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A REVIEW OF SURGICAL TREATMENT, OUTCOMES AND THE ROLE OF
GASTROINTESTINALSTROMAL TUMOUR OF THE RECTUM:
M.J. Wilkinson, J.E.F. Fitzgerald, D.C. Strauss, A.J. Hayes, J.M. Thomas. The
Royal Marsden Hospital NHS Foundation Trust, London, UK
Aims: Gastrointestinal stromal tumours (GISTs) of the rectum are rare,
accounting for only 0.1% of all rectal tumours. This study investigates the
presentation, management and outcomes of rectal GISTs at a specialist
Methods: Retrospective cohort study analysing a prospectively main-
tained database at a tertiary referral centre from Jan 2001 - Jan 2012.
Results: A total of 14 patients (6 female, 8 male), presented with a pri-
mary rectal GIST. Commonest presenting symptoms were rectal bleeding
(n¼6) and tenesmus (n¼6). Median tumour size at presentation: 8cm
(range 2 - 12cm). 12 patients received neoadjuvant imatinib; median
reduction in tumour size 2.8cm (range 0.5 - 5.6cm); p ¼ 0.001. Surgical
resection was performed in 6 of the 14 patients (2 patients declined
surgery and 6 are continuing imatinib to downsize). Complete macro-
scopic clearance was obtained in 100% of patients. On follow up, 12
patients are alive without metastases: median follow-up 31.3 months.
There were 2 deaths from unrelated causes. The remaining 5 patients
operated on are disease free (median DFS ¼ 36.2 months).
Conclusions: Biopsy is essential in establishing the diagnosis. Neoadjuvant
imatinib substantially downsizes rectal GISTS which may permit less
invasive surgery. Favourable outcomes can be achieved for rectal GISTs in
0283: A PROPOSED STANDARD FOR PRE-OPERATIVE LAPAROSCOPIC
RECOVERY CANCER CENTRE
Ajay Sud, Arkeliana Tase, Elinor Baker, Santanu Bhattacharjee, Shiva
Dindyal, Stefano Andreani. Whipps Cross University Hospital, London, UK
Aims: The National Bowel Cancer Screening Program specifies a 100%
target for tattooing of suspected malignant lesions. There remains no
all-inclusive guideline for colorectal tattooing. We aim to identify factors
contributing to suboptimal practice.
Methods: The data collected incorporated retrospective analysis of all 144
colorectal surgery patients at Whipps Cross Hospital whom underwent
oncological colorectal resections for ten months from January 2008 and six
months from June 2010.
Results: In 2008 and 2010, 39% and 52% respectively, of our patients
received pre-operative tattooing. In 2008 and 2010, 30% and 50% respec-
tively of lesions were only documented to be distally tattooed. The mean
number of days between their pre-operative endoscopy to surgery in 2010
was 69 days. In 2008 consultant gastroenterologists tattooed 70% of
suspect lesions, but by2010 this reduced to 36%. Only 40% were underwent
solely distal tattooing, and 22% of ulcerating lesions were tattooed.
Conclusions: Surgeons are the direct recipients of suboptimal tattooing.
They are best placed to lead the colonoscopy community to ensure effi-
cacious tattooing practices, enabling optimal uncomplicated oncological
resection. The standard for practice should be a recent distal ‘360-degree'
tattoo with one vial per 30 degrees, to all suspicious lesions, irrespective to
the endoscopic morphology.
0316: IROBOT - INITIALIZING A ROBOTIC COLORECTAL SERVICE
Faira Eldriana Rizal, Benjamin Stubbs, P. Mathur, Colin Elton, Daren
Francis. Department of Coloproctology, Barnet and Chase Farm Hospital,
Aims: Robotic surgery has potential advantages in the difficult pelvis,
however use in coloproctology has been limited. We describe our early
Methods: 3 colorectal surgeons gained certification as console surgeons on
the da Vinci robot and a mentoring programme was undertaken with an
experienced robotic colorectal surgeon. (2 anterior resections at the
mentor's hospital followed by 2 ventral mesh rectopexies performed at our
trust.) Data was collected prospectively on all cases performed over 1 year.
Results: 12 robotic colorectal procedures were performed (6 ventral
rectopexies, 5 anterior resections and 1 ultra-low Hartmann's). No
intra-operative complications occurred, with one conversion to open
surgery. Mean operative times were: mesh rectopexy 270 minutes
(range 205-310), anterior resection 366 minutes (304-408) and Hart-
mann's 355 minutes. Mean length of stays were: ventral rectopexy 2
days (range 1-3), anterior resection 7.6 days (5-10) and Hartmann's was
8 days. 1 post-operative ileus occurred with no other post-operative
complications. All patients with rectal cancer had good oncological
clearance on histology.
Conclusions: Initiation of a robotic colorectal service is a safe and feasible
option within a supervised mentoring programme. We anticipate an
improvement in operating time with increased experience, however
further studies into economic viability are needed.
PRESENTING WITH AIR-FLUID LEVEL – A CLINICAL REVIEW AND
Santosh Bhandari, Pravin Ranchod, Ashish Sinha, Arun Gupta, Susan
Clark, Robin Phillips. St Mark's Hospital, Harrow, Middlesex, UK
Aim:Familial adenomatous polyposis (FAP) related desmoid tumors (DT)
can present with a liquefied centre containing gas, accompanied by
abdominal pain and sepsis. We present our experience of managing these
desmoids grouped together as ‘intra-abdominal desmoids (IAD) with
Material and methods:Retrospective review of prospectively maintained
polyposis registry database was conducted at a tertiary referral centre
specializing in FAP and desmoid disease.
Results:A total of nine patients had an IAD with air-fluid level, seven were
primary surgery to DT development was 24 months (range 0 – 48 months),
(range 0 – 226 months). DT size ranged from 10cm to greater than 20cm in
diameter. Two patients were successfully managed with antibiotics alone,
andtwo patientswithpercutaneousdrainage andantibiotics.Theotherfive
patientsrequiredsurgicalintervention involvingeitherexcision ordrainage
with or without proximal defunctioning/exclusion.
Conclusions:The majority of IAD patients with an air-fluid level require
surgical intervention. Antibiotics and percutaneous drainage are only
successful in a limited number of patients. We present our current treat-
ment algorithm based on this experience.
0362: LOCAL RECURRENCE (LR) RATES AFTER OPERABLE RECTAL
Khera. Wirral Hospital, Liverpool, UK
Aims: LR rates following curative resection have been reported to be
between 2.4 - 50% with LR rates hypothesised to be higher for abdomi-
noperonial resection (APR) vs anterior resection (AR). We analysed our LR
rates over an 11 year period
Methods: Between 1999 and 2010, 312 patients with operable rectal
cancer (<15cm from the anal verge) were followed up to determine local
or regional recurrence. Total Mesorectal Excision (TME) principles were
adhered to, together with tailored neo and adjuvant chemo-radiotherapy
Results: Age range 38 - 98 years, 60% male, follow-up for up to 11 years.
Rates of APR were 23%, AR 56% and Hartmann's 8%. Total LR rates were 5%.
In those developing LR, distance from the anal verge was 2-15cm (median
6cm), with AR being performed as lowas 3cm. The distant recurrence rates
Conclusions: Concerns have been raised in the Association of Colo-
proctology of Great Britain and Ireland guidelines regarding the plane of
dissection and potentially higher recurrence rates in APR vs AR. Our study
demonstrates however, that with the TME technique both APR and ultra-
low AR can be performed with low LR, highlighting the importance of
specialist rectal surgeons in cancer surgery.
0384: LAPAROSCOPIC TECHNIQUES MAY MINIMIZE THE SHORT-TERM
IMPACT OF REPEATED SURGICAL RESECTION IN THE MANAGEMENT
OF CROHN'S DISEASE
Christopher Whitfield, Richard Slater. Rotherham NHS Foundation Trust,
Abstracts / International Journal of Surgery 10 (2012) S1–S52S24