novel treatment a stoma can be prevented in most patients. A randomised trial should prove the safety of lavage as compared to sigmoid resection.

LTP64 Laparoscopic total colectomy and panproctocolectomy: a 5 year single centre experience B. Reddy, M. Gowda, R. Clarke & J. Griffith Bradford Royal Infirmary, Bradford, UK

LTP68 Cost comparison of Robot-assisted versus hand assisted laparoscopic anterior resections for rectal cancer! S. Marecik1,2, M. Zawadzki1,2, V. Velchuru1,2, S. Albalawi1,2, J. Park2, H. Abcarian1,3 & L. Prasad1,2 1 University of Illinois, Chicago, Illinois, USA, 2Advocate Lutheran General Hospital, Park Ridge, Illinois, USA, 3John Stroger Hospital of Cook County, Chicago, Illinois, USA

Aim: Laparoscopic total or panproctocolectomy is challenging and has a longer learning curve. Method: Data were collected prospectively between January 2005 and April 2010. Results: Forty-five patients underwent laparoscopic STC (n = 25), TC (n = 10) & panproctocolectomy (n = 10) Median age was 50 (IQR 32–64) years. Mean BMI was 27.12 (IQR 24.29–29.34). Thirty-one for IBD (30 UC & 1 Crohn’s) and 14 for cancers. 10 were acute (9 UC and 1 splenic flexure cancer). Average operating time was 202.6 (IQR 161–246) min. One was converted to open for small bowel adhesions and four had Pfannensteil incision for completion of pelvic dissection. Median no. of lymph nodes in cancer resections was 21 (range 19–42). Mean blood loss was 172 ml (IQR 100–200), mean pre-op Hb was 12.2 g/dl (IQR 10.5–13.8) and mean post-op Hb was 10.7 g/ dl (IQR 9.9–11.9). Median length of hospital stay was 7 days (IQR 5–11). Seven had delayed discharge after being surgically fit for social reasons. Six had small bowel obstruction and problems with ileostomy, one had post-op bleeding that required evacuation of haematoma, three had pelvic collections one of which was due to rectal stump leak. Conclusion: Laparoscopic total and panproctocolectomy is associated with a higher incidence of complications.

LTP65 Emerging clinical leaders network (eCLN): facilitating change in bowel preparation guidelines for CT and endoscopic colonoscopy in a University Hospital Trust H. Rielly & C. Smart University Hospitals South Manchester, Manchester, UK Aim: eCLN is a new network in NHS North West supporting and encouraging emerging clinical leaders. Its aim is to provide leadership strategies for junior clinicians to facilitate improvements in care and manage change. Method: Through this platform we assessed the quality of bowel preparation in our trust for CT colonoscopy (CTC > 500 per annum) and colonoscopy (> 1700 per annum) and its impact on patient care. Results: Five hundred and thirteen consecutive CTCs and 1194 consecutive colonoscopy reports were reviewed and standard of bowel preparation recorded. Trust policy for preparation was sodium picosulfate (Picolax). One hundred and thirty-five patients in the CTC group (26.3%) had preparation that was ‘poor’ or ‘inhibiting accurate assessment of the colon’. One hundred and eighty-nine patients (15.8%) had poor preparation in the colonoscopy group. Of these, 39 (20.6%) went on to have further procedures (14 repeat colonoscopies, 23 CT imaging, 2 Barium enemas) at a cost of £16 000. Conclusion: Bowel preparation for diagnostic imaging of the colon is poor and through this audit and eCLN, we have demonstrated the need for change of local policy to improve patient care and save money. With presentation of this data to appropriate funds managers we are completing the audit cycle using Moviprep to establish long-term changes.

LTP66 Interobserver agreement of intrastomal 3D ultrasound K. Striga˚rd1, A. Gurmu1, P. Na¨svall2 & U. Gunnarsson1 1 CLINTEC at Karolinska Institutet, Stockholm, Sweden, 2Umea˚ University, Umea˚, Sweden Aim: Previous research has revealed the hazard to differ between bulging, parastomal hernia and protrusion. 3D intrastomal ultrasound has been published as a promising diagnostic tool. The aim of this study was to determine interobserver reliability. Method: A ProFocus 2202 ultrasound machine with the BK Medical transducer 2050 was used with the setting 9 MHz and the probe covered with a water-filled balloon. Seventeen patients with stoma complaints were investigated by three different physicians from two hospitals. Two physicians investigated another twelve patients of whom nine were investigated after a careful consensus meeting. A strict protocol was followed to standardize the investigation and evaluation. Statistics was evaluated with Fleiss’ kappa between investigators. Results: Inter observer Fleiss’ j was 0.59 for the initial 17 patients. When comparing the two physicians who investigated 29 patients, j for the initial 20 patients was 0.55. j for the entire series was 0.59 and for the last nine patients, the j value was 0.67. Conclusion: Although two of the investigators had a short training period, 3D intrastomal ultrasound show good inter observer reliability, a reasonable learning curve and may be the tool of choice to investigate stoma complaints.

LTP67 Laparoscopic lavage for perforated diverticulitis H. Swank1, I. Mulder2, J. Lange2 & W. Bemelman1 1 Academic Medical Centre, Amsterdam, The Netherlands, 2Erasmus Medical Centre, Rotterdam, The Netherlands Aim: For the treatment of perforated diverticulitis, laparoscopic lavage has recently emerged as a promising alternative for sigmoid resection. We have examined the safety and efficacy of this novel method in the Netherlands. Method: The files of all patients with complicated diverticulitis were searched in 34 teaching hospitals. Patients treated with laparoscopic lavage between 1 January 2008 and 31 December 2010 were included. Results: Forty patients were included in seven hospitals. Treatment with laparoscopic lavage had been performed on patients with Hinchey I (1), Hinchey II (7), Hinchey III (30) and Hinchey IV (2). The ASA classification was I (21%), II (30%), III (42%) and IV (6%). The mean Mannheim Peritonitis

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Aim: Robotic surgery is gaining acceptance in the field of minimally invasive rectal surgery. High cost is considered a major limitation of this technique, however clinical outcomes are the priority. The aim of our study is to evaluate the cost of robotic assistance in rectal dissections for cancer. Comparison was made with hand assisted laparoscopic (HALS) rectal resections. Method: Consecutive patients undergoing robot assisted (n = 33) and laparoscopic assisted (n = 25) anterior resections for rectal cancer between January 2007 and September 2010, were included. Patient characteristics, hospital cost, outcomes were compared. Results: Demographics and tumor staging were comparable in both groups. There was no difference in hospital stay or intra-operative and postoperative complications. The robotic group had higher Actual Total Cost (robot cost included) per case ($21 627 vs $15 939, P = 0.002) and longer operative time (325 min vs 211 min, P < 0.001). Circumferential margin was positive in three patients in the HALS group compared with none in the robotic group (NS). Conclusion: Robotic assistance in rectal cancer resection is at least comparable if not better than HALS technique but is associated with higher hospital costs and longer operative times. Emergence of competition in the robotic market may have a role in reducing the cost of this promising technology.

LTP69 Complete response rates of rectal cancer to neo-adjuvant chemo-radiotherapy: the North East of Scotland experience L. Stevenson1, L. Nicol1, G. MacDonald1, L. Samuel1, G. Murray2, S. Yule1 & E. Aly1 1 Aberdeen Royal Infirmary, Aberdeen, UK, 2University of Aberdeen, Aberdeen, UK Aim: Recent studies have shown that between 10% and 33% of patients can have a complete pathological response to neo-adjuvant chemo-radiotherapy (CRT). We aimed to determine the percentage of patients at our centre who have underwent neo-adjuvant CRT and were found to have a complete pathological response. Method: Patients who were diagnosed with rectal cancer between 2005 and 2009 were identified from a database held in the Pathology Department at Aberdeen Royal Infirmary. The pathological response rates to neo-adjuvant treatment were then analysed for individual patients who underwent surgery. Results: Three hundred and sixty-eight patients were diagnosed with rectal cancer in the time period being investigated. Out of these, 255 patients underwent neo-adjuvant treatment. Fifty-seven patients (22%) over the 5 years being studied had a complete pathological response, with an average complete response rate per year of 22.4%. The average lymph node yield for these patients in the complete response group was 14.46. Conclusion: In our study, over one-fifth of patients achieved a complete pathological response to neo-adjuvant treatment. This is within the figures quoted by other centres and shows that there is potentially a group of patients who could be treated with only neo-adjuvant therapy if this could be identified pre-operatively.

LTP70 Enhanced recovery and the elderly patient, a district general experience V. Brown, M. Knowles & M. Saunders Eastbourne District General Hospital, Eastbourne, East Sussex, UK Aim: Enhanced recovery programmes shorten hospital stay and reduce complication rates after colorectal surgery. Few studies have compared how an elderly patient population tolerates such a programme. This study compares the outcomes of patients aged 80 and over (> 80 years) with those aged < 80 years within such a programme. Method: Two hundred and nine patients entered into our enhanced recovery after surgery programme (ERAS) between April 2009 and April 2011. Data was collected prospectively. The primary endpoint was length of stay. Complications were also recorded. Results: Forty-eight patients were ‘> 80 years’; mean 83.4 years (range 80–89). One hundred and sixty-one patients were ‘< 80 years’; mean 65 years (range 27–79). Patients had similar demographics. Most underwent open surgery (70.2% ‘> 80 years’ vs 87% ‘< 80 years’). Similar LOS (median 8 days) were recorded in both groups. In > 80 years group; 60% were discharged by day 9 despite significant delays (P < 0.05) through social services. Complications including leak rate (5.0% vs 2.1%), ileus (9.9% vs 6.3%) and readmission rate (7.5% vs 4.2%) were all lower in the > 80 years group. Conclusion: Elderly (> 80 years) colorectal patients tolerate ERAS well achieving comparable lengths of stay with low rates of complications.

LTP71 Effects on tumour response of short course preoperative radiotherapy and different intervals before surgery in locally advanced rectal cancer P. Delrio1, E. Cardone1, L. Montesarchio1, B. Pecori2, F. Tatangelo3, E. De Lutio di Castelguidone4 & G. Romano1 1 Colorectal Surgery, Istituto Nazionale dei Tumori, Napoli, Italy, 2Radiotherapy, Istituto Nazionale dei Tumori, Napoli, Italy, 3Pathology, Istituto Nazionale dei Tumori, Napoli, Italy, 4Radiology, Istituto Nazionale dei Tumori, Napoli, Italy Aim: We investigated the tumour pathological response after different intervals before surgery after short course radiotherapy (5x5Gy-SCRT) in patients with locally advanced rectal cancer (LARC).

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Lunchtime Posters Method: Fifty-four LARC patients underwent SCRT between 2002 and 2011. Patients were operated on after < 4 weeks (Group 1–11 pts); after 4 weeks (Group 2–22 pts), after 6 weeks (Group 3–7 pts) and after 8 weeks (Group 4–14 pts). Response to SCRT was measured by modified Mandard’s tumour regression grade (TRG). Results: Pre treatment patients characteristics: 4 T2N0, 3 T3Nx, 36 T3N0, 11 T3N1; mean distance from anal verge was 6 cm. Forty-seven anterior resections, five abdomino perineal resections and two local excisions were performed. TRG scores were: group1 0 TRG1, 1 TRG2, 2 TRG3, 7 TRG4, 0 TRG5 (major response 9%) group2 2 TRG1, 6 TRG2, 8 TRG3, 6 TRG4, 0 TRG5 (major response 36%) group3 3 TRG1, 2 TRG2, 2 TRG3, 0 TRG4, 0 TRG5 (major response 71%) group4 4 TRG1, 4 TRG2, 2 TRG3, 4 TRG4, 0 TRG5 (major response 57%) Conclusion: Preoperative SCR with surgery after more than 4 weeks can downsize rectal cancer; a higher rate of major response can be achieved increasing time interval to surgery.

LTP72 A negative FOBT during work-up of colorectal cancer patients is associated with a lower survival rate E. Ericsson1, A. Gillberg1, F. Granstro¨m2 & L. Olsson1,3 1 Department of Surgery and Urology, General District Hospital, Eskilstuna, Eskilstuna, Sweden, 2 Center for Clinical Research, So¨rmland county council, Uppsala University, Eskilstuna, Sweden, 3 Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden Aim: Fecal occult blood test (FOBT) is used as an adjunct to clinical assessment and for prioritising among referred patients. Our aim was to determine the outcome of FOBT in symptomatic unselected patients in relation to colorectal cancer (CRC), and to clarify the clinical consequences of a negative FOBT. Method: All patients tested with FOBT (n = 8964) at twenty primary care centres during 2000–2005 were included. Data linkage to the Swedish Cancer Registry identified patients with CRC. Diagnostic work-up time and survival were retrieved from surgical records. Results: Among patients diagnosed with CRC within 2 years, 33/158 (20.9%) had a negative FOBT. Median diagnostic work-up time in this group was 191 days vs 84 days among patients with a positive FOBT (P < 0.001). For right-sided cancer the difference was 222 days vs 83 days (P < 0.001). Two-year survival in negative FOBT patients was 60% vs 80% among patients with a positive FOBT (P = 0.03). HR for death during first 2 years after surgery in FOBT negative group, adjusted for age and sex, was 2.0. Conclusion: A negative FOBT is associated with a longer work-up and a double risk of death during the first 2 years after surgery. A causal relation cannot be excluded and the use of FOBT should not guide further investigation in symptomatic patients.

LTP73 Short term outcome after neoadjuvant high dose rate endorectal brachytherapy or short course external beam radiotherapy in resectable rectal cancer C. Hesselager1, T. Vuong2, L. Pa˚hlman1, C. Richard3, S. Liberman4 & J. Folkesson1 1 Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden, 2Department of Radiation Oncology, Jewish General hospital, McGill University, Montreal, Quebec, Canada, 3 Department of colo-rectal Surgery, Montreal University, Montreal, Quebec, Canada, 4Department of colo-rectal Surgery, McGill university, Montreal, Quebec, Canada Aim: The purpose of this study was to compare immediate postoperative outcome between preoperative external beam radiotherapy and preoperative endorectal brachytherapy. Method: Three hundred and eighteen patients treated with preoperative endorectal brachytherapy (HDEBRT) at the McGill University Hospital, Canada were matched to patients from the Swedish Rectal Cancer Register treated with; short course preoperative radiotherapy, SCRT, (n = 318) and TME-surgery alone, RT-, (n = 318). The brachytherapy group was given 6.5 Gray (Gy) daily over 4 days followed by TME-surgery after 4–8 weeks. The SCRT-group was given 5 Gy daily over 5 days and TME-surgery the next week. Results: A total of 954 patients were included in the analysis. The SCRT group had a lower number of cardiovascular complications than both HDEBRT (10 vs 25, P = 0.0136) and RT-(10 vs 23, P = 0.0273). No differences between countries or groups were found regarding infections or surgery related complications. The HDEBRT group had a lower frequency of R2 resections than both Swedish groups. Conclusion: No major postoperative complication differences, except a higher rate of cardiovascular complications in HDEBRT patients, could be seen. A longer interval between radiotherapy and surgery is beneficial for tumour regression and this could be reflected in the number of radical resections.

LTP74 Transanal endoscopic microsurgery for upper rectal tumors N. Issa1,3, I. Igov2, E. Powsner1,3, Z. Dreznick1,3, Y. Kluger2,4 & D. Duek2,4 1 Surgery B, Hasharon Hospital, Rabin Medical Center, Petah-Tikva, Israel, 2Surgery Department Rambam Medical Center, Haifa, Israel, 3Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, 4Rappaport Faculty of Medicine, Technion, Haifa, Israel Aim: Transanal-Endoscopic-Microsurgery (TEM) is considered an adequate technique for benign or low malignant lesions in middle and lower rectum. TEM for upper rectum is less clear for the risk of peritoneal perforation. The aim was to report the outcome of TEM for upper rectal lesions. Method: Patients who underwent TEM for upper rectal lesions between 2001 and 2010. Upper lesions were defined as 10 cm or more from the anal verge. Results: One hundred and forty-one patients underwent 147 operations, median age was 69 years. The average distance from the anus was 12 cm. Median tumour size was 2.5 cm. The pathology included 98 (67%) Adenoma, 43 (30%) Adenocarcinoma, three Carcinoid, and one GIST. Median operative time was 87.5 min. Rectal perforation occurred in three patients, two had immediate repair, and the third underwent laparotomy. Six had re-TEM for positive margins. No postoperative major complications or mortality. In median follow-up of 7.62 years, three had adenoma recurrence and underwent re-TEM, two had carcinoma recurrence and underwent anterior resection. Conclusion: TEM for upper rectal tumours is safe, and may be an alternative to major surgery in selected cases. Patients with a malignant tumour should be selected with caution using this approach.

LTP75 Standardized shape index (SSI): a robust, effective and reproducible DCE-MRI semi quantitative index to monitor LARC after combined neo-adjuvant radio and chemo therapy M. Petrillo, R. Fusco, M. Sansone, V. Granata, P. Delrio, A. Avallone, B. Pecori, F. Tatangelo, C. Sassaroli & A. Petrillo Department of Radiology, National Cancer Institute ‘G. Pascale’, Naples, Italy Aim: Dynamic Contrast Enhancement MRI can reveal angiogenic changes induced by pre-operative chemo-radiotherapy. Our purpose was to discriminate between post-therapy pT0-pT2 stages and to identify pT3 or pT4 tumours that converted into pT2 or lower stages (responder). Method: Morphological MRI, qualitative DCE-MRI, DCE-MRI based pattern analysis (DCEMRI PA). were compared. DCE-MRI PA was focused on combining 14 TIC shape descriptors to find a semi-quantitative index in comparing LARCs before and after pCRT. Thirty patients, LARC affected, underwent DCE-MRI. Clinical TNM index (cTNM) was obtained before and after pCRT. After total surgical mesorectal excision (TME), pathological TNM (pTNM) was obtained from histological specimens. Morphological MRI and qualitative DCE-MRI evaluation were performed by two expert radiologists. DCE-MRI PA was based on multiple ROIs positioning: TIC shape descriptors were computed for each ROI. Paired sample tests, Hotelling Trace Criterion and ROC analysis were applied. Results: DCE-MRI PA allowed the best separation of patient according to the pT with a sensitivity of 91.7%, a specificity of 100%, positive predictive value of 75% and a negative predictive value of 100%. Conclusion: DCE-MRI pattern analysis, resumed by a numerical semi-quantitative index, named Standardized Shape Index (SSI), could lead to an objective differentiation between responders and non responders.

LTP76 Clinical, surgical and pathologic factors affect the number of lymph nodes harvested in a national cohort of colon cancer B. S. Nedrebø1,2, K. Søreide1,2, A. Nesbakken3,5, M. T. Eriksen4, J. A. Søreide1,2 & H. Kørner1,2 1 Department of Surgery, Stavanger University Hospital, Stavanger, Norway, 2Department of Surgical Sciences, University of Bergen, Bergen, Norway, 3Department of Gastrointestinal Surgery, Oslo University Hospital, Aker, Oslo, Norway, 4Department of Surgery, Oslo University Hospital, Oslo, Norway, 5Faculty of Medicine, University of Oslo, Oslo, Norway Aim: The number of harvested lymph nodes (LN) is regarded a proxy for quality of surgery for colon cancer. Since 2007, the Norwegian Colon Cancer Registry has recorded prospectively clinical, surgical and pathological data. Method: National cohort of all patients curatively resected for adenocarcinoma of the colon in 2007 and 2008. Endpoints were numbers (median) of retrieved LN and percentage of specimens with ‡ 12 or £ 8 nodes, respectively Results: From a total of 5068 patients, 4145 (81.8%) underwent a major resection. Complete histopathological data were available in 3733 (73.7%) patients. A median of 14 lymph nodes was retrieved (IQR 11–18). In 73% of the specimens, ‡ 12 lymph nodes, and in 11.5% £ 8 nodes were found. Multivariate analysis revealed age < 70 years, elective surgery, operation in 2008, operation at high volume hospitals, pT stage > I, pN-stage 1–2, right-sided resection and the use of pathology report template as independent factors for achieving ‡ 12 LN. Conclusion: In our national cohort, the numbers of LN retrieved in surgical specimens for colon cancer was sufficient in the majority of the patients. However, other factors than surgery are important for the number of harvested lymph nodes.

LTP77 Extentended posterior abdominoperineal resection for rectal cancer improves the outcome G. Palmer, C. Anderin, A. Martling & T. Holm Karolinska Institutet, Stockholm, Sweden Aim: Conventional abdominoperineal resection (APR) for low rectal cancer is frequently associated with intraoperative tumour perforation, positive circumferential margins (CRM+) and wound infections. Outcome after APR has higher degree of local recurrences and worse overall survival compared low anterior resection. The aim was to report the results after introduction of extended APR in a consecutive prospective study from a single colorectal unit. Method: Between 2000 and 2009, 109 patients with low rectal cancer were treated with extended APR. The principal difference in the surgical procedure from conventional APR is that mesorectum is not dissected off the levator muscles. The perineal dissection is done in prone position where the levator muscle is dissected en bloc with the anus. Results: Sixty-seven (61%) had preoperative assessed locally advanced rectal cancer. R0 was obtained in 91; R1 in 18. Positive circumferential margin occurred in 21 (19%). During the follow up (11 months–10 years) seven local recurrences occurred and 37 received disseminated disease. Conclusion: The method of extended posterior perineal resection of low rectal cancer has a low risk for bowel perforation and CRM involvement. Local recurrences occurred less frequently in this study compared to previous reported studies of outcome after APR surgery.

LTP78 Survival outcome of screening versus symptomatic colorectal cancers – an 8 year follow up R. Pande, P. Froggatt, P. Baragwanath & C. Harmston University Hospitals of Coventry and Warwickshire, Coventry, UK Aim: The national bowel cancer screening programme has been rolled out nationwide following pilot screening in two health authorities in the UK. The aim of this study was to compare survival outcome over an 8 year period of screened versus symptomatic patients. Method: All cancers treated at one trust in patients of screening age (50–69) during the pilot screening programme were analysed. Patients were defined as screen detected or symptomatic. Disease pathology and recurrence data was obtained from the hospitals’ computerised results reporting system and mortality from the West Midlands Cancer Intelligence Unit. Results: Five hundred and ninety patients were identified in the study period. One hundred and fifty-two patients had a screen detected cancer and 438 did not. A log rank test completed on survival

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Lunchtime Posters outcomes indicated survival was significantly worse in the symptomatic group. Overall mortality was 26% in the screened group and 52% in the symptomatic group. Proportion of Dukes A, B, C and D tumours was 23, 34, 26, 17% in the screened group compared with 8, 29, 35, 28% in the symptomatic group. Conclusion: Survival outcome was significantly better in the screened versus the symptomatic population.

LTP79 Validation of the seventh edition of the American Joint Committee on Cancer tumor node staging system in patients with colorectal carcinoma in comparison with sixth classification: an international multicenter study J. S. Park1, G.-S. Choi1, S. Hasegawa2, Y. Sakai2, J. W. Huh3, H. R. Kim3 & S. G. Kwak4 1 Kyungpook National University Hospital, Daegu, Korea, 2Kyoto University Hospital, Kyoto, Japan, 3 Chonnam National University Hwasun Hospital and Medical School, Hwasun-gun, Korea, 4 Kyungpook National University, Daegu, Korea Aim: The aim of this study was to compare survival rates assessed by American Joint Committee on Cancer (AJCC) seventh staging for colorectal cancer with those by the sixth classification. Method: This was a retrospective study of 3260 patients who underwent surgery for colorectal adenocarcinoma from 1995 to 2005. The overall survival (OS) and cancer-specific survival (CSS) rates were compared between patients whose stages according to the seventh staging system remained the same and patients whose stages migrated, and between subgroups within each new stage. Results: In 7th edition, the 5-year OS and CSS rates were significantly greater in the downstaged patients (T3N2a) than in other patients (T3N2b). The 5-year survival rates for patients with T4a and T4b sub-classifications according to the seventh edition did not differ from those in patients with T4N0-1. Homogeneity analysis of subgroups classified using the seventh system showed that some subgroups of stage IIIB (T3N2a / T4aN1) had poorer survival rates compared with patients in other sub-categories in the same stage IIIB. Conclusion: Overall, the seventh edition provides a more detailed classification of the prognosis than the old system. However, further validation is needed because of the inadequacy in stage subclassification, especially for T4a-b and T3N2a tumours.

LTP80 Correlation between chemoradiation total dose and rectal carcinoma treatment outcomes A. Rasulov1, Y. Sheligin1, A. Boiko2, I. Droshneva2 & D. Pikunov1 1 State Research Center of Coloproctology, Moscow, Russia, 2Moscow Herzen Research Oncology Institute, Moscow, Russia Aim: The aim was to assess the impact of chemoradiation dose on rectal carcinoma treatment results. Method: From 2006, 154 pts with T2-4N0-2M0 rectal carcinoma were enrolled into study. Irradiation was given 4 Gy per day first 3 days concurrently with 5-FU 350 mg/m2 and cisplatin 90 mg, then 1.25 Gy twice a day up to total dose 39.5 Gy (71 pts – 1 group) or 47 Gy (83 pts – 2 group). Surgery was performed in 4–7 weeks after chemoradiation. Results: Side effects occurred in 25.4% and 19.8%, accordingly. On univariate analysis PCR and near PCR (TRG 1–2) were 23.9% vs 43.2% (P = 0.022), sphincter-saving procedures – 69% vs 77.1% (ð = 0.28), intraoperative blood loss – 276.1 ± 212.8 ml vs 165.7 ± 94.4 ml (ð = 0.0001), duration of operation – 216 ± 76.3 min. vs 159.2 ± 44.4 min. (ð = 0.0001) and postoperative complications – 32.4% vs 21%, respectively (ð = 0.14). On multivariate analysis there were increase of TRG 1–2 (ð = 0.046) and decrease of operation duration (ð = 0.001) in second group. Conclusion: The escalation of chemoradiation total dose from 39.5 Gy to 47 Gy leads to increased number of PCR and near PCR in resected specimens, reduces surgical procedure duration but does not affect postoperative complications and sphincter saving procedures rate.

LTP81 Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer A. Rasulov1, Y. Sheligin1, A. Boiko2, I. Droshneva2 & S. Zhdankina1 1 State Research Center of Coloproctology, Moscow, Russia, 2Moscow Herzen Research Oncology Institute, Moscow, Russia Aim: The aim was to assess the value of tumour regression as a prognostic factor in rectal carcinoma patients treated by preoperative chemoradiotherapy Method: From 2006, 157 pts with T2-4N0-2M0 rectal carcinoma were enrolled into study. Irradiation was given concurrently with 5-FU 350 mg/m2 and cisplatin 90 mg up to total dose 47 Gy. Surgery was performed in 4–7 weeks after CRT. Results: Downstaging was seen in 66.9%. TRG 1, 2, 3, 4, 5 was found in 11.5%, 24.2%, 36.3%, 26.8%, 1.3% of resected specimens, respectively. Sphincter-saving procedures (SSP) were performed in 72.6%. Postoperative complications developed in 26.7%. With median follow-up of 17 months local relapses and distant metastases were developed in 1.3% (2/157) and 9.5% (15/157). Three-year actuarial DFS was 82.1%. On univariate analysis TRG 1, 2 correlated with downstaging in compare to TRG 3, 4, 5 (ð < 0.0001). Poor pathologic response (TRG3-5) associated with postoperative complications (a = 0.015). Downstaging T was related to SSP (P = 0.037) and DFS (P = 0.04). On multivariate analysis only TRG3-5 increased postoperative complications rate (P = 0.02) and downstaging T had tendency to prognostic factor for better survival (P = 0.053) Conclusion: Radioresistant rectal carcinomas associated with high postoperative complications rate. Downstaging T predicts higher DFS after preoperative chemoradiotherapy.

LTP82 Local recurrence of rectal cancer: an Italian perspective from three units of Coloproctology F. Selvaggi1, C. Fucini2, S. Pucciarelli3, G. Pellino1, S. Canonico1 & G. Sciaudone1 1 Second University of Naples, Naples, Italy, 2University of Florence, Florence, Italy, 3University of Padua, Padua, Italy Aim: The aim of this study was to review the role of surgery in the management of patients with rectal cancer recurrence. Method: We combined and evaluated by means of Cox regression and Kaplan-Mayer survival analysis data of patients with recurrent rectal cancer from three prospective databases (1987–2005).

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Results: One hundred and fifty patients, median age 60.4 years presented with local recurrence after surgery for rectal cancer. One hundred (66.7%) patients fit surgery criteria and accepted to undergo surgery: 51 underwent radical and 49 extended resection. Carcinoembryonic antigen (CEA) was elevated in 41% patients. Twenty-four percent and 15% patients received pre- and post-surgical RT respectively, 24% neo-adjuvant CT, 2% IORT and 7% double-cycle CT. Thirty-one percent experienced major post-operative complications. R0 margins were obtained in 61% of patients. Median overall survival was 37 months. Pre-(P = 0.004) and post-operative (P = 0.04) RT, stage (P = 0.004) and R0 resection (P = 0.00001) are significant predictors of survival. Conclusion: Resection for recurrent rectal cancer results in good survival with acceptable morbidity. Patients undergoing surgery have improved overall survival compared with patients who refuse or do not fit surgery. Advanced stage of the primary tumour and lateral recurrence are associated with impairment of survival. Negative resection margin (R0) is the strongest predictor of survival.

LTP83 Does the National Bowel Cancer Screening Programme identify lower stage disease in clinical practice? – results from a single centre B. Stubbs, T. Wiggins, T. Agrawal, J. Peck, J. McCullough & A. Obichere University College London Hospital, London, UK Aim: Patients diagnosed with early stage bowel cancer have better prognosis, which is one of the principles for the introduction of the NHS Bowel Cancer Screening Programme (NHSBCSP). We assessed the impact of the NHSBCSP on cancer stage at one institution, and compared it to those presenting via other pathways. Method: Patients diagnosed with colorectal cancer were recorded in a prospective database. Final histopathological stage of cancers presenting via the NHSBCSP was recorded and compared to that of cancers diagnosed outside the screening programme. Results: Histopathological disease stage was available for 368 patients presenting outside the screening programme and 116 patients within. For those patients presenting outside the screening programme 15% of cases were Dukes stage A, 37% Dukes B, 30% Dukes C and 18% Dukes D. The screening group had a higher proportion of Dukes A (43%) and Dukes B (24%) cases, and a lower proportion of Dukes C (23%) and Dukes D (10%). Conclusion: These results confirm that, in clinical practice, the NHSBCSP is capable of detecting colorectal cancer at an earlier stage, thereby potentially improving survival. Further long-term survival data is needed to confirm an actual survival benefit.

LTP84 Preoperative carcinoembryonic antigen levels predict short-term survival and D-dimer levels long-term survival in patients with curatively intended resection for colorectal cancer K. G. Sunesen, M. T. Stender & O. Thorlacius-Ussing Department of Gastroenterological Surgery A, Aalborg Hospital, A˚rhus University Hospital, Aalborg, Denmark Aim: Plasma D-dimer levels are better predictors of overall survival than carcinoembryonic antigen (CEA) levels in patients with metastatic colorectal cancer (CRC). However, controversy exits regarding the prognostic value of preoperative D-dimer levels in relation to CEA levels in patients with resectable CRC. We examined this issue in a prospective cohort study. Method: We measured preoperative D-dimer and CEA levels in a consecutive series of 166 patients with curative-intent resection for CRC. Kaplan–Meier survival curves were computed according to these levels. We used adjusted Cox-regression analysis to compute mortality rate ratios (MRR) according to preoperative D-dimer and CEA levels for postoperative year 0–1 and 1–5. Results: Patients with normal preoperative D-dimer and CEA levels had a cumulative 5-year mortality of 15% [95% confidence interval (CI): 9–25%]. Adjusted MRRs were 9.8 (CI:2.5–38.3) and 1.1 (CI:0.5–2.7) for postoperative year 0–1 and 1–5, respectively, in the elevated CEA group when compared to the normal CEA group. Corresponding figures were 2.6 (CI: 0.7–10.1) and 2.2 (CI: 1.4– 2.8) in the elevated D-dimer group compared to the normal D-dimer group. Conclusion: Preoperative CEA levels were associated with survival the first year after curatively intended resection for CRC while D-dimer levels were associated with survival also after first postoperative year.

LTP85 Leakage after TME for locally advanced rectal cancer does not compromise oncological outcome but restrains patients from adjuvant chemotherapy A. Wolthuis1, F. Penninckx1, S. Fieuws2 & A. D’Hoore1 1 Department of Abdominal Surgery, University Hospital Gasthuisberg Leuven, Leuven, Belgium, 2 Interuniversity Centre for Biostatistics and Statistical Bioinformatics, Leuven, Belgium Aim: Clinical anastomotic leakage (CAL) after TME has a major impact on the patient’s postoperative course and could affect local recurrence and disease-free survival. This study evaluates the effect of CAL on oncologic therapy and outcome. Method: From a database with 356 patients with locally advanced rectal adenocarcinoma treated with neoadjuvant chemoradiotherapy, 295 patients with colo-anal anastomosis were identified. Mean age was 64 years (range: 14–85 years) and 67% were males. Data on type of surgery, postoperative complications, adjuvant treatment, disease recurrence and survival after a median follow-up of 4.7 years were reviewed. Results: There were 23 clinical anastomotic leaks (7.8%), requiring reintervention. There was no postoperative mortality. The overall 3-year survival rate was 94% and the disease-free survival rate was 83%. Fourteen out of 23 patients with CAL (61%) did not receive adjuvant chemotherapy versus 76 out of 272 patients (28%) without CAL (P = 0.002). No significant difference in survival and diseasefree survival was observed comparing patients with CAL and patients without CAL: 94% versus 93% and 79% versus 85%, respectively (P = 0.22 and P = 0.37). Conclusion: Although no impact of CAL on oncologic outcome could be observed, a temporary defunctioning ileostomy is indicated in patients requiring adjuvant therapy.

LTP86 Relation between motor and sensory threshold during percutaneous nerve evaluation J. Duelund-Jakobsen, L. Lundby, S. Buntzen & S. Laurberg Surgical Research Unit, Department of Surgery P, Aarhus University Hospital, Aarhus, Denmark Aim: This study aimed to determine the relationship between the amplitude necessary to elicit a motor/sensory threshold during the Percutaneous Nerve Evaluation (PNE-test) and to evaluate early lead displacement.

 2011 The Authors Colorectal Disease  2011 The Association of Coloproctology of Great Britain and Ireland. 13 (Suppl. 6), 16–27

Lunchtime Posters Method: Fourteen patients had a PNE-test in deep sedation. Motor threshold was tested with a testneedle and test-electrode placed anterior to the sacrum. The position was verified by fluoroscopy. Sensory threshold was determined, in the fully awake patient, after Propofol infusion was stopped and secondly, the day after surgery where the temporary pacemaker was activated. Pelvic-CAT-scan was preformed the day after surgery to verify exact electrode-tip location. Results: In total 40 temporary electrodes were inserted. A significantly higher (P-value: < 0.001) amplitude was necessary to elicit a motor response on test-electrodes than on test-needles 2 V (0.5–5) vs 1 V (0.5–4). Sensory threshold increased from 1.75 V (0.5–8) to 2 V (0.5–9.9) the day after surgery (P-value:0.008). Seventeen (42.5%) electrodes were displaced posteriorly 24-hour postoperative. Delta-amplitude to elicit a sensory response had increased significantly (P-value: < 0.001) compared to the non-displaced electrodes [2 V (0–7) vs 0 V ()2 to 1.5)]. Conclusion: The amplitude necessary to elicit a motor response on the test-lead was significantly higher than compared to the test-needle. Posterior lead-displacement is common and associated with an increase in sensory threshold.

LTP88 Rectovaginal fistula after anterior resection for rectal cancer: Incidence, treatment and outcome T. Paumet, Q. Denost, L. Quintane, M. Martenot, C. Laurent & E. Rullier Saint-Andre Hospital CHU Bordeaux, Bordeaux, France Aim: Rectovaginal fistula occurring after anterior resection is a complex situation that may compromise natural bowel function. We aimed to clarify the incidence, risk factors, treatment and outcome of such complication. Method: Of 1120 patients treated for rectal cancer, 321 were women and received a low anterior resection. Preoperative radiochemotherapy was given in 59% of the patients and a loop ileostomy was used in 61% of the cases. We evaluated the impact of clinical and surgical characteristics on the risk of anastomotic leakage. Treatment of rectovaginal fistula was also analysed. Results: The rate of anastomotic leakage was 10% (32 of 321), of whom 4.4% (n = 14) were rectovaginal fistulas. The only independent factor of fistula was an associated colpectomy during the anterior resection (OR = 5.46, IC = 1.84–16.18; P = 0.002). Treatment of rectovaginal fistula included defunctionning stoma (n = 8), transvaginal suture (n = 3), graciloplasty (n = 1), redo coloanal anastomosis (n = 1) and APR (n = 1). The rate of success was 79% (11 of 14) with three patients still having a stoma. Conclusion: In females, rectovaginal fistula represents half of anastomotic morbidity following anterior resection for rectal cancer. Preservation of the anastomosis can be obtained in most cases with a low rate of definitive stoma.

Results: In the AFP group: septic complications occurred in two of 10, one required explantation; mean healing time was 6 weeks. In CF group: the mean healing time was 24 weeks; four of 10 patients required revisional surgery. CCF-FII was reduced in the AFP group (8.3–7.8) while in CCFFII the difference was highly significant (from 8.6–7.0). On anorectal manometry BAP and SAP were significantly reduced in the CF group 12 months after treatment as compared to the AFP group. TAUS revealed anal sphincter defects in four of 10 CF patients. Conclusion: Anal Fistula Pflug (SURGISIS) was effective in the treatment of transsphincteric anal fistulas and preserving faecal continence.

LTP90 A systematic review comparing the role of trans-anal haemorrhoidal dearterialisation and stapled haemorrhoidopexy management of haemorrhoidal disease M. S. Sajid, U. Parampalli & M. K. Baig Worthing Hospital, Worthing, West Sussex, UK Aim: To systematically analyze the clinical trials on the effectiveness of trans-anal haemorrhoidal dearterialisation (THD) and stapled haemorrhoidopexy (SH) in the management of haemorrhoidal disease (HD). Method: Clinical trials on the effectiveness of THD and SH in the management of HD were analysed systematically by using RevMan where combined outcome was expressed as risk ratio (RR) and mean difference (MD). Results: Three randomized trials encompassing 283 patients were analysed systematically. There were 80 patients in THD group and 103 patients in SH group. There was no significant heterogeneity (I2 = 0%) among included trials. Therefore, in the fixed effects model, THD and SH are statistically equivalent in terms of treatment success rate (P = 07), operation time (P = 0.13), peri-operative complications (P = 0.18) and recurrence (P = 0.15) of HD. In addition, THD was associated with significantly less postoperative pain (P < 0.0006) as compared to SH. Conclusion: Both THD and SH are equally effective and can be attempted for the management of HD. However, THD is associated with significantly less postoperative pain and therefore, may be considered a preferred procedure for the management of HD if first line treatment of rubber band ligation fails.

LTP89 Biocompatible anal fistula plug versus conventional treatment of transsphincteric anal fistulas M. Nowakowski1, R. Herman2, J. Kucharz2 & R. Herman2 1 Department of Medical Education, Jagiellonian Univeristy School of Medicine, Krakow, Poland, 2 Department of Experimental and Clinical Surgery, Jagiellonian University School of Medicine, Krakow, Poland Aim: The SURGISIS AFP is cone shaped device from porcine small intestine. The aim of the study was to evaluate clinical and functional results of AFP versus fistulectomy. Method: Twenty patients with transphincteric anal fistulas randomized to Anal Fistula Plug (AFP) or fistulectomy (CF). 3D ERUS and/or NMR was applied to confirm transsphincteric fistula. Anorectal manometry and EMG were performed pre and postoperatively. Primary end points were healing of fistula at 12 months and anal continence CCF-FII < 8. Secondary end points were QoL, weekly number of incontinence episodes, subject acceptance and adverse events.

 2011 The Authors Colorectal Disease  2011 The Association of Coloproctology of Great Britain and Ireland. 13 (Suppl. 6), 16–27

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