Poster Abstracts

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The blood and intestinal tissue were investigated by paraoxonase 1 ... study was to report our experience of HR after «primary» HP or in redo-surgery ..... orectal surgery from January 2007 to September 2014 was analysed for demograph-.
Poster Abstracts P001 The effects of curcumin on lipid levels, endothelial damage and oxidative damage markers in rats after splenectomy Y. Altinel1, E. Kose2, A. Karacaglar5, V. Sozer3, O. Gulcicek1, G. Ozkaya1, G. Simsek7 & H. Uzun6 1 Bagcilar Research and Training Hospital, General Surgery, Istanbul, Turkey, 2 Okmeydani Research and Training Hospital, General Surgery, Istanbul, Turkey, 3 Yildiz Technical University, Biochemistry, Istanbul, Turkey, 4Uludag University Medical Faculty, Biostatistics, Istanbul, Turkey, 5Bagcilar Research And Training Hospital, Pathology, Istanbul, Turkey, 6Cerrahpasa University Medical Faculty, Biochemistry, Istanbul, Turkey, 7Cerrahpasa University Medical Faculty, Physiology, Istanbul, Turkey Aim: Curcumin has anti-inflammatory, antioxidant, hypolipidaemic properties. We investigated curcumin on lipid and oxidative stress parameters following splenectomy in rats. Method: 28 rats were operated under general anaesthesia, then fed for 30 days by gastric lavage. The curcumin and splenectomy group (CS), the corn oil and splenectomy group (COS), the control group (L), only laparotomy; the sham group (S), only splenectomy was performed. After 30 days, colectomy was performed for histopathology. The blood and intestinal tissue were investigated by paraoxonase 1 (PON 1), oxide low density lipoprotein (oxLDL), oxidized low density lipoprotein receptor-1 (LOX-1), NFjB, Cu,Zn-SOD, GPx, MDA. Results: The mononuclear cells, monocytes of the intestine were increased in CS, but insignificantly. Triglyceride, total cholesterol, VLDL and LDL were elevated in S compared with L. Differences between groups were not identified for TG, LOX1, LDL. The oxLDL of CS was lower than S (P = 0,029). Tissue MDA was lower in CS than S (P = 0.01). Serum GPx (P = 0.018), PON1 (P < 0.01) activity was higher in CS and L than S. Tissue NFjB was lower in L than S and COS. Tissue GPx was higher in L than S and COS. Conclusion: Curcumin partially improved the lipid profile and inflammation. The histopathological results may have effects for anti-inflammatory therapies.

P002 Is trans-anal rectal irrigation (TARI) an effective treatment for patients with severe anorectal dysfunction? C. Byrne, S. Ghag, T. McCaffrey, C. Molyneux, W. Baraza, A. Sharma & K. Telford University Hospital of South Manchester, Manchester, UK Aim: To establish whether there is any reduction in symptom severity or improvement of quality of life (QOL) in patients with anorectal dysfunction using TARI. Method: From 2014–2016, a prospective series of 211 symptomatic patients taught TARI were retrospectively followed up by postal questionnaire. Symptom and QOL questionnaires were recorded pre- and post- treatment. (KESS, Vaisey, MHQ). Results: 211 patients were contacted (response rate of 35%): 24.6% with constipation (C), 16.4% with a combination of obstructive defecation disorder and constipation (C/ODS), 31.1% with faecal incontinence (FI) and 17 27.9% with FI/ODS. KESS score significantly decreased in patients with C or C/ ODS (23.5 vs 20.4, SD 3.0, P = 0.015). There was no significant difference in the Vaizey score for the combined FI and FI/ODS group (13.5 vs 12.4, SD 1.2, P = 0.16). However, in this cohort of patients those who irrigated frequently reported larger decreases in post treatment Vaizey scores (P = 0.030, n = 28). MHQ decreases in all study patients who underwent TARI and this approached statistical significance (514.2 vs 444.2, P = 0.05). Conclusion: TARI is effective in improving severity in those with constipation/ constipation with ODS. Further research is needed in order to determine how useful it is in other types of anorectal dysfunction.

P003 A cross-sectional review of reporting variation in post-operative bowel dysfunction following rectal cancer surgery S. J. Chapman, W. S. Bolton, N. Corrigan, N. Young & D. G. Jayne University of Leeds, Leeds, UK Aim: Postoperative bowel dysfunction affects quality of life after sphincter-preserving rectal cancer surgery. The purpose of this study was to assess variation in reporting of postoperative bowel dysfunction and make recommendations for future standardisation.

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Method: MEDLINE and EMBASE databases and the Cochrane Library were queried systematically between 2004 and 2015. Studies selected reported at least one component of bowel dysfunction (stool incontinence, flatus incontinence, frequency, urgency, clustering) following resection of rectal cancer. The primary outcomes were reporting, measurement and definition of post-operative bowel dysfunction. Results: Of 5428 studies, 234 were included. Widely reported components of bowel dysfunction were stool incontinence (227/234; 97.0%), frequency (168/234; 71.8%) and flatus incontinence (158/234; 67.5%). Urgency and stool clustering were reported less commonly, with rates of 106/234 (45.3%) and 61/234 (26.1%). Bowel dysfunction measured as a primary outcome was associated with better reporting (OR: 3.49; 95% CI: 1.99–6.23; P < 0.001). Less than half of outcomes were assessed using a dedicated research tool (337/720; 46.8%), and the remaining measures were infrequently defined (56/383; 14.6%). Conclusion: Considerable variation exists in reporting, measurement and definition of postoperative bowel dysfunction. These inconsistencies preclude reliable estimates of incidence. A broadly accepted outcome measure may address this deficit in future studies.

P004 Hartmann’s reversal in a tertiary centre: a retrospective study of 150 patients N. Chereau, J. Lefevre, N. Chafai, T. Hor, E. Tiret & Y. Parc H^opital Saint-Antoine, Paris, France Aim: The high morbidity rates reported in many studies might influence surgeons’ decisions of whether to perform Hartmann’s reversal (HR). The aim of the present study was to report our experience of HR after «primary» HP or in redo-surgery for failed anastomosis. Method: All patients who underwent an HR between 2007 and 2015 were included. Clinical and demographic data were obtained from a review of medical records. Results: 150 patients [age 60, range (20–91) years, 62% male] were included. Thirty-height (25%) patients had three or more comorbidities and 86 patients (57%) were ASA≥2. Most common indications for the HP were complicated diverticulitis (29.3%) and anastomotic leakage (24%). Fifty-two patients (35%) were secondarily referred for HR. HR was possible in 97% of our patients including 6 patients with previous failed attempt at reversal. Overall morbidity was 22.7% including 11.7% severe complications (Dindo 3–4) with five anastomotic leakages (3.4%) and 8 pelvic abscess (5.5%). Univariate analysis revealed that operative blood loss was the only significant risk factor for postoperative anastomotic event. Conclusion: Despite that 35% of the patients were referred from outside institutions, including 6 patients with previous attempt to HR, HR was possible in 97% of our patients with low morbidity.

P005 The use of biochemical markers in complicated and uncomplicated acute diverticulitis D. Kumarasinghe3, A. Zahid1,2, G. O’Grady1, T. Leow3, T. Sheriff4, G. Ctercteko1 & S. Adusumilli2 1 Westmead Hospital, Sydney, NSW, Australia, 2Blacktown Hospital, Sydney, NSW, Australia, 3School of Medicine, University of Western Sydney, Sydney, NSW, Australia, 4School of Medicine, Bond University, Gold Coast, QLD, Australia Aim: This study explores the ability of white cell count, C-reactive protein and bilirubin in differentiating patients with complicated and uncomplicated diverticulitis as well as progression to surgical intervention. Method: A retrospective study of patients admitted with acute diverticulitis over a 5-year period (2009–2014) at a single institution in Australia. Patients classified into three groups; uncomplicated diverticulitis, complicated diverticulitis without surgery and complicated diverticulitis with surgery. ANOVA and Bonferroni’s post-hoc analyses were used to compare the groups. Results: A total of 541 patients met the inclusion criteria. One-way ANOVA showed a significant difference in white cell count (P < 0.0001), C-reactive protein (P < 0.0001) and bilirubin (P = 0.0006) between all three groups. Post-hoc analyses showed a significant difference in white cell count, C-reactive protein and bilirubin when comparing uncomplicated diverticulitis against complicated diverticulitis without surgery (P < 0.05) and complicated diverticulitis with surgery (P < 0.05). White cell count also showed a significant difference when comparing complicated diverticulitis without surgery and complicated diverticulitis with surgery (P < 0.05). Conclusion: Using biochemical markers we found statistically significant differences between the three groups. However, due to the scatter within each group, these biochemical markers are of no predictive value for any individual patient. Whilst

ª 2016 The Authors Colorectal Disease ª 2016 The Association of Coloproctology of Great Britain and Ireland. 18 (Suppl. 1), 44–125

Poster Abstracts White cell count, C-reactive protein and bilirubin appear to have a strong ability to distinguish between uncomplicated and complicated diverticulitis. We look forward to prospectively collecting further data to confirm this.

P009 Laparoscopic versus robotic hand-sewn ileo-colic anastomosis with intracorporeal knot tying S. Giuratrabocchetta, S. Tou, K.You & R. Bergamaschi State University of New York, Stony Brook, USA

P006 Are Hirschsprung’s disease and anorectal malformations sequelae comparable at adult age? Results of disease specific HAQL questionnaire comparison F. Drissi1, C. Baayen1, A. Guinot2, G. Podevin3, V. Wyart1, C. Cretolle4 & P.-A. Lehur1 1 Colorectal Unit, IMAD, University hospital of Nantes, Nantes, France, 2Department of paediatric surgery, University hospital of Nantes, Nantes, France, 3Department of paediatric surgery, University hospital of Angers, Angers, France, 4CRMR MAREP, Hopital Necker-Enfants Malades, Paris, France

Aim: There are concerns about the ergonomics of laparoscopic and robotic handsewn anastomosis. The aim of the study was to compare the first consecutive robotic (R) hand-sewn ileo-colic anastomosis (HSA) with laparoscopic (L) HSA performed by the same surgeon. Method: The first consecutive R-HSA were compared to historical L-HSA in right colon resections. To overcome the sample size difference between arms, 12 R-HSA were matched to 12 L-HSA according to age, BMI, previous abdominal surgery, and diagnosis. Anastomosis were hand-sewn in two layers: running 3-0 polyglycolic acid and interrupted 3-0 silk. Outcome measures included interrupted suturing and knotting time and number of interrupted sutures placed and torn. Results: 12 R-HSA patients were comparable to 218 L-HSA patients for demographics, pre-existing comorbidities, and diagnosis. Robotic interrupted suturing and knotting time was significantly shorter [89.5 sec (76103.5) vs 165 sec (146–219), P < 0.0001]. Fewer interrupted sutures were placed in R-HSA than in L-HAS [13 (11–14) vs 9.5 (8.5–10), P < 0.0001]. Fewer interrupted sutures were torn in LHSA [1 (0–5) vs 0, P < 0.0001]. Similar results were found after matching. Conclusion: Despite the learning curve, R-HSA entailed fewer interrupted sutures and shorter operating time when compared to L-HSA. However, sutures were torn more frequently during R-HSA.

Aim: Hirschsprung’s disease (HD) and anorectal malformations (ARM), mostly treated during childhood, could impair quality of life (QoL) at adult age despite initial optimal surgical management. To better support these adult patients, we aimed to assess and compare their QoL. Method: Data from two referral centres for HD and those from the national clinical trial MARQOL(NCT02029248) for ARM were merged. Self-administered disease specific (HAQL) questionnaires, filled out by patients, were assessed (8 dimensions explored-score from 0 to 100 Normal each). A total score was computed and compared. Results: Respectively 34 HD and 135 ARM patients (males: 76–46% - mean age: 28–23 years) entered the study. Mean total HAQL scores, respectively 611 and 651, were not significantly different (P = 0.56). The 2 most affected dimensions were “Physical symptoms” (63–65) and “Diarrhea” (73.6–79.2). “Faecal continence” (89.1–87.8 for ARM) (NS-P > 0.05) was marginally affected. Conclusion: QoL of adult patients suffering from HD and ARM sequelae is impaired although acceptable as assessed by HAQL. No significant differences were identified between both types of disease in terms of QoL. This suggests that the impact of HD and ARM sequelae on patient’s daily functioning and QoL is similar. Most of them could benefit from support and counselling. Regular follow-up is recommended.

P007 Faecal soiling in children: our institutional experience M. E. Hemaly Gastroenterology surgical centre, Mansoura University - Mansoura, Egypt Aim: To evaluate outcome of treatments in children with functional faecal soiling. Method: A prospective study of 300 children with faecal soiling presenting between February 2009 and February 2014. Children were classified into Group I (250 children with faecal retention) & Group II (50 children with no retention). Barium enema & anorectal manometry was performed on all children. All were treated conservatively & if showing partial success, Biofeedback therapy was given. Results: Manometric variables before treatment for both groups showed comparable values. After conventional treatment: A total of 180 from 300 children showed success in faecal control at 3 months (68%) from Group I and only (20%) children of Group II. The remaining 120 children showed partial improvement. After biofeedback therapy: Group I showed good success in (93.7%). Group II showed good success in (62.5%). Manometric results after biofeedback training showed non-significant changes in both groups as regard pressures but significant improvement in rectal sensations especially in Group I. The success rate after conventional treatment was (68%) for Group I and 20%, for Group II. After biofeedback treatment 94% of Group I and 75% of Group II children achieved successful faecal control. Conclusion: Biofeedback training gives good results if combined with conventional treatment.

P008 Effect of age, gender, and type of trauma on the correlation between size of sphincter defect and anal ressures in posttraumatic faecal incontinence S. Emile, M. Youssef, W. Thabet, H. Elfeki, H. Elgendy, W. Omar, W. Khafagy & M. Farid Mansoura University, Mansoura, Egypt This abstract has been previously published.

P010 Automated method for recto-anal inhibitory reflex analysis in high resolution manometry J. Gosling, R. Cohen & A. Emmanuel University College London Hospital, London, UK Aim: To develop a customised automated method for rapid and accurate analysis of the rectoanal inhibitory reflex (RAIR) using high resolution anal manometry (HRAM). Method: A customised program was written using MATLAB to analyse the RAIR traces measured using a 16 channel water perfused HRAM catheter. This program was tested on 320 RAIR traces from 80 individuals. Each graph individually checked to determine accuracy of automated method. Results: In all 320 traces the automated method correctly identified the presence of the RAIR, the start and finish point along with the baseline pressure and minimum pressure during the RAIR. Conclusion: With ever increasing number of channels employed in HRAM automated analysis is essential in order provide precise measurements in timely manner. This method has been shown to reliably identify and accurately measure temporal and pressure aspects of the RAIR in a large number of RAIR traces.

P011 Optimum measurements for passive and urge incontinence when using high resolution manometry J. Gosling, R. Cohen & A. Emmanuel University College London Hospital, London, UK Aim: To determine the optimum measurement to make using high resolution anal manometry (HRAM) in patients with passive and urge faecal incontinence. Method: 16 channel water perfused high resolution manometry setup was used to compare 40 female healthy volunteers with 22 female patients with faecal incontinence. A multitude of measurements were calculated during the resting and squeeze period and used to determine the optimum measurement to take for passive and urge incontinence respectively. Receiver operating characteristic was used to determine the optimum measurement. Results: The minimal anorectal pressure had the highest area under the ROC curve (0.74) for measurements taken during the resting period in passive incontinence. The squeeze increment had the highest area under the ROC curve (0.92) for measurements taken during the squeeze period in urge incontinence. Conclusion: The minimum anorectal pressure during the resting pressure and the squeeze increment during the squeeze period were the most accurate measurements for distinguishing passive and urge incontinent patients respectively from healthy volunteers when using HRAM. Although squeeze increment is commonly measured, the minimum anorectal pressure is not routinely calculated. This study suggests that this is a functionally important measure in passive incontinence.

ª 2016 The Authors Colorectal Disease ª 2016 The Association of Coloproctology of Great Britain and Ireland. 18 (Suppl. 1), 44–125

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Poster Abstracts P012 Functional consequences following low anterior resection (LAR) including bowel, voiding and sexual dysfunction: review of the literature B. Gys, N. Komen, L. De Valensart Schoenmaeckers, L. Blondeau, G. Hubens & S. Van den Broeck University Hospital Antwerp, Edegem, Belgium Aim: Functional complications following sphincter-preserving resection are underestimated. We aim to review the evidence for predisposing factors so patients can be informed about this late complication. Increasing knowledge will allow for better decision making concerning reconstruction of continuity or reconstruction of a colostomy after LAR. Method: Review of the literature was performed with emphasis on incidence, risk factors and treatments. Results: Bowel dysfunction (incl. low anterior resection syndrome) is encountered in 40–46% of all patients following LAR. Level 2 evidence exists stating preoperative radiation therapy, female sex, TME compared to PME, younger age at time of surgery and postoperative complications are risk factors. Reported treatments vary from medication, pelvic floor rehabilitation and feedback training with transanal irrigation to interventional Method (incl. surgery and neurostimulation). Approximately 33–51% of all patients develop (stress-) incontinence. Female sex is a risk factor for voiding dysfunction in general (level 3 evidence). Sexual dysfunction after LAR is seen in 39–76% of all patients. Preoperative ASA status ≥ III is the main risk factor (level 3 evidence). Symptomatic treatment is advised. Conclusion: Pro-active assessment of risk factors should be performed preoperatively in order to inform patients about the occurrence of these late complications and the treatment modalities.

P013 Integrated total pelvic floor ultrasound can serve as a screening tool prior to defaecatory MRI in women with pelvic floor defaecatory dysfunction A. Hainsworth1, S. Pilkington2, A. Schizas1, K. Nugent2 & A. Williams1 1 St Thomas’ Hospital, London, UK, 2University Hospital Southampton, Southampton, UK Aim: The accuracy of integrated total pelvic floor ultrasound (PFUSS) (transperineal, transvaginal, endoanal) for the detection of rectocoele, intussusception, enterocoele and cystocoele, compared to defaecatory MRI. Method: The dynamic images from 68 women (mean time between tests 4 months) who had undergone PFUSS and defaecation MRI for defaecatory dysfunction between 2009 and 2015 were blindly reviewed. The following were recorded; rectocoele (1 cm or over on ultrasound, 2 cm or over on MRI) intussusception (grade 3 or above), enterocoele (grade 1 to 3) and cystocoele (grade 1–3). Results: There were 26 rectocoeles on MRI (49 on ultrasound), 24 cases with intussusception on MRI (19 on ultrasound), 23 enterocoeles on MRI (24 on ultrasound) and 49 cystocoeles on MRI (35 on ultrasound). Accuracy (positive and negative predictive value) of PFUSS when compared to MRI; Rectocoele 47% and 78%, intussusception 79% and 80%, enterocoele 63% and 82%, cystocoele 91% and 48%. Conclusion: Integrated total pelvic floor ultrasound may be a useful screening tool for defaecatory dysfunction; when normal, defaecatory MRI can be avoided as rectocoele, intussusception and enterocoele are unlikely to be present. A cystocoele, and to a lesser extent intussusception seen on ultrasound, are likely to be seen on MRI.

P014 Posterior tibial nerve stimulation (PTNS) for faecal incontinence – does treatment affect anorectal physiology? J. Pearson1, N. Heywood1, J. Nicholson1,2, C. Molyneux1, W. Baraza1, K. Telford1 & A. Sharma1 1 University Hospital of South Manchester, Manchester, UK, 2East Lancashire Hospitals NHS Foundation Trust, Blackburn, UK

Results: Median age 62 yrs; 43 female. 26 (49.1%) had urge, 20 (37.7%) mixed and 7 (13.2%) had passive incontinence. Bowel diaries revealed a successful reduction in urge FI episodes (58.8%, P = 0.026), passive FI episodes (57.6%, P = 0.016) and urgency episodes (30%, P = 0.011). Vaizey score decreased post-treatment (16.1 vs 14.6, P = 0.005). Rectal sensations were significantly reduced: onset (40.5 ml vs 31.9 ml, P = 0.003), call (76.3 ml vs 57.1 ml, P < 0.001) and urge (105.3 ml vs 88.0 ml, P = 0.003). Following treatment there was no significant difference in anal canal pressures. There was however no correlation between successful treatment and change in rectal sensations. Conclusion: PTNS reduces FI episodes without an appreciable effect on anorectal pressures and has an unpredictable effect on rectal sensitivity suggesting a complex mechanism of action.

P015 Long-term outcome of constipation treated by sacral neuromodulation: youths versus adults P. T. J. Janssen, Y. Meyer, L. P. S. Stassen, N. D. Bouvy, J. Melenhorst & S. O. Breukink Maastricht University Medical Center, Maastricht, The Netherlands Aim: Sacral neuromodulation (SNM) is a relative new therapy in the treatment of constipation. Long-term results of SNM in the treatment of constipation in a single high-volume centre were compared between youths and adults. Method: All patients treated with SNM for constipation between 2004 and 2014 were evaluated. Primary endpoint was increased defecation frequency objectified by a 3-week bowel-habit-diary. Quality-of-life (QoL) was assessed using the ShortForm 36. Outcomes of youths (age 10–24 years) were compared to adults (≥25 years). Results: 180 patients were eligible for SNM-screening (73 youths, 107 adults) and 126 patients (62 youths, 64 adults) received permanent SNM. Mean age was 17.5 (10.4–23.4) years for youths and 47.0 (25.0–78.6) years for adults; mean follow-up was 32.2 (1.5–125.2) and 32.8(1.5–132.0) months respectively. Defecation frequency per 3 weeks increased from 6.9 (youths) and 7.9 (adults) at baseline to 17.2 (youths, P = 0.004) and 21.6 (adults, P < 0.001) after SNM. Increase was maintained up to 24 (youths, P = 0.037) and 12 months (adults, P = 0.037). Defecation frequency did not differ between youths and adults during follow-up. Regarding QoL, youths scored better on physical functioning than adults. Conclusion: This study shows no differences between youths and adults on longterm efficacy of SNM in the treatment of constipation.

P016 Is an enhanced recovery programme always indicated in colorectal surgery? H. Joshi, D. Hodge, A. Wheeler, K. Jaggs & P. Mathur Royal Free London NHS Trust, London, UK Aim: Enhanced Recovery Programmes (ERPs) in Colorectal Surgery aim to reduce length of post-operative hospital stay (LOS), whilst avoiding excess post-operative morbidity or mortality. This study was to identify factors associated with LOS of over 5 days. Method: A prospectively collated ERP database of patients undergoing major colorectal surgery from January 2007 to September 2014 was analysed for demographics, procedure, LOS and complications. Results: The database comprised 442 unselected patients (58% male). Median age was 66 years (range 21 to 95 years), Procedures were completed laparoscopically in 776% (conversion rate 14%) 73% of procedures were for cancers. Anastomotic leaks occurred in 13 cases (3% overall, 4.9% for anterior resections (AR)). There is no significant difference in overall LOS between Right Hemicolectomy and Anterior Resection. Median LOS for laparoscopic procedures was 5 days but 7 days for open cases (P = 0001). Defunctioning ileostomy was associated with increased LOS (P < 001). Median LOS for patients over 70 years was 7.5 days, and 4.5 days for those under 70 years (P < 0001). Conclusion: ERP has yielded favourable outcomes. Factors identified as associated with increased LOS were open resections, defunctioning ileostomy, post-operative complications, and patient age.

Aim: PTNS is a new treatment for patients with faecal incontinence (FI) and may be an effective treatment in selected patients; however its mechanism of action is unknown. We aimed to determine the effects of PTNS on physiological parameters. Method: 53 patients with FI underwent 30 minute PTNS treatment, weekly for 12 weeks. High-resolution anorectal manometry, bowel diaries and Vaizey questionnaires were performed before and after treatment. Successful treatment was determined as a greater than 50% reduction in episodes.

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ª 2016 The Authors Colorectal Disease ª 2016 The Association of Coloproctology of Great Britain and Ireland. 18 (Suppl. 1), 44–125

Poster Abstracts P017 Obstructed defecation and involvement of the enteric nervous system M. Kim1, N. Schlegel1, C. Isbert3 & M. Metzger2 1 Surgery I, University hospital Wuerzburg, Wuerzburg, Germany, 2Tissue Engineering and Regenerative Medicine, University Hospital Wuerzburg, Wuerzburg, Germany, 3Amalie Sieveking Hospital, Hamburg, Germany Aim: This experimental study is to elucidate the pathogenesis of obstructed defecation (OD) and the involvement of the autonomous enteric nervous System (ENS). Method: Full thickness rectal wall samples of patients with OD, who underwent STARR, were analysed and compared to controls. Differentiated gene expression analysis by high-throughput next generation sequencing, RT-qPCR, Western Blot, and immunohistochemical analysis were performed. In order to assign gene expression profiles to changes of biological processes, cellular components, ligand-receptor composition, and to genetic diseases, different biological libraries were used. Results: High-throughput next generation sequencing showed that genes associated with the ENS were significantly down-regulated in OD. Main neuronal associated biological processes, cellular compartments, and ligand-receptor interactions were significantly influenced. These results could be confirmed by RT-qPCR and Western Blot analysis. Conclusion: The ENS is significantly altered in patients with OD. These results indicate that OD may represent an enteric neuropathy, comparable to Hirschsprung disease and slow-transit constipation.

P018 Prevalence of gastrointestinal symptoms after low anterior resection S. Qiu, S. Mills, O. Warren, C. Kontovounisios, E. Tan & P. Tekkis Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London, London, UK Aim: To establish the prevalence of gastrointestinal functional symptoms after low anterior resection (LAR) and risk factors for developing these symptoms. Method: A systematic review of literature and meta-analysis of data. Weighted means were used to calculate the prevalence of symptoms. Results: Data from 4376 patients in 27 studies were included. The top 10 most common symptoms are incontinence to flatus (52.7%), Clustering of stool (48.8%), difficulty evacuating bowels (40.9%), unproductive call to defecation (40.3%), increased stool frequency (36.9%), urgency (31.3%), incontinence pad usage (29.8%), soiling (28.4%), straining (27.6%), and inability to discriminate between flatus and stool (22.3%). When the LAR syndrome score was recorded, 58.7% of patients had scores consistent with major risk factors for developing significant GI symptoms after LAR. These include lower tumour height, & anastomotic height, chemotherapy, and radiotherapy. Conclusion: GI symptoms are prevalent after LAR with significant proportion of patients affected. Patients should be consulted and informed regarding these symptoms prior to surgery. Management of these symptoms after surgery is an integral part of improving the quality of rectal cancer survivorship.

P019 Transanal irrigation as rehabilitative approach for patients with anterior resection syndrome J. Martellucci, A. Sturiale, C. Bergamini & A. Valeri Careggi University Hospital, Florence, Italy Aim: Transanal irrigation (TAI) has been reported to be a cheap and effective treatment for the anterior resection syndrome (ARS). This study aimed to evaluate its rehabilitative effect on symptoms and quality of life (QOL) improvement in patients suffering from ARS. Method: In a single centre prospective study, 13 patients (9 male; age 63 (29–79) years) were selected with LARS score as having major ARS and entered into the study. All patients were trained to perform TAI using the PeristeenTM System for 6 months. QOL was estimated by the SF-36. LARS score and MSKCC score were performed before treatment, at the end of the TAI period and after 12 months. Results: The median duration of ARS was 21(6–72) months. Three patients discontinued the treatment (2 for cancer recurrence and 1 for intolerance). The median volume of water used for the irrigation was 450 (300–1000) ml. There was a significant decrease in the number of daily defaecations (baseline 7[0–14]; last follow up 1 [1–2]). The LARS Score fell from 41 (33–42) baseline to 5 (0–21) after 6 months and 13 (5–39) after 12 months and four component of the SF-36 significantly improved. Conclusion: Transanal irrigation is an effective treatment of anterior resection syndrome and results in a marked improvement of the continence score and QOL.

P020 Internal rectal prolapse, an anatomo-functional study. Can we predict when to resect or suspend? L. Brusciano1, F. Messina2, P. Limongelli1, G. Del Genio1, S. Tolone1, J. Martellucci1, G. Docimo1 & L. Docimo1 1 XI Divisione di Chirurgia Generale e dell’Obesita. Master in Coloproctologia e Riabilitazione Pelviperineale. Seconda Universita di Napoli, Naples, Italy, 2 Dipartimento di Chirurgia. AUSL Ferrara, Ferrara, Italy Aim: To investigate whether there isany significant correlation between rectal wall thickness (RWT) and ano-rectal pressure (AP), in patients with obstructed defecation syndrome (ODS) caused by internal rectal prolapse. Method: An Observational case-control study was designed. We selected 55 patients with defeacography diagnosis of ODS caused by internal rectal prolapse and compared to 25 healthy volunteers from an analogous population. Clinical assessment was undertaken and a questionnaire completed. Patients and volunteers underwent to 3D Endorectal Ultrasound to measure RWT and High Resolution Anorectal Manometry to measure AP. Statistical analysis and correlation with Pearson linear correlation index were calculated. Results: Endorectal Ultrasound: 4 patients showed normal RWT (1.74 to 2.8 cm); 35 patients with RWT slight reduction (1.60 to 1.73 cm); 16 patients with RWT marked reduction ( 0.05). Conclusion: Robotic procedure may offer favorable results comparing laparoscopy regarding sphincter preservation and perioperative morbidity.

P163 Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in colorectal and appendiceal tumours B. Batman1, N. C. Arslan1, D. S. Uymaz2, Y. Iscan3, S. Bademler4, N. Omarov5 & O. Asoglu1 1 Department of General Surgery, Liv Hospital, Istanbul, Turkey, 2Department of General Surgery, Bakirkoy Sadi Konuk Training and Research Hospital, Istanbul, Turkey, 3Department of General Surgery, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey, 4Oncology Institute, Istanbul University Faculty of Medicine, Istanbul, Turkey, 5Department of General Surgery, Istanbul University Faculty of Medicine, Istanbul, Turkey Aim: We present the results of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in colorectal and appendiceal tumours including open and laparoscopic procedures. Method: A prospectively recorded database of 22 consecutive patients with peritoneal carcinomatosis (PC) of colorectal and appendiceal origin who underwent CRS and HIPEC between 2012 and 2015 was reviewed. The primary intent of surgery was complete radical resection of the whole tumour burden. Extent of the peritoneal disease was scored with peritoneal carcinomatosis index(PCI). After CRS, all patients received HIPEC at 42°C with closed abdominal technique. Results: Eight patients were female and 14 were male. Origin of PC was colon cancer in 13 patients, rectum cancer in 4 patients and mucinous appendix tumours 5 patients. Laparoscopic SRC and HIPEC was performed in 7 (31.8%) patients. Median PCI was 7 (2–27). Complete cytoreduction was achieved in all patients. Mean operative time was 432  191.5 minutes. Perioperative morbidity was seen in 6 (26%) patients. No perioperative mortality occurred. Eight (34.7%) patients had recurrent disease (4 exitus). During 11(1–30) months of median follow up overall and disease free survival rates are 81.8% and 60.8%. Conclusion: Our results are encouraging regarding laparoscopic approach to PC.

P164 Total pelvic exenteration with aggressive approaches for locally recurrent rectal cancer: composite bone resection, intraoperative radiotherapy and hyperthermic intraperitoneal chemotherapy B. Batman1, D. S. Uymaz2, Y. Iscan3, N. Omarov4, N. C. Arslan1 & O. Asoglu1 1 Department of General Surgery, Liv Hospital, Istanbul, Turkey, 2Department of General Surgery, Bakirkoy Sadi Konuk Training and Research Hospital, Istanbul, Turkey, 3Department of General Surgery, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey, 4Department of General Surgery, Istanbul University Faculty of Medicine, Istanbul, Turkey Aim: We present the operative and oncologic results of total pelvic exenteration (TPE) combined with composite bone resection, intraoperative radiotherapy (IORT) or hyperthermic intraperitoneal chemotherapy (HIPEC) in treatment of locally recurrent rectal cancer. Method: Data of the patients who underwent TPE in our institution were collected. Results: Between 2013 and 2016 9 patients underwent TPE. Mean 12.5 Gy IORT was performed in 4 cases. In 2 patients cytoreductive surgery and peritonectomies were performed to achieve R0 resection and these patients received HIPEC. Abdominoperineal resection and sacrectomy were required in 4 patients. One patient underwent right inferior pubic ramus. We did not have hospital mortality. One patient had pelvic abscess and 5 patients (%55) had minor complications including surgical site infection (3), prolonged ileus (1) and pleural effusion (1). During 15 (2–25) months of follow-up 2 patients are alive with disease at 25 and 15 months. Five patients (at 2, 12, 15, 15 and 25 months) are alive without disease and 1 patient died due to pneumonia at 8th month without any sign of recurrent disease. Conclusion: Aggressive surgery combined with IORT, HIPEC or bony pelvic resections can be performed with low morbidity, better local control and acceptable survival in selected patients.

P165 Quality of rectal cancer resection in a laparoscopic colorectal fellowship programme R. Brady, K. Carney, B. Griffiths, A. Horgan & H. Gallagher Colorectal Surgery Departments, Royal Victoria Infirmary and Freeman hospitals, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK Aim: The UK national laparoscopic colorectal fellowship training programme has been in place for almost a decade to train senior coloproctology trainees in laparoscopic colorectal resections. Little has been documented on outcomes of rectal cancer resections from within laparoscopic training programmes. Method: This retrospective study was conducted in a single contributing UK centre, and examined outcomes from fellow’s rectal cancer resections over a 3.5 year period (7 individual fellows). Data on 30-day mortality/morbidity, complications,

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Poster Abstracts discharge timing, CRM/DRM positivity, node count, stoma placement and reversal were recorded. Results: 58 laparoscopic rectal resections for cancer were identified (17 high, 24 low, 3 ultra-low anterior resections, 10 APRs and 4 Hartmann’s). There were 2 (3.4%) open conversions. 27/44 (52%) anterior resections were defunctioned. 3/56 (5.1%) were CRM positive, of which 1 (1.8%) patient was DRM positive (0.5 mm). The average number of lymph nodes harvested was 20.5 nodes. 8/58 (13.7%) had less than 12 nodes harvested; 75% of these had undergone pre-op long course chemoradiotherapy. 21/58 (36%) had 30 day morbidity; 5/44 (8.6%) had an anastomotic leak/pelvic sepsis. 9 (15.1%) patients required return to theatre. There was no 30-day mortality. Conclusion: Good outcomes are achievable from laparoscopic rectal cancer resections within a formal fellowship programme.

P166 Newly appointed consultants can accomplish national standards in elective colorectal cancer resections despite a poorer patient prognostic group D. Browning1, S. Mills1, E. Tan1,2, C. Kontovounisios1,2, P. Tekkis1,2 & O. Warren1,2 1 Chelsea and Westminster Hospitals NHS Foundation Trust, London, UK, 2Imperial College London, London, UK This abstract has been previously published.

P167 Pathological gold standards can be achieved despite a poorer prognostic patient group. A central london teaching hospital experience D. Browning1, S. Mills1, E. Tan1,2, C. Kontovounisios1,2, P. Tekkis1,2 & O. Warren1,2 1 Chelsea and Westminster Hospitals NHS Foundation Trust, London, UK, 2Imperial College London, London, UK This abstract has been previously published.

P168 Colorectal cancer screening initiation coincides with a dramatic increase in malignant polyp incidence T. Buchbjerg1, R. Krøijer2 & G. Baatrup2 1 Sydvestjysk Hospital, Esbjerg, Denmark, 2Odensen University Hospital, Svendborg, Denmark Aim: To investigate the incidence and treatment of colorectal polyp adenocarcinomas before and after screening initiation in March 2014 in a single Danish center. Method: 70 patients with malignant colorectal polyps in a single center from 2012 to 2015 were reported retrospectively. Results: There was a significant increase (P = 0.0003) in incidence of colorectal polyp adenocarcinoma from 2012–2013 to 2014–2015 (6 vs 64) relative to the increase in colonoscopies with polypectomy (1029 vs 2614). It coincides with the initiation of screening in March 2014, but only 45% (29/64) of malignant polyps were screening patients. 94% (60/64) of the polyps in 2014–2015 were incidental cancers removed with simple snare polypectomy. 57% (36/64) had unclear resection margins and this was the primary indication for surgery. 50% (32/64) underwent additional surgery with 28 bowelresections and 4 transanal endoscopic microsurgery (TEM). 19% (6/32) had remaining cancer at either the polypsite or as lymphnode metastasis. Conclusion: Malignant colorectal polyps have become dramatically more frequent after the initiation of screening. The primary but modifiable indicator for surgery is unclear resection margin and 1 in 5 operated has remaining cancer.

P169 The effect of preoperative radiotherapy for rectal cancer on ovarian function and sexual desire – a prospective cohort study € k4 & J. Segelman1, C. Buchli2, M. Machado1, P. Matthiessen3, O. Hallb€ oo A. Martling2 1 Ersta Hospital, Stockholm, Sweden, 2Department of Molecular Medicine and Surgery, Karolinska Institutet, and Karolinska University Hospital, Stockholm, € € University, Orebro, Sweden, 4Department Sweden, 3Department of Surgery, Orebro of Surgery, Link€oping University, Link€oping, Sweden

Method: A prospective cohort study including women with rectal cancer stage IIII. Follow-up one year. Serial measurements: blood hormone assays and questionnaires (gender, sexual function index and psychological general well-being). Differences in testosterone levels over time between women treated with and without radiotherapy were analysed with longitudinal regression analysis, adjusted for confounding factors. The association between testosterone and sexual desire was quantified with multivariable analysis. Results: 84 women were treated with radiotherapy and 25 were not. Menopause followed radiotherapy in 10 of 12 premenopausal women (P = 0.002). Mean serum testosterone in women not treated with radiotherapy was 0.58 (0.26 SD) nmol/L at baseline compared with 0.63 (0.34 SD) nmol/L one year postoperatively. The corresponding figures for women treated with radiotherapy were 0.72 (0.48 SD) and 0.57 (0.33 SD). The alteration in serum testosterone over time differed significantly between the two groups (P = 0.003). Decreased levels were associated with reduced desire (P = 0.042). Conclusion: Preoperative radiotherapy for rectal cancer induced menopause and impaired ovarian testosterone production. Decreased testosterone was associated with reduced sexual desire. Adequate information and rehabilitation should be offered.

P170 Increased use of advanced polypectomy as primary treatment of colorectal cancers M. M. Buijs1, C.-P. Rancinger1, I. Al-Najami1,2, R. Eckardt2, M. KobaekLarsen1 & G. Baatrup1,2 1 Institute of Clinical Research, University of Southern Denmark, Odense, Denmark, 2 Department of Surgery, Odense University Hospital, Svendborg, Denmark Aim: To evaluate trends in colonoscopy activity and endoscopic treatment of colorectal cancers in our center prior to the implementation of cancer screening. Method: Data were prospectively collected from 2008 to 2013 in a local database, the electronic patient files and the National Database. Results: Colonoscopy activity increased from 3752 to 5543 colonoscopies per year (48%). 36% more cancers were detected (374 vs 509), but the frequency per colonoscopy decreased (10.0% to 9.2%). The frequency of simple polypectomies also decreased (25.7% to 15.5%), however advanced polypectomies were increasingly used as primary treatment (2.7% vs 1.0%). Cancer was detected in 0.7% of cases (36/ 5483) after simple polypectomy and in 10.2% (65/637) after advanced polypectomy. Cancer patients treated with advanced polypectomy had higher ASA scores (2.09 vs 1.87 (P < 0.05)) and increased age (74.8 vs 71.1 (P = 0.05)) compared to patients treated with major surgery. Conclusion: Prior to the implementation of colorectal screening the awareness of CRC in the general population increased, due to advertisements and pilot studies, resulting in an almost 50% increase in colonoscopy activity. Advanced polypectomy was increasingly used as primary treatment, mainly in patients unfit for surgery this suboptimal oncologic treatment was accepted as a compromise.

P171 Clostridium difficile infection and colorectal surgery: is there any risk? V. Calu1,2 & A. Miron1,2 1 Elias Emeregency University Hospital, Bucharest, Romania, 2University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Aim: Clostridium difficile infection is a common problem nowadays in all surgical departments. The consequences are sometimes severe from medical, financial and legal points of view. The literature is scarce in showing if there is any relationship between C.difficile infection and anastomotic fistula in colorectal surgery. Method: We studied retrospectively all the patients operated for colorectal cancer in our department between 1st of January 2012 and 31st of December 2013, 360 cases, 242 patients operated for colon cancer and 118 patients for rectal cancer. Results: There were 19 cases for anastomotic fistulas (6% of all anastomoses) and 28 cases with C. difficile infection in the studied group. 13 cases with anastomotic fistula had C. difficile infection (P < 0,001), with a mortality rate of 38, 46%. Grade B and C were more frequent in this subgroup, with a higher mortality rate, an increased reoperation rate and worse prognosis. Conclusion: There seems to be that Clostridium difficile infection can be a risk factor for anastomotic fistula in colorectal surgery with a poor outcome. Further multicentric studies are needed to assess this problem worldwide.

Aim: The aim was to examine the effect of preoperative radiotherapy for rectal cancer on ovarian function and sexual desire.

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Poster Abstracts P172 An audit of referrals to the Newcastle Anal Cancer Multidisciplinary Team from 2009–2015 K. Carney, P. Coyne, S. Plusa & B. Griffiths Royal Victoria Infirmary, Newcastle, UK Aim: To provide an overview of anal cancer referrals to the Royal Victoria Infirmary (RVI) from 2009–2015, their management and outcomes. Method: Retrospective analysis of referrals to the RVI Anal Cancer MDT from 2009 to 2015. Results: 289 referrals made during the study period, with an average of 41 referrals per year. A 2:1 ratio of female:male patients with an average age of 62 years. 2.4% were HIV positive. 79% were squamous cell carcinomas (SCC), 8% AIN II or III, 5% other lesions included basal cell carcinoma, melanoma and Paget’s. 8% had missing data. 67% (154) had chemo-radiation with 16% (24) developing a recurrence of disease within 5 years of treatment. Three patients were treated with a salvage APER for this recurrence, the remainder being treated with palliative intent. 7% had radical radiotherapy and subsequent APER in 2 cases. Of those treated with radical radiotherapy, 27% developed a recurrence, and only 1 deemed suitable for salvage APER. 1% had a primary APER, 2 of which developed recurrence. 7% had palliative treatment and 2% had best supportive care. Overall mortality was 2%. Conclusion: The natural history and management of anal cancer in this region is similar to the national experience. Workload associated with this group is predominantly clinical rather than operative.

P173 Comparison of the results of patients who underwent open and laparoscopic resection because of rectal cancer F. Cengiz, E. Kamer, T. Acar, E. Durak, K. Atahan, S. C. Celik & M. Haciyanli Izmir Katip Celebi University Ataturk Training And Research Hospital, Izmir, Turkey Aim: In this study, we compared the short-term results of patients who were operated on by laparoscopic or open surgery method for colorectal cancer. Method: Patients who were operated by the laparoscopic or open surgery for rectal cancer between January 2014 and December 2015 were retrospectively analysed. We compared patient characteristics, operative findings, histopathologic findings, postoperative complications and mortality rates. Results: 133 patients were operated (44 patients with laparoscopic and 89 patients with open surgery). There is no statistical difference between the groups on sex, age and additional disease distribution(P > 0.05). According to distribution of rectal cancer location, TNM staging had no significant difference between groups. Post operative management (oral feeding and hospital discharge criteria) were identical for each group. There was no difference between the groups in the short term oncological results (number of dissected lymph nodes, circumferential and distal surgical margins). Conclusion: In rectal cancer, laparoscopic method safely may be used similarly to open surgery. Laparoscopy is seen more advantageous than open surgery method because it has same oncologic results with minimally invasive technics.

P174 Our synchronous colorectal tumour cases F. Cengiz, E. Kamer, T. Acar, N. Acar, S. Karaisli, K. Atahan & M. Haciyanli Izmir Katip Celebi University Ataturk Training And Research Hospital, Izmir, Turkey Aim: Any organ of the gastrointestinal tract is known that developing multiple malignancies. In patients with colorectal tumours, secondary tumour incidence ranges from 2 to 9%. In this study, we present synchronous colorectal tumours that we operated in the last two years. Method: Between January 2014 and December 2015, 384 patients who were operated in our clinic for colorectal tumours were examined and 11 patients with synchronous tumours evaluated via literature review. Results: Six (55%) of the patients were men and average age was 68.4 (54–83). 2 (18%) patients were treated by laparoscopic surgical technique. One patient was operated urgently because of ileus. Synchronous tumours were detected in 8 patients intraoperatively. In all cases, wide resection was performed to encompass both tumours. In 4 patients (36.4%) postoperative complications developed and the most common was intestinal obstruction/ileus. Conclusion: The preoperative diagnosis of the synchronous colon cancer is extremely important because it changes the surgical procedure. In the literature, two separated resections and two anastomosis or subtotal colectomy and single anastomosis were reported with level of evidence equally.

P175 Prognostic value of local peritoneal involvement according to Sheperd´s clasification in colon cancer patients  GarcıaC. Cerda´n1, B. Arencibia2, F. Giner1, M. Frasson1, G. Baguena3, A. Granero1 & E. Garcıa-Granero1 1 Hospital Universitario y Politecnico la Fe. Universidad de Valencia, Valencia, Spain, 2 Hospital Universitario de Gran Canaria Doctor Negrın, Gran Canaria, Spain, 3 Hospital de la Ribera, Alzira, Valencia, Spain Aim: To determine if the grade of peritoneal involvement (classified according to Sheperd) is associated to oncologic results in advanced colon cancers. Method: Retrospective analysis of a prospectively maintained institutional database of colon cancer patients (1993–2015). pT3 and pT4a colon cancer patients were included for analysis. Specimens were re-evaluated by a specialist pathologist and colorectal surgeon in order to establish the grade of peritoneal involvement according to Sheperd Classification. Shepherd classified peritoneal involvement as follows Grade 1: absence of serosal involvement; Grade 2: inflammatory component but no tumour affecting the serosa; Grade 3: serosal invasion. Grade 4: serosal ulceration. The association between local peritoneal involvement and oncological outcomes (local recurrence, carcinomatosis, disease free survival and overall survival) was analysed by multivariate Cox Regression including tumour stage and grade, and adjuvant treatment. Results: 717 patients with pT3-T4aM0 colon cancer were included. Distribution according Shepherd´s clasification was: 274 Grade 1 (38%), 258 Grade 2 (36%), 124 Grade3 (17%) and 61 Grade 4 (8.5%). At multivariate analysis, the grade of peritoneal involvement was not an independent risk factors for oncologic outcome (P > 0.36). Conclusion: Local peritoneal involvement has no prognostic significance after curative resection ofadvanced colon cancer.

P176 Validation of proposed scoring model for predicting survival in stage IV colorectal cancer patients W. J. H. Tan1, S. R. Dorajoo2, M. Y. H. Chee3, F. J. Foo1, W. S. Tan1, M. H. Chew1 & C. L. Tang1 1 Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore, 2Department of Pharmacy, National University of Singapore, Singapore, Singapore, 3Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore Aim: Stage IV colorectal cancer patients experience heterogeneous survival; prognosis may affect treatment. We aim to validate our previously proposed scoring model for predicting survival following primary tumour resection in stage IV colorectal cancer patients with unresectable metastases in a recent cohort of patients. Method: Survival data was collected from all newly diagnosed stage IV colorectal cancer patients between January 2008 and December 2014 (n = 324). Patients were stratified based on the model into good, moderate and poor survivors. Kaplan-Meier estimation of survival was performed based on the prognostic group. Results: 324 patients were included. Median age 63.1 (32–94) years, 50.5% male 49.5% female. 68.1% had liver metastasis, 28.0% peritoneal carcinomatosis, 26.9% lung metastasis. Other metastatic sites include ovary, bone and brain. Median survival duration for all patients was 24.4 (4.1–83.5) months. 72% underwent elective primary tumour resection, 33% diversion, 4% did not undergo surgery. Using the simplified scoring table, patients were separated into poor (17%), moderate (59%) and good (23%) survivor groups. At 36 months, survival rates for poor, moderate and good groups were 3%, 13% and 25% respectively (P = 0.0008). Conclusion: Our proposed scoring model accurately predicts survival in stage IV colorectal cancer patients and is a useful prognostic tool to guide clinical decisionmaking.

P177 A proposed prognostic scoring model for stage IV colorectal cancer patients W. J. H. Tan1, S. R. Dorajoo2, M. Y. M. Chee3, F. J. Foo1, W. S. Tan1, M. H. Chew1 & C. L. Tang1 1 Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore, 2Department of Pharmacy, National University of Singapore, Singapore, Singapore, 3Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore Aim: We aim to develop a scoring model to predict survival of stage IV colorectal cancer patients based on a recent cohort of patients treated with recent chemotherapy regimes. Method: Survival data was collected from all stage IV colorectal cancer patients between January 2008 and December 2014 (n = 315). Coefficients of significant covariates from the multivariate Cox regression model were used to compute individual survival scores to classify patients into three prognostic groups (poor,

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Poster Abstracts moderate, good). Survival functions were derived for each group via Kaplan-Meier estimation. Internal validation was performed. Results: Median age 63.1 (32–94) years, 50.5% male 49.5% female. Median survival duration for all patients was 24.4 (4.1–83.5) months. Right-sided tumour (hazard ratio, HR 2.31 (1.49–3.57)); poorly-differentiated/undifferentiated tumour (HR 2.60 (1.43–4.73)); bilobar liver metastasis (HR 2.42 (1.57–3.71)) and hypoalbuminaemia (HR 0.95 (0.92–0.99) were shown to significantly shorten survival. The model separated patients into three prognostic groups with distinct median survival of 9, 22 and 49 months. Internal validation revealed concordance probability estimate of 0.69 and time-dependent area under receiver-operating-curve of 0.76, 0.73, 0, 72 at 12, 24, and 36 months post-resection, respectively. Conclusion: The proposed scoring model reliably predicts survival in stage IV colorectal cancer patients. Model-based survival prognostication may be useful to support clinical decision-making.

Results: Total 380 cases including 177 HNPCC and 203 HNPCC-like cases (lacking one A-II criterion) patients were analysed. Overall, 63.3% HNPCC and 16.3% HNPCC-like cases demonstrated loss of MMR protein (dMMR). dMMR patients had larger-sized tumours (28 cm2 vs. 18 cm2, P < 0.0001), deeper (T4) tumour invasion (40.7% vs. 29.0%, P < 0.0173), a lower rate of LN involvement (N0, 31.0% vs. 48.5%, P = 0.0034), and fewer distant metastases (M0, 8.3% vs. 15.3%, P = 0.0447). Significantly superior DFS (P = 0.0132) and OS (P = 0.0104) were observed in dMMR patients. Significantly different rates of secondary CRC observed among different subgroups ranged from 3.28 to 37.78 person-years. The dMMR/HNPCC-like group also had significantly more male patients (72.7% vs. 43.8%, P = 0.0481) and a higher rate of poor differentiation (42.4% vs. 22.9%, P < 0.0001). Conclusion: Using combined MMR expression status and A-II C, we stratified patients into four subgroups with distinct clinicopathological features.

P178 Laparoscopic surgery vs. open surgery in elderly patients with colorectal cancer I. Chernikovskiy, V. Gelfond, A. Zagryadskih & S. Savchuk St. Petersburg Cancer Center, St. Petrsburg, Russia

P181 Circulating stem cells in colorectal cancer: new tools and potential therapeutic targets L. Colace1, F. L. Torre1, F. Francescangeli2, M. L. De Angelis2, P. Contavalli4, V. D’Andrea1, R. De Maria3 & A. Zeuner2 1 Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy, 2 Department of Hematology, Oncology and Molecular Medicine, Istituto Superiore di Sanita, Rome, Italy, 3Department of General Pathology, A. Gemelli Hospital, Catholic University of the Sacred Heart, Rome, Italy, 4Catholic University of the Sacred Heart, Rome, Italy

Aim: The place of laparoscopic radical surgery in elderly patients with colorectal cancer is still being studied. Method: 106 patients older than 75 years with colorectal cancer were divided into 2 groups: 66 patients underwent traditional surgery and 40 laparoscopic surgery. Results: The average duration of operation in laparoscopic group was 127 minutes vs. 146 minutes. Intraoperative blood loss was 167 ml vs. 109 ml respectively (P = 0.36). The quality of lymph node dissection did not differ significantly. The average hospital stay was not significantly lower in the laparoscopic group (P = 0.43). Complications occurred in both groups with the same frequency (13.6% vs. 15.0%), which did not exceed the average in the other age groups. Median follow-up was 16 months (6 - 30 months). The number of deaths among patients operated traditionally was twice more than in the laparoscopic group. However, the differences did not reach statistical significance. Conclusion: Both groups are comparable, but there was a tendency to increasing of mortality in the long term from non-colorectal cancer causes and as a result, reducing overall survival among elderly patients who were operated in traditional way.

P179 Transanal endoscopic microsurgery for rectal cancer S. Chernyshov, O. Maynovskaya, E. Rybakov & Y. Shelygin State Scientific Centre of Coloproctology, Moscow, Russia Aim: Transanal endoscopic microsurgery (TEM/TEO) is a method of choice for large rectal adenomas and selected early rectal carcinomas. This prospective study presents experience of TEM in single center. Method: Preoperative work-up included: proctoscopy with biopsy, colonoscopy, EUS, pelvic MRI, CEA. Results: Sixty five patients at mean age of 65.1  12.4 (31–85) had TEM/TEO. The mean size of tumours was 2.5  1.0 (1.5–4.0) cm. Mean distance from anal verge was 6.0  2.5 (3.0–14.0) cm. Preoperative biopsy revealed adenocarcinoma in all cases. The median operating time was 35 (20–140) min. There was no fragmentation of surgical specimens. R0 excision was obtained in 63/65 (97%) cases, 2/65 (3%) specimens had positive lateral margins. Morbidity was 1/65 (1.5%). Pathological investigation revealed: adenocarcinoma stage pTis 16/65 (25%) cases, pT1 in 32/ 65 (49%): SM1 - 11/65, SM2 – 5/65, SM3 – 16/65. Adenocarcinoma pT2 in 12/ 65 (18%), pT3 in 5/65 (8%). One patient with pT1SM3 and all cases with pT2, pT3 salvaged by radical resections (TME). At median follow-up of 26 (1–48) months, there were no recurrences. Conclusion: TEM/TEO for early rectal carcinomas is associated with low morbidity and low recurrent rate. If deep tumour invasion is found in surgical specimen, the TME should be done for salvage.

P180 A distinct subgroup of Lynch syndrome presenting with male predominance and an extremely high rate of poorly differentiated adenocarcinoma J. M. Chiang, S.-F. Chiang, J.-F. You & H.-Y. Huang Chang Gung Memorial Hospital, Taipei, Taiwan

Aim: Circulating tumour cells (CTCs) are responsible for tumour dissemination. However, low numbers and scarce propensity to expand have hampered the molecular characterization of CTCs in colorectal cancer (CRC) and the identification of cancer stem cells (CSCs) among CTCs. Taking advantage of a new in vivo model of CTC generation, we analysed colorectal CTCs with specific focus on CSCsrelated features. Method: CRC cells derived from surgical specimens are infected with lentiviral particles containing a luciferase-GFP reporter and injected orthotopically into the cecal wall of immunecompromised mice to generate patient-derived xenografts (PDX). Following the appearance of liver metastases, blood is collected via cardiac puncture to isolate CTCs and both metastases and primary tumours are harvested for subsequent analyses. Results: PDX-derived CTCs (PDCs) exhibit stem cell features, being able to generate organoids in vitro and secondary tumours in vivo and contain a subpopulation of cells expressing markers of CSC and/or metastatic cells. Gene expression and proteomic analyses reveal significant differences in pathway activation in PDCs as compared to primary tumour and metastasis-derived cells. Conclusion: Recapitulating the process of CTCs dissemination with primary tumour cells offers an unprecedented opportunity to explore the mechanisms of metastasis formation and to identify new potential therapeutic targets.

P182 Oncologic outcomes of harvested >12 lymph nodes after curative resection of stage II-III rectal cancer and other characteristics affecting the survival E. Colak Samsun Training and Research Hospital, Samsun, Turkey Aim: To identify factors affecting the survival after curative resection of stage II-III rectal cancer (RC) and to investigate the association between examining >12 harvested lymph nodes (hLNs). Method: Retrospective analysis of rectal cancer operations from 2008 to 2013 identified all stage II-III rectal cancer patients who underwent curative resection. The clinicopathological features analysed included the patients’ gender, age, tumour size, AJCC stage, depth of invasion, numbers of hLNs, positive hLNs, vascular invasion, perineural invasion, tumour histology and neoadjuvant- adjuvant theraphy. Results: With a median follow-up of 35 months, the 3-year OS and relapsefree survival were 67.5% [95% confidence interval: 59.5% to 75.6%] and 71.9% [95% confidence interval: 64.1% to 79.8%] respectively for the 99 patients. Positive hLNs, perineural invasion, T4 invasive depth, neoadjuvant chemoradiotheraphy (NCRT) and stage IIIC disease independently influenced OS.There was no an association between >12 hLNs and survival rates of in stage II-III RC. Conclusion: This study demonstrated that the number of hLNs had no impact on survival whereas increased positive hLNs was a significantly prognostic indicator for worse survival. The paucity of nonmetastatic hLNs in stage II-III rectal cancer did not imply poor oncologic outcomes.

Aim: We investigated the clinicopathological findings of different subgroups of colorectal cancer (CRC) related to family history and MMR gene expression. Method: Immunohistochemistry was used to detect MMR genes expressions, and the Cox proportional hazard model, to investigate the effect of the A-II C and MMR status on survival and clinicopathological factors.

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Poster Abstracts P183 Colostomy creation in case of colorectal cancer with acute mechanical obstruction or before starting neo-adjuvant treatment in case of rectal cancer. Is loop colostomy a better stoma than an end colostomy? A. C. Marinez1, J. Grenabo2 & E. Angenete3 1 Sahlgrenska University Hospital, Gothenburg, Sweden, 2Kung€alv Hospital, Kung€alv, Sweden, 3SSORG, Gothenburg, Sweden Aim: About 20% of the patients with colorectal cancer present as emergency bowel obstruction. In some cases rectal cancer patients need a diverting colostomy prior neo-adjuvant treatment. It is not well studied if there are any differences regarding complications and stoma function between a loop colostomy or end colostomy. Method: All patients who underwent surgery due to cancer in the left side of the colon or in the rectum between 2011 and 2015 at Sahlgrenska University Hospital were identified. All who only received a stoma for emergency decompression or before start of neo-adjuvant treatment were included. Surgical charts and stoma care nurses’ notes were analysed. Endpoint: complications at 90 days postoperatively. Results: Out of 547 patients 91 recived a stoma due to bowel obstruction or before neo-adjuvant treatment. 77/91(85%) end colostomy, 13/91(14%) loop colostomy and 1/91(1%) split. 36/91 suffered a postoperative complication. There were less complications in the group that had a loop/split than in the end colostomy group. There were no differences in stoma complications. Conclusion: End colostomies had more postoperative complications than the loopcolostomies but the type of stoma didn’t affect stoma complications. A larger material is required to fully evaluate if a loop colostomy is better than an end colostomy.

P184 Prospective European study to identify predictive markers of rectal carcinomas for response to neoadjuvant chemoradiation by proteomic analysis R. Croner1, M. Metodiev2, B. Lausen3 & K. Matzel1 1 Department of Surgery, University Hospital Erlangen, Erlangen, Germany, 2School of Biological Sciences/Proteomics Unit, University of Essex, Colchester, UK, 3 Department of Mathematical Sciences, University of Essex, Colchester, UK Aim: Neoadjuvant chemoradiation (nCRT) is an established procedure in stage UICC II/III rectal carcinomas. If reliable selection markers would exist poor responders could be identified prior to treatment. Method: During a national pilot project tumour biopsies were harvested from patients with rectal carcinomas prior to nCRT. Patients received standardised nCRT with 5-FU (nCRT I) or 5-FU  Oxaliplatin (nCRT II) according to the CAO/ ARO/AIO-04 protocol. After surgery regression grading (Dworak) of the tumours was analysed and differences in expressed proteins between poor and good responders to nCRT I and II were identified by proteomic analysis. Results: We identified 138 differentially regulated proteins regarding the response to nCRT. Fourteen of these proteins were synchronously up-regulated at least 1.5 fold after nCRT I or nCRT II. Thirty-five proteins showed a complete reciprocal regulation (up or down) after nCRT I or nCRT II and the rest was regulated either after nCRT I or II. Conclusion: We established a valid protocol to identify predictive proteomic markers for nCRT. But our findings need to be reproduced and validated on a bigger prospective cohort first. Therefore we plan an international European study including our current experiences and scientific network.

P185 Skeletal muscle loss during neoadjuvant therapy negatively impacts on prognosis in patients with locally advanced low rectal cancer P. De Nardi1, N. Pecorelli1, D. Chiari1, M. Salandini1, G. Cristel1, A. Damascelli1, F. De Cobelli1,2 & M. Braga1,2 1 San Raffaele Scientific Institute, Milan, Italy, 2Vita-Salute University, Milan, Italy Aim: Skeletal muscle loss (SML) has been recognised as a negative prognostic factor in several malignancies. Aim of the present study is to determine the relationship between muscle mass variation during neoadjuvant chemoradiation (nCRT) and tumour regression grade (TRG) and oncological outcome, in patients with locally advanced low rectal cancer. Method: 52 patients with clinical stage T ≥ 3 or N+ rectal cancer, who underwent nCRT and surgical resection were studied. Total abdominal muscular area was measured by computed tomography at the level of the third lumbar vertebra, before and after nCRT. TRG, and disease-free survival (DFS) were assessed. Survival curves were compared by the Kaplan-Meier method, and the correlations between categorical variables were obtained with Pearson’s v2 test. Results: Nineteen (36%) patients had a SML> 2% after nCRT. In this subgroup high TRG occurred only in 31.8% of patients compared to 68.2% in patients with no SML after nCRT (P = 0.09). After a mean 60-month follow-up (range 20–93) all patients are alive. SML after nCRT correlated with a shorter DFS both in the overall population (P = 0.06) and in the 38 N0 patients (P = 0.05).

Conclusion: SML after nCRT is associated to poor TRG and negatively impacts on DFS in rectal cancer patients.

P186 Differences in managing a ‘significant polyp’ which may harbour a cancer detected at bowel screening or in symptomatic patients: the significant polyp and early colorectal cancer (SPECC) program initial findings F. Di Fabio1, M. Dattani1, S. T. Ward2, P. McCullough2, F. Soliman3, A. Cunningham3, A. Maw3, N. Suggett4, D. Edwards5 & B. Moran1 1 Basingstoke North Hampshire Hospital, Basingstoke, UK, 2University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK, 3Glan Clywd Hospital, Rhyl, UK, 4University Hospital Birmingham NHS Trust, Birmingham, UK, 5Frimley Health NHS Foundation Trust, Frimley, UK Aim: The benign to malignant polyp spectrum has been developed into a concept ‘SignificantPolypEarlyColorectalCancer’ (SPECC) with an English national MDT development program to improve diagnosis and treatment. The management of SPECC lesions within the Bowel Cancer Screening Programme (BCSP) compared with SPECC presenting in symptomatic patients (SP) is reported. Method: The management and outcome of all SPECC lesions, defined as sessile/ flat polyps greater than 20 mm in size, diagnosed on endoscopy in a twelve-month period (2014) at 5 hospitals in England. Results: One-hundred-sixty-three SPECC lesions were treated, 38(23%) in BSCP and 125(77%) in SP (median age 70 yr; male 61%). BCSP patients compared with SP were younger (median 65 vs. 72 years, P = 0.0005), less frequently had polyp biopsy (32% vs. 56%, P = 0.008), tendency toward smaller detected polyps (median 25 vs. 30 mm, P = 0.36), higher proportion of endoscopic resection (87% vs. 68%, P = 0.047), tendency toward lower surgical resection rate (16% vs. 23%, P = 0.36), higher proportion of high-grade dysplasia/adenocarcinoma at histology (44% vs. 21%, P = 0.007), and a tendency toward lower polyp recurrence rate after endoscopic excision compared to SP (17% vs. 23%, P = 0.54). Conclusion: Differences in management and outcome of a SPECC in the BCSP compared with SP suggests areas for development and improvement.

P187 Surgical manipulation increases number of circulating tumour cells (CTCs) during TME and the first postoperative week G. Dimofte1,2, D. Scripcariu1,2 & S. Lunca1,2 1 University of Medicine and Pharmacy ‘Gr. T. Popa’, Iasi, Romania, 2Regional Institute of Oncology, Iasi, Romania Aim: To evaluate the dynamics of circulating tumour cells (CTCs) during abdominal dissection for open rectal cancer surgery and the persistence of CTCs in circulation one week after surgical resection. Method: 10 consecutive patients with stage III rectal cancer were evaluated in a pilot study, 8 weeks after completion of chemoradiation. All patients had TME performed as open surgery, either LAR or ELAPE. CTCs were collected using an imporved GILUPI Cell Collector, with 4 cm harvesting tip. Cells were collected within 30 minutes at 3 time points: 24 hours before surgery, after TME completion and 7 days after surgery. Results: The mean number of CTCs increases after full surgical dissection, with a mean of 2.0 CTCs (range 0–12) as compared with preoperative samples 1.4 CTCs (range 0–6), but no statistical significance was reached in this pilot study. CTCs collection drops 7 days postoperative in all but one case to levels similar or bellow preoperative range. In one case a large number of CTCs were found 7 days postoperatively, without clinical correlation. Conclusion: Surgical manipulation during open rectal cancer surgery increases the number of CTCs, but capture results are not consistant and require better cell characterization.

P188 Early experiences with robotic right colectomy with intracorporeal anastomosis N. Dohrn, J. Olsen & M. Klein Herlev University Hospital, Copenhagen, Denmark Aim: Robotic right colectomy (RRC) is performed with either an extracorporeal anastomosis or an intracorporeal anastomosis (ICA). The advantages of ICA are: a short Pfannenstiel incision for specimen extraction and lesser bowel manipulation with resulting lesser postoperative pain, shorter time to first bowel movement, and shorter length of stay. The disadvantage is a greater technical difficulty with the need of laparoscopic suturing. Robotic surgery has made the ICA technique significantly more accessible and the purpose of this study was to evaluate the feasibility and safety and to describe our early experiences.

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Poster Abstracts Method: A descriptive study of the first series of patients undergoing RRC with ICA at our institution. Demographic-, operative- and 30-day-postoperative- data were collected from medical records. Results: In total 10 patients had RRC with ICA. Median operating time was 159 (137–264) minutes and median number of harvested lymph nodes was 37(28–47). Median number of days until first bowel movement was 2(2–5) and median length of stay were 7(2–44) days. Only one patient had adverse outcomes; obstructive ileus, which required reoperation. Conclusion: RRC with ICA is feasible and safe. Randomised clinical trials are needed to evaluate the potential advantages and we are in the process of this.

P189 ‘Watch and wait’ for rectal cancer- a systematic review D. Donato-Brown1, C. Bryant2,1, S. Haque1 & C. Chan1 1 The Royal London Hospital, London, UK, 2Homerton University Hospital, London, UK Aim: Advancements in neo-adjuvant therapy for rectal cancer have lead to the increasing adoption of a ‘watch and wait’ approach. The aim of this study was to review current published evidence and report on the complete clinical (cCR) and pathological response (cPR) rate and longer term survival. Method: Based on PRISMA guidelines, a systematic review of electronic databases was undertaken to determine the proportion of cases that demonstrate cCR and longer survival. This also includes loco-regional and systemic recurrence rates. Results: A total of 9 studies were selected and suitable for analysis. The median study population was 47 and median cCR of 75% was demonstrated at completion of study (median 32 months, range 23–57). The mean 5 year disease-free survival was 85% with 92% overall disease survival. There appears to be an over 90% salvage success rate for loco-regional recurrence. Conclusion: Oncological organ-preserving strategies are still a relatively novel concept. Further research into tumour biology and behaviour is critical to our future understanding and identification of patients who would benefit from a ‘watch and wait’ policy.

P190 Emergency surgery versus self-expandable metallic stent placement for acute malignant colorectal obstruction  Suarez, M. M. Lorenzo, I. M. Ares, L. D. Castro, O. M. Dıaz, B. A. P. M. Santome, I. T. Garcıa, M. M. Mıguez, A. L. Baz & J. C. Vales Lucus Augusti Hospital, Lugo, Galicia, Spain Aim: The use of self-expandable metallic stent (SEMS) as a bridge to surgery for patients with acute malignant colorectal obstructions is still controversial. We conducted this study to compare the outcomes with emergency surgery. Method: From January 2007 to December 2015, 190 patients with acute malignant colorectal obstruction from Lucus Augusti Hospital were retrospectively enrolled in this study. 101 patients received SEMS as a bridge to surgery and 89 patients received emergency surgery (ES). Results: Difference was not significant in the postoperative morbidity. In SEMS group we performed more laparoscopic operations: 16.5% vs 3.4% (P = 0.02) and more primary anastomosis (P = 0.01). The postoperative hospital stay was shorter in SEMS group (14 days VS 18 days). The median time to recurrence was 17 months in SEMS group and 14.6 months in ES group (P = 0.149). The median follow-up was 40 months. The 5-year overall survival rates was 57% in SEMS group and 38% in ES group (P = 0.02). Conclusion: SEMS as a bridge to surgery is a safe and feasible procedure. Technical and clinical success rates were high without increased rates of recurrence. It seems associated with lower mortality rate, shorter hospital stay, lower colostomy formation rate and a higher possibility of laparoscopic surgery.

P191 Laparoscopic assisted abdominoperineal resection of lower third adenocarcinoma of the rectum: evaluation of the technique and urogenital functional outcome H. Elgendy1, M. Morshed1, M. Bassuni2, W. Thabet1, H. Elfeki1, S. Emile1 & W. Omar1 1 Mansoura University Medical school, Mansoura, Dakahliya, Egypt, 2Sheffield University Medical School, Sheffield, UK Previously published in Egyptian journal of surgery, volume 32, issue 2, 2013.

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P192 Interpretation of pretherapeutic MRI and influence on treatment selection in rectal cancer - room for improvement? A. Elliot1,2, L. Blomqvist1,2, A. Martling1,2, B. Glimelius3, H. Johansson1 & P. Nilsson1,2 1 Karolinska Institutet, Stockholm, Sweden, 2Karolinska University Hospital, Stockholm, Sweden, 3Uppsala University, Uppsala, Sweden Aim: Magnetic resonance imaging (MRI) is routinely used for pretherapeutic rectal cancer tumour staging. This study aim to investigate adherence to MRI protocol standards and relation between MRI interpretation and selection to preoperative therapy in rectal cancer. Method: Data on 100 consecutive patients who underwent elective rectal cancer surgery in the region from January to June 2010 were retrieved from the Swedish Rectal Cancer Registry. MRI reports and investigations were re-evaluated by two radiologists. Results: Six patients were excluded because of absence of MRI. Among the remaining 94 patients, 81 (86.2 %) had pretherapeutic MRI in accordance with defined imaging standards. In 34.0 % of original reports, extramural vascular invasion (EMVI) and T stage were not mentioned. Complete tumour staging was not possible because of missing data in 28 (29.8 %) of the patients. The agreement between original reports and re-evaluation for tumour stage was moderate (j = 0.46) and for selected compared to proposed treatment according to re-evaluation, fair (j = 0.32). Conclusion: MRI protocol standards were not universally applied. Insufficiencies in original reports, made adequate treatment selection impossible and agreement between original report and re-evaluation was moderate. The results calls for improved interpretation standards and MRI protocol adherence.

P193 Is laparoscopic surgery feasible and oncologically safe for T4 colon cancer? D. Estefania, L. Fernandez, C. Funes, H. Ruiz, M. Cillo, J. C. P. Uriburu, F. Bugallo, C. Tyrrell & M. Salomon British Hospital of Buenos Aires, CABA/Bs As, Argentina Aim: Laparoscopic approach for T4 Colorectal cancer remains controversial. It is argued that the risk of incomplete resection would be greater than in open surgery. Objective: To assess the feasibility and oncological results of T4 colon cancer laparoscopic resection. Method: 46 patients with T4NxMx colon cancer were included. 29 patients in the laparoscopic group (A) were compared with 17 patients operated on conventionally (group B). Immediate surgical results, pathological reports and oncological outcomes were evaluated. Results: The conversion rate was 17.24 %. Resected lymph nodes were 16.4 for laparoscopic group and 13.4 for conventional group. R0 resection was achieved in 28 of 29 cases in the laparoscopic group and in all conventional cases. The overall morbidity and mortality was 20.68% and 3.44% for the laparoscopic group and 35.3% and 5.8% for the conventional group. After a mean follow up of 28 months the overall survival rates and disease-free survival were 65 % and 68 % in the laparoscopic group and 35% and 70% in the conventional group. Conclusion: Laparoscopic approach is technically feasible and oncologically safe for T4 colon cancer.

P194 Laparoscopic treatment of colorectal cancer of aged patients R. Aiupov1,2, D. Feoktistov1,2, R. Agliullin2, N. Tarasov2, N. Suleymanov2, F. Zaynullin1,2 & Y. Akmalov2 1 Bashkir State Medical University, Ufa, Russia, 2Republican Oncological Clinical Dispensary, Ufa, Russia Aim: The evaluation of the results of treating aged patients with colorectal cancer by LAP approach. Method: We have studied 399 cases of laparoscopic treatment of the colorectal cancer from 2010 to 2015. 96 patients (24.06%) were older than 70. We have studied time of the operation, the blood loss, postoperative course, disease stages, types of operations and complications. Results: The average age was 75 years (70 to 93). 64 patients were men (66.7%), 32 women (33.3%). The BMI was 24 (17.4–35.6). The operations takes 200.7 minutes (120–300) average. The intraoperative blood loss averaged 105.5 ml (70–280). The average hospital stay was 11.3 days (8–22). 58 patients had II stage (60.4%), the III stage in 29 cases (30.2%) and the fourth stage took place in 9 cases (9.4%). Laparoscopic procedures: 33 (34.4%) anterior resections, 13 (13.5%) abdomoperineal resections, 8 left hemicolectomies (8.3%), 20 right hemicolectomies (20.8%), 16 (16.7%) sigmoid resections and 6 (6.3%) Hartmann’s procedures. Postoperative complications pseudomembranous colitis in 1 case (1%) and anastomotic leakage in 3 cases (3.1%). There was no mortality. Conclusion: Laparoscopic surgical treatment of patients with colorectal cancer at older age groups based on a comprehensive preoperative evaluation allows to achieve good short-term outcomes.

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Poster Abstracts P195 Does neoadjuvant chemoradiation effect on lymph node retrieval change the prognosis in rectal cancer? M. Fragoso,  E. Afonso, R. Rocha, M. Sousa, R. Marinho, D. Aparicio, A. Jo~ao, A. Soares, F. Sousa, V. Geraldes & V. Nunes Hospital Prof Doutor Fernando Fonseca, Amadora, Portugal Aim: The implications of reduced lymph node (LN) retrieval in rectal cancer are still unclear. Our aim was to evaluate the impact of preoperative chemoradiotherapy (CRT) on the LN retrieval and status and evaluate its prognostic properties. Method: We performed a retrospective study of adult patients with curative resected low and middle rectal cancer from 2007 to 2013. A 36-months follow-up was assured. Stage IV patients and non-R0 resection were excluded. Statistical analysis was accomplished with IBM SPSS 20. The studied variables were TNM staging before and after CRT, number of LN retrieved, positive LN, LN ratio, recurrence and overall survival. Results: A total of 105 patients were included with a mean age of 63.5 years. 70,5% were men and 58% treated with neoadjuvant CRT. The median number of lymph nodes retrieved was smaller after neoadjuvant therapy (9.01 vs 12.51 P = 0.045), as well as LN ratio although not statistically significant. Pre-operative CRT did not influenced recurrence nor the overall survival (P > 0.1). Conclusion: Neoadjuvant therapy for rectal cancer significantly decreases the number of total lymph nodes, however in this study it was not associated with reduced recurrence nor prolonged survival. In conclusion, the prognosis was not improved.

P196 Pattern and timing of recurrence in ypT0 rectal cancer patients – a retrospective, multicentric, international study L. Lorenzon1,11, M. Frasson2,11, V. Vigorita3,11, D. Parini5,11, D. Rega4,11, G. Marino6,11, G. Gallo7,11, M. Scheiterle8,11, A. Mellano9,11, F. Bellafiore1,11, R. J. Rosellon2,11, L. De Franco8,11, P. Marsanic9,11, A. Failla9,11, A. Nardone10,11 & R. De Luca10,11 1 Surgical and Medical Department of Traslational Medicine - La Sapienza University Sant’Andrea Hospital, Rome, Italy, 2Hospital Universitario y Politecnico La Fe, Valencia, Spain, 3Unit of Coloproctology Dept of General and Digestive Surgery University Hospital Complex of Vigo Alvaro Conquieiro Hospital, Vigo, Spain, 4Unit of Colorectal Surgical Oncology INT Pascale, Naples, Italy, 5General Surgery Unit Misericordia Hospital, Rovigo, Italy, 6Surgery Unit Regional Oncologic Center Rio Nero in Vulture, Potenza, Italy, 7Coloproctology Unit Santa Rita Clinic, Vercelli, Italy, 8 Surgery Unit Santa Maria Delle Scotte, Siena, Italy, 9Surgery Unit IRCS S. Candiolo, Turin, Italy, 10G. Paolo II Cancer Institute, Bari, Italy, 11Young SiCO (Societa Italiana di Chirurgia Oncologica), Rome, Italy Aim: Complete pathologic response after neo-adjuvant therapy in rectal cancers (RC) has been reported ranging from 8 to 39%. ypT0 could be treated with local excision and about the 10% of ypT0 could present positive nodes in the TME specimen, so standard surgery is still required. Definitive data regarding the longterm outcome of ypT0 patients are scant. Method: An Italian/Spanish study group of Young-S.I.C.O. members aimed to collect data on ypT0/ypTis patients treated with TME resection in different centres over the last 10 years. Clinical-surgical and pathological features and treatments performed were retreived. Main outcome measures were patients’ survival, type and timing of relapses. Results: 196 ypT0 RC were analysed (M/F 1.9, mean age 63.2 yrs). 87.8% received neo-adjuvant CHT-RT. 8.7% of patients who underwent TME were pN1. Mean follow-up was 46.9 months (range 3.0–127.0). We reported 12 relapses (6.1% of the series), 25.0% local and 75.0% at distant sites. Mean time to relapse was 22.1 months (median 19.5, range 2.6–65.0). Conclusion: Preliminary data from this large series of ypT0 RC show a low recurrence rate, with a prevalence of distant metastases.Further analysis on a larger series might confirm the favourable behaviour of patients with complete response after neoadjuvant CHT- RT.

P197 Perineal symptoms and quality of life are not associated to the extension of the perineal descent after extra-elevator abdominoperineal rectal excision M. Frasson, E. Montilla, B. Flor-Lorente, A. Camacho, A. Garcıa-Granero, E. Lucas, S. Pous & E. Garcıa-Granero University and Polytechnic Hospital La Fe. University of Valencia., Valencia, Spain Aim: To determine the perineal descent after extra-elevator abdomino-perineal rectal excision (ELAPE) and to evaluate its association to the perineal symptoms and patients’ quality of life (QOL). Method: 25 patients that underwent ELAPE for rectal cancer were included. A biologic mesh was used for perineal closure. Long-term perineal morbidity was assessed by physical exploration. Perineal descent was measured by perineometer at rest and during Valsalva. Moreover, a detailed questionnaire of perineal symptoms

was completed by the patients. The QOL was assessed using the EORTC questionnaires QLQ-C30 and QLQ-cr29. Results: Delayed healing of the perineum (>4 weeks) occurred in 8 (32%) patients. Perineal symptoms occur in 60% of the cases. Two patients (8%) had a clinically diagnosed perineal hernia. Mean perineal descent for the whole group was 0.6 cm at rest (range 0–4 cm) and 1.2 cm during valsalva (range 0–6 cm). Perineal descent was not associated to perineal symptoms or their relevance (minimum P 0.4). The QOL was comparable to the EORTC reference values. The QLQ-29 revealed a high median of impotence (79.8), and low sexual interest (86.6). Conclusion: Perineal hernia rate is low after ELAPE. Perineal symptoms are common but are not correlated to the extension of the perineal descent.

P198 Accuracy of computed tomographic colonography in the preoperative assessment of colon cancer patients. A prospective study of 217 patients M. Frasson, J. Maupoey, J. Pamies, F. Giner, C. Cerdan & E. Garcıa-Granero University and Polytechnic Hospital La Fe, University of Valencia, Valencia, Spain Aim: To assess the accuracy of Computed Tomographic Colonography (CTC) in determining preoperatively colon cancer stage. Method: This is an institutional prospective study including a series of colon cancer patients. A CTC was performed in all of them as part of the preoperative assessment. TN stage and location of the tumour were evaluated by CTC and compared to pathological and intraoperative findings, respectively. Results: 217 patients were analysed. In 8 patients with incomplete colonoscopy a synchronic tumour was diagnosed by CTC. Cancer location was exactly detected in the 89.4% by CTC of the patients and in the 65.4% by optic endoscopic. CTC accuracy was 71% for tumour T stage and 67.3% for tumour N stage. Accuracy of CTC for exactly assessing high-risk tumours (T3–T4) was 87.5%, with a 89% sensibility and 82% specificity. Accuracy for detection of extra-mural venous infiltration was 86.2%. Conclusion: CTC is an accurate tool to determine tumour location and to identify high-risk colon cancers.

P199 Do converted patients in colorectal cancer surgery have a worse long-term oncologic outcome compared to primarily open operated patients? A review of the literature E. Furnee Diakonessenhuis Utrecht, Utrecht, The Netherlands Aim: Summarise the literature regarding the long-term oncologic outcome in patients who were converted in colorectal cancer surgery compared to patients who primarily underwent open surgery. Method: A literature search was performed in Pubmed. Results: The search strategy resulted in seven studies eligible for inclusion. Overall, a total (range) of 9190 (57– 8307) patients were included in the open group (OG) and 238 (17–56) in the converted group (CG). In none of the studies, differences were found in baseline characteristics and disease stage between both groups. The median (range) overall survival (OS) in the OG was 68.9% (55–97.4%) and 62.3% (55.6–100%) in the CG. The median disease-free survival (DFS) was 69.1% (59.1– 88%) and 63.8% (40–100%), respectively. In one study, difference in DFS between both groups was statistically significant in favour of the OG (63.3% vs. 40.2%, P = 0.045). There were no significant differences between both groups with regard to local recurrence and distant metastasis rate. Conclusion: This literature review has demonstrated that there were no statistically significant differences in OS and local and distant recurrence rate between the OG and CG in colorectal cancer surgery. Only one study reported a statistically significant difference in DFS in favour of the OG.

P200 Abdominoperineal resection for rectal cancer: pelvic drain externalization site I. M. Galları´n, M. E. Del Valle, J. L. J. Redondo & J. S. Martınez Servicio de Cirugıa General y Aparato Digestivo, Hospital Infanta Cristina, Badajoz, Extremadura, Spain Aim: The aim of this paper is to investigate if the externalization of pelvic drain through a puncture skin wound of the perineum could be considered as a risk factor for perineal wound infection, after abdominoperineal resection for rectal malignancy. Method: Between 2011 and 2015, 80 patients underwent elective abdominoperineal resection for malignancy. In 60 patients (75%), the pelvic drain catheter was externalization through an abdominal stab incision (Abdominal Incision AI group), while in the remaining 20 (25%) through a puncture skin wound of the perineum

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Poster Abstracts (Perineum Incision PI group). Patients’ data with respect to age (P = 0.24), stage (P = 0.83), sex (P = 0.47)) and comorbidity (P = 0.79) were similar in both groups. Results: The overall morbidity rate was 46,8% (45,6% was clasificated ClavienDindo grades I-II). The incidence of perineal wound infection was significantly higher in the Perineum Incision group (PI versus AI: 38.3% versus 10.1% P = 0.018). The incidence of presacral abscess was similar in both groups. Conclusion: The externalization of pelvic drain through a puncture skin wound of the perineum could be considered as a risk factor predisposing to perineal wound infection.

P201 Next-generation sequencing miRNA profiling in stool and plasma samples of patients with colorectal cancer or precancerous lesions G. Gallo1, G. Clerico1, S. Tarallo2, F. Cordero3, B. Pardini2, G. Ferrero3, P. Vineis2,4, A. Naccarati2, A. R. Luc1 & M. Trompetto1 1 Department of Colorectal Surgery - S. Rita Clinic, Vercelli, Italy, 2Human Genetics Foundation, Torino, Italy, 3Department of Computer Sciences, Torino, Italy, 4School of Public Health-Imperial College, London, UK Aim: MicroRNAs (miRNAs) are key gene regulators in most biological and pathological processes, including colorectal cancer (CRC). The possibility of using circulating or faecal miRNA expression as non-invasive early detection biomarkers open interesting possibilities about their potential clinical utility. In this respect, diet and other lifestyle factors may also modulate miRNA expression and need to be explored in the context of search of biomarkers for disease stratification. Method: We report our study on the search of CRC biomarkers in surrogate specimens which includes: (A) an implementation of the methodology and pipeline of analysis for detection of microRNAs by Next-Generation Sequencing in stool and plasma exosome samples. (B) a concomitant evaluation of miRNA expression profiles in plasma and stools samples from healthy subjects and patients with CRC or precancerous lesions. (C) a parallel investigation on the role of diet, lifestyle and other factors in influencing miRNA expression. Results: Preliminary results of a set of 48 samples shows that several miRNAs are dysregulated in patients with precancerous lesions and inflammatory diseases in comparison with healthy subjects. Conclusion: The present study shows the importance to use high-throughput techniques and complex computational analyses to globally define miRNA signatures involved in colorectal carcinogenesis in surrogate specimens.

P202 Laparoscopic right colectomy with completive extended D3 anterior/posterior mesenterectomy: a Norwegian pilot series R. Gaupset1, A. M. Kazaryan1,2, B. V. Stimec4, A. Bakka1,3, B. Edwin2,3 & D. Ignjatovic1 1 Akershus University Hospital, Lørenskog, Norway, 2Oslo University Hospital Rikshospitalet, Oslo, Norway, 3Institute for Clinical Research, University of Oslo, Oslo, Norway, 4Anatomy Sector, University of Geneva, Geneva, Switzerland Aim: Extended D3 anterior/posterior mesenterectomy (ED3APM) in right colectomy has received increased attention. Aim: to demonstrate feasibility of the procedure and provide short-term outcome data. Method: Right colectomy with ED3APM, including lymph nodes anterior/posterior to the superior mesenteric vessels to the left edge of the superior mesenteric artery was performed (video). A 3D reconstructed anatomy map derived from the staging CT was used as a road-map at surgery. Intention-to-treat analysis was performed. Results: 11 patients, 2 men, age 67(57–74) years; BMI 27(22–46) were operated from July 2013 to April 2016. Follow-up: 3(1–34) months. Conversions: 2(18%) for bleeding and unclear anatomy, both early cases. Median operative time and blood loss were 320(198–439)min and 200(0–400) ml, respectively. Postoperative complications developed in 4(36%), including 1(9%) major complication requiring reoperation (resection of necrotic omentum). Hospital stay: 5(3–13) days. R0 resection was achieved in all cases. Lymph node harvest was 45(25–86), including 12(4–19) in the D3 volume. Six patients had positive nodes, 2 of them in the D3 volume. There was no mortality, and all patients are alive and disease free at follow-up. Conclusion: Laparoscopic right colectomy with ED3APM is feasible, associated with acceptable morbidity and fast recovery. The procedure can be readily introduced in specialised colorectal institutions.

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P203 Impact of neoadjuvant therapies on long-term functional outcomes after coloanal anastomosis for rectal cancer X. Gayrel1, S. Kirzin1, P. Leblanc1, M. Rives3, R. Guimbaud2 & G. Portier1 1 Department of colorectal and oncological surgery, Purpan university hospital, Toulouse, France, 2Department of medical oncology, Rangueil university hospital, Toulouse, France, 3Department of radiation therapy, University Cancer Institute, Toulouse, France Aim: To compare the long-term functional outcomes of coloanal anastomosis for rectal adenocarcinoma according to neoadjuvant treatment: chemoradiotherapy (CRT) vs radiotherapy (RT) vs no treatment (NT) using the LARS (Low Anterior Resection Syndrome) score. Method: Patients alive, recurrence-free and stoma free, who had undergone a coloanal anastomosis over the 2003 – 2013 period were identified from a prospectively maintained database. LARS score data and eventual medication related to functional outcomes were collected. Results: Data were available for 122 patients (56 CRT, 22 RT and 44 NT). Mean follow-up was 4.5 years. LARS Score was significantly higher (bad results) in the CRT group than in the in RT and NT groups (respectively 32.1, 25.7 and 26.5, P = 0.0004). However, LARS score category (Major vs Minor vs No LARS) didn’t show significant difference between groups. Only 73 patients (51.6%) used medications for LARS. Medication rate was higher in the groups experiencing the worst results (Major LARS 61%, minor LARS 47%, No-LARS 19 %). Conclusion: Neoadjuvant CRT was associated with poorest functional outcomes after coloanal anastomosis for rectal cancer treatment. Therapeutic strategy for LARS treatment is not yet standardised, and only few patients experiencing LARS symptoms are treated.

P204 Predictive factors for ileostomy formation after right hemicolectomy. A. Ghanbari, G. Gravante & J. Yeung Leicester University Hospitals, Leicester, UK Aim: Right hemicolectomy and primary anastomosis for right sided colon cancer is the current gold standard in colorectal practice. However, in situations where an anastomosis is likely to fail, an end ileostomy is formed. A poorly sited ileostomy can lead to complications resulting in severe morbidity and have huge cost implications. Our aim was to investigate the risk factors that lead to patients requiring an end ileostomy following a right hemicolectomy. This will therefore help us focus the stoma care service to the appropriate patient in the climate of reduced health resources. Method: We examined a prospectively maintained colorectal database within our institution between 2014 and 2015. Data for these patients included age, sex, histology; mode of operation (emergency or elective), type of operation (laparoscopic/ open), ASA grade and BMI. Results: We operated on 92 patients between January 2014 and January 2015. Mean age was 68 years 13, BMI 27  6. 44. 47.8% of Patients were males, 25 operations were conducted as an emergency (27.2%), 32 patients (34.8%) had a laparoscopic operation. Ileostomy formed in 20 patients (21.7%). Conclusion: A significant association was found with the formation of ileostomy and Age (P = 0.018), Emergency mode (P < 0.001), ASA (P = 0.049).

P205 TEM for distal margin determination in ultra-low anterior resection H. Gilshtein, E. Manassa, W. Khoury & D. Duek Rambam Health Care Campus, Haifa, Israel Aim: To assess the utility of TEM for distal margin determination as part of a combined approach, in patients undergoing ultra-low anterior resection Method: Patients with very low rectal cancers have undergone an ultra-low anterior resection with hand sewn anastomosis in a combined transabdominal and TEM approach. Operative and post-operative data were retrospectively collected Results: 12 patients were operated in the combined approach. Their average age was 62.8 and the LOS was 9.75 days. Both the distal and circumferential resection margins were found to be free in all patients. The complication rate was low and comparable to the standard transabdominal anterior resection patients Conclusion: We find the addition of TEM as being extremely helpful in the visualization and resection of locally advanced very low rectal cancer. It provides a safe platform with an excellent 3-D vision, achieving free distal margins in all patients, thus providing an attractive adjunctive method for sphincter preservation with sound oncological principles TEM implementation in the resection of low rectal cancer in a combination with transabdominal approach carries a promise with further research needed to solidify its role in transanal TME.

ª 2016 The Authors Colorectal Disease ª 2016 The Association of Coloproctology of Great Britain and Ireland. 18 (Suppl. 1), 44–125

Poster Abstracts P206 Anastomotic leakage in total/subtotal colectomy: 5-year experience in a Spanish Teaching Hospital P. G. Giordano, J. P. Fernandez, J. D. Trill, I. M. Montes, E. T. De Blas & E. L. Martınez H. U. Ramon y Cajal, Madrid, Spain Aim: Total/subotal colectomy with ileorectal or ileosigmoid anastomosis is frequently performed for colorectal cancer. Colectomy with anastomosis has significant mortality and morbidity, including a 10% anastomotic leakage rate. The object of this study was to determine our experience in a series of patients undergoing these operations. Method: All patients who underwent ileorectal or ileosigmoid anastomosis between 2011 and 2016 were retrospectively reviewed. Results: A total of 150 patients (female 36% and males 64%) with a median age of 67 years underwent total/subtotal colectomy (117 elective and 33 emergency operations) for colorectal cancer (94%), chronic constipation (2%), volvulus (1,9%), inflammatory bowel disease (1,3%). Mortality and morbidity rates were 1,3% and 44%, including 18 (12%) cases of anastomotic leakage, leading to 28 re-operations. Anastomotic leakage rate was 9% in emergency cases (comparing to 12,8% in elective operations) and 11% in open surgery (comparing to 2 cases out of 8 with laparoscopic surgery). All patients with an anastomotic leakage underwent a reoperation and none of these died in post-operative period. Conclusion: Total/subtotal colectomy is associated with high postoperative morbidity and mortality. The rate of anastomotic leakage presents a high incidence; it is necessary to know the main risk factors to reduce this complication.

P207 Short and midterm oncological outcomes of robotic colonic resections. Our experience after 239 robotic colonic resections in a single institution study M. G. Ruiz1,2, C. C. Fernandez1, J. A. Martın1, L. C. Poch1, J. I. M. Parra1, C. M. Palazuelos1, M. G. Fleitas1,2 & J. C. Diego1 1 Hospital Universitario Marques de Valdecilla, Santander, Spain, 2Universidad de Cantabria, Santander, Spain Aim: Minimally invasive approach for colonic resections is increasing but complete mesocolon excision (CME) and intracorporeal anastomosis (ICA) remain technically challenging. This study analyses perioperative outcomes of robotic colonic resections (RCR), especially regarding the pitfalls such as T4 tumours. Method: This prospective observational study included 239 patients undergoing robotic surgery due to colon cancer in a single institution. Clinicopathological parameters, morbidity, perioperative recovery and midterm oncological outcome were analysed. Results: 239 surgeries were carried out between November 2010 and April 2016. 2 Total Colectomies, 80 right colectomies, 100 left colectomies and 56 high anterior resections were performed. Median age was 66 years and median Charlson 5, 4. Conversion rate was 4, 2 % and median operative time was 215 minutes. Complications with a Clavien-Dindo score >2 were observed in 5, 4%. 27 T1, 35 T2, 140 T3 and 35 T4 tumours were treated. Positive margins were observed in 10 cases (4, 2%). Median hospital stay was 6 days. Local recurrence in 9 cases (3, 8%) with median follow up of 16 months. Conclusion: This is the largest European, prospective, evaluation of RCR to date. The well-known technical difficulties of minimal-invasive rectal surgery like ICA, CME and T4 tumours were sufficiently managed by RCR.

P208 A pilot study of squamous-cell anal carcinoma chemoradiotherapy with capecitabine, mitomycin and paclitaxel S. Gordeyev, A. Rasulov, S. Tkachev, M. Fedyanin, V. Glebovskaya, N. Besova, Y. Surayeva & D. Kuzmichev N.N.Blokhin Russian Cancer Research Center, Moscow, Russia Aim: To investigate safety and efficacy of chemoradiotherapy (CRT) with capecitabine, mitomycin and paclitaxel for squamous-cell anal carcinoma (SCAC). Method: Patients with stage I-IIIB SCAC received 50–56 Gy (based on T stage) IMRT in 1.8 Gy fractions with capecitabine 650 mg/m2 bid on radiation days, mitomycin 10 mg/m2 iv day 1 and paclitaxel 45 mg/m2 iv days 3, 10, 17, 24, 31. Primary endpoints were protocol compliance, toxicity and complete response at 6 months. Results: 38 patients were enrolled. The percentage of patients with stage I, II, IIIA, and IIIB disease were 1(2.6%), 5(13.2%), 15(39.5%), and 17(44.7%), respectively. 84.2% patients completed protocol treatment without significant alterations. Grade 3–4 toxicity occurred in 23(60.5%) patients: 11(28.9%) skin, 8(21.1%) diarrhoea, 10 (26.3%) leucopenia, 6 (15.8%) neutropenia, 8(21%) proctitis. 33(86.8%) patients had complete clinical response at 6 months. Median follow up was 17 months. 6 (15.8%) patients experienced disease progression: 5 local recurrences and 3 distant metastases.

Conclusion: Investigated treatment scheme has high toxicity, but good response rate in patients group with predominantly advanced disease. Further investigation is warranted.

P209 Baseline T-stage predicts early tumour regrowth after WW in rectal cancer following extended neoadjuvant chemoradiation and complete clinical response A. Habr-Gama1,3, G. P. S~ao Juli~ao1, J. Gama-Rodriguez1,3, B. B. Vailati1, C. Ortega1, L. M. Fernandez1 & R. O. Perez1,3 1 Angelita & Joaquim Gama Institute, S~ao Paulo/SP, Brazil, 2University of S~ao Paulo School of Medicine Colorectal Surgery Division, S~ao Paulo/SP, Brazil, 3University of S~ao Paulo School of Medicine, S~ao Paulo/SP, Brazil Aim: Selected patients with rectal cancer and complete clinical response (cCR) after neoadjuvant chemoradiation (nCRT) may be managed without immediate radical surgery. However, at least 20% will develop an early tumour regrowth. We investigated the influence on baseline T-stage of patients undergoing consolidation nCRT on early tumour regrowth rates after a cCR managed non-operatively. Method: Consecutive patients with cT2-4N0-2M0 distal rectal cancer treated with consolidation nCRT and cCR at 10 weeks were included. Early (≤12 months) and late recurrences were compared according to baseline staging. Results: 91 patients were included. 61 patients developed initial cCR (67%). cT2 patients developed similar cCR rates to cT3/T4 (72% vs 63%; P = 0.2). Early tumour regrowths were more frequent in baseline cT3/4 (30% vs 3%; P = 0.007). Actuarial local-recurrence-free survival at 1 year was inferior for baseline cT3/4 cancers (68% vs 96%; P = 0.01). Conclusion: Baseline cT2 cancers that develop cCR after consolidation nCRT managed by W&W are less likely to develop early local recurrences. cT3/T4 patients may be candidates for more intensive neoadjuvant treatment regimens and active surveillance.

P210 Anastomotic leakage after laparoscopic mesorectal excision for rectal cancer: does location of leakage matter? E. Hain, L. Maggiori, C. Mongin, J. P. La Denise & Y. Panis Beaujon Hospital, Clichy, France Aim: To compare after laparoscopic mesorectal excision for rectal cancer (TME) and side-to-end colorectal or coloanal anastomosis outcomes of anastomotic leakage (AL) on the colonic stump (cAL) vs on the anastomosis (aAL). Method: Patients presenting AL following TME were identified from our prospective database. CT-scans with enema were reviewed for exact AL location. Results: Among 428 patients who underwent TME from 2005 to 2014, 120 (28%) presented AL. After exclusion of 35 with end-to-end anastomosis and 15 with isolated pelvic abscess, 70 patients were included: 27 (39%) with cAL and 43 (61%) with aAL. cAL was associated with similar rate of symptomatic AL (63% after aAL vs 48% after cAL; P = 0.339) and severe postoperative morbidity (33% vs 18%; P = 0.313). AL tract healing rate (56% vs 63%; P = 0.732) and delay for healing (24  6 weeks vs 20  7 P = 0.311) were similar, leading to similar stoma reversal rates (87% vs 96%; P = 0.388). Functional outcome was similar between aAL and cAL patients (major low anterior resection syndrome: 57% vs 53%; P = 0.960). Conclusion: This study suggested that whatever the location of leakage after laparoscopic TME (either colonic stump or anastomosis), long term outcome in terms of spontaneous healing, stoma closure, and function are similar.

P211 Risk factors for postoperative ileus after laparoscopic sphinctersaving total mesolectal excision for cancer: an analysis of 428 consecutive patients E. Hain, L. Maggiori, C. Mongin, J. P. la Denise & Y. Panis Beaujon Hospital, Clichy, France Aim: To identify risk factors for postoperative ileus (POI) after laparoscopic sphincter-saving total mesorectal excision (TME) for cancer. Method: All patients who underwent a laparoscopic sphincter-saving TME for cancer from 2005 to 2014 were identified from our prospective database. POI was defined as the need for nasogastric tube insertion during the postoperative period. Results: Among 428 patients, 65 patients (15%) presented POI. In univariate analysis: male, age >70, ASA score ≥ 3, pulmonary comorbidity, T3-4 stage, synchronous metastasis, conversion into laparotomy, and postoperative surgical site infection (SSI) were associated with a higher risk of POI with a P-value 70 (Odds-Ratio (OR): 2.1 [1.1–4.2]; P = 0.024), ASA score ≥ 3 (OR: 2.8 [1.0–7.7]; P = 0.042), conversion to laparotomy (OR: 4.8 [1.5–15.2]; P = 0.07), and SSI (OR: 3.9 [2.0–7.6]; P < 0.0001) were identified as independent risk factor for POI.

ª 2016 The Authors Colorectal Disease ª 2016 The Association of Coloproctology of Great Britain and Ireland. 18 (Suppl. 1), 44–125

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Poster Abstracts Conclusion: Two risk factors (i.e. age > 70, and ASA score ≥ 3) for POI after laparoscopic TME cannot be modified. The 2 others risk factors (i.e. conversion into laparotomy and postoperative SSI) reflected, at least in part, expertise of the surgeon and/or the centre and can thus improve with surgical expertise.

Conclusion: These results showed that rhPEDF decreased the migration of colorectal cancer cells and indicate a potential role in the prevention of metastases formation. Further work is proposed to investigate cellular signalling pathways.

P212 Hartmann’s procedure: reversal and rate of stoma free survival S. Hallam, B. Mothe & R. M. R. Tirumularaju Heart of England NHS trust, Birmingham, UK

P215 Expression of pigment-epithelium derived factor (PEDF) within colorectal cancer tissues using immunohistochemistry R. L. Harries1,2, J. Cai1, F. Ruge1, M. Morgan2, K. Harding1, J. Torkington2 & W. Jiang1 1 Cardiff University, Cardiff, UK, 2University Hospital of Wales, Cardiff, UK

Aim: Hartmann’s procedure (HP) is commonly performed for complicated diverticulitis or malignancy. Timing for Reversal of Hartmann’s (ROH) is not well defined as it is technically challenging, and also carries a high complication rate. Method: Retrospective audit of all HP patients between 2008 and 2014. ROH rate, timing, ASA grade, length of stay, and complications (Clavien-Dindo) including 30 day mortality were recorded. Results: HP (n = 228) indications: complicated diverticular disease 44% (n = 100), malignancy 32% (n = 73) and other causes 24%, (n = 54). ROH rate 47% (n = 108). Median age 58 years (21–84), ASA 2 (1–4); length of stay 8 days (2–42). Median time to ROH 11 months (4–96). ROH overall complication rate 21%, 3.7% had a major complication of IIIa or above including 3 anastomotic leaks and one deep wound dehiscence. Failure of ROH and permanent stoma was less than 1% (n = 2). 30 day mortality following HP was 14% (n = 15). HP’s not reversed: 34% (n = 41) was patient’s choice and 83% were either high risk or unfit. Conclusion: HP is reversed less frequently than thought and consented for. Only 46% of HP’s were stoma free at the end of the audit period. Anastomotic complication rate of 1% is also low for ROH in this study.

P213 Prognosticators for rectal cancer metastases and pelvic recurrence Z. Hanif, M. Maung, H. Abudeeb & A. Mukherjee Hairmyres Hospital, East Kilbride, Glasgow, UK Aim: Rectal cancer treatment outcome has improved considerably with TME and use of neoadjuvant chemoradiotherapy. Risk of local recurrence (LR) and distant metastases (DM) however could be as high as 10%. The present study aim at assessing the risk factors associated with LR and DM after primary curative resection. Method: Retrospective analysis of prospective colorectal database of 132 patients who had curative rectal cancer resection between 2007 and 2012. 21of 132 patients had local recurrence/distant metastases. Risk factors as tumour differentiation, neoadjuvant chemoradiotherapy, anastomotic leak, EMVI, CRM and Dukes C were analysed for quantitative assessment. Result: 21 patients had either local recurrence and or distant metastases; liver, lung and local recurrence (1), Lung and Liver (3), Lung and Bone(2), Lung(6), Local recurrence(5) Liver (3) Bone (1) 5(5/15) had a poor differentiation (P = 0.0642), 11 (11/55) of the neo-adjuvant group (P = 0.3369), no patients with anastomotic leak (0/3) (P = 1.000) disease, 11(11/33) positive EMVI (P = 0.016), 5(5/12) positive CRM (P = 0.0238) and 12 (12/47) Dukes C (P = 0.0445). Conclusion: This series demonstrates that the most statistically significant risk factor for metastatic disease/pelvic recurrence from rectal cancer was EMVI followed by positive CRM and Dukes C, while poor tumour differentiation, neoadjuvant therapy and anastomotic leak did not show significant statistical association. A multicentre prospective study may help in validating further this observation.

P214 The role of pigment-epithelium derived factor (PEDF) on cellular function in colorectal cancer cells R. L. Harries1,2, J. Cai1, S. Owen1, K. Harding1, J. Torkington2 & W. Jiang1 1 Cardiff University, Cardiff, UK, 2University Hospital of Wales, Cardiff, UK Aim: PEDF is a 50 kDa, secreted glycoprotein closely related to P53, tumour suppressor gene, and has been shown to exhibit anti-angiogenic and anti-tumourigenic effects. We have previously demonstrated that PEDF expression is lower in colorectal cancer cell lines compared with normal colorectal cells. The aim of our study were to determine the role of PEDF on cellular function in colorectal cancer cells. Method: HT115 and HRT-18 (a colonic adenocarcinoma and rectal adenocarcinoma cell line, respectively) were used for this study. Functional assays (growth, adhesion and migration) with treatment of varying doses (10 ng/ml, 50 ng/ml and 100 ng/ml) of recombinant PEDF (rhPEDF) were performed, compared to a control (normal growth medium). Results: There was a statistically significant decrease in HT115 and HRT-18 migration over a 6-hour period with rhPEDF treatment. This was evident at both 50 ng/ml and 100 ng/ml for HT115 (P = 0.007 and P < 0.001 respectively) and all doses of rhPEDF for HRT-18 (10 ng/ml P = 0.006, 50 ng/ml P < 0.001 and 100 ng/ml P = 0.001). There was no significant difference demonstrated in either growth or adhesion.

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Aim: PEDF is a glycoprotein closely related to P53, tumour suppressor gene. It has previously been demonstrated to have anti-tumourigenic effects in a range of cancers. Previously work from our unit has found PEDF expression to be lower in colorectal cancer cell lines compared with normal colorectal cells. The aim of our study were to determine the expression profile of PEDF within colorectal cancer tissue and its association with clinicopathological data. Method: Colonic and rectal cancer, cancer adjacent and normal tissue samples were analysed using immunohistochemistry (IHC) and assessed for levels of expression. Results: On IHC highest expression of PEDF was seen within smooth muscle, endothelial cells and fibroblasts. Tumour expression was more positive in well-differentiated mucinous adenocarcinomas compared to poorly differentiated mucinous adenocarcinomas and all grades of adenocarcinoma. There was a significant decrease in expression with worsening tumour grade in both adenocarcinomas and mucinous adenocarcinomas (P = 0.008 and P < 0.001, respectively). There was no difference seen in expression in tumour location (colon v rectum), Dukes Stage or TNM Stage. Cancer adjacent and normal tissue overall had poor expression. Conclusion: These findings suggest a loss of PEDF expression with worsening tumour differentiation. Correlation with quantitative polymerase chain reaction is ongoing.

P216 Outcome after robot-assisted rectal cancer surgery: a consecutive cohort study S. Harsløf, A. Stouge, N. Thomassen, S. Laurberg & L. H. Iversen Department of Surgery, Aarhus University Hospital, Aarhus, Denmark Aim: The aim of this study was to investigate outcome after robot-assisted rectal cancer surgery (RARCS). We focused on conversion rate, postoperative complications, pathological evaluation (adequacy of resection margins), and bowel function (Low Anterior Resection Syndrome (LARS)) one year after surgery. Method: An observational study of prospectively registered patients with data obtained from medical records. Data comprise the initial 208 patients operated on at a single Danish university hospital from October 2011 to October 2014. Results: In total, 27 procedures (13%) were converted to open surgery, and 23 of the 27(85%) conversions were in the obese and overweight patients. The anastomotic leak rate was 12(9%). In total, 14(7%) patients had a circumferential resection margin (CRM) ≤ 1 mm (R1-resection). In regard to bowel function, 15/22 (68 %) of TME patients had major LARS at 6 months follow-up but at 12 months followup this was reduced to 18/34 (53%). Conclusion: This study presents outcomes after RARCS at a single centre with results being overall comparable to outcomes reported from laparoscopic surgery. The results are satisfying because they are achieved during implementation of RARCS. Randomised trials are, however, needed and focus should especially be on long-term follow-up in regard to functional outcome.

P217 Hypermethylated SEPT9 in colorectal cancer compared to pancreatic cancer and benign gastrointestinal disease S. D. Henriksen1,3, S. L. Rasmussen1,3, M. Stender1, A. C. Larsen1, K. G. Sunesen1, P. H. Madsen2, H. Krarup2 & O. Thorlacius-Ussing1,3 1 Department of Gastrointestinal Surgery, Aalborg University Hospital, Aalborg, Denmark, 2Section of Molecular Diagnostics and Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark, 3Department of Clinical Medicine, Aalborg University, Aalborg, Denmark Aim: To compare the colorectal cancer biomarker SEPT9 in plasma from colorectal cancer (CRC) patients, to patients with pancreatic cancer (PC) and patients without malignant gastrointestinal disease. Method: Patients with CRC and PC were included prospectively from a single institution with blood samples collected before treatment. Additional, blood samples were collected from patients suspected of, but without, upper or lower gastrointestinal cancer (GIC) and patients with pancreatitis. SEPT9 was analysed by methylation specific polymerase chain reaction. Results: We evaluated 188 CRC, 95 PC, 129 patients suspected of GIC, and 156 patients with pancreatitis. SEPT9 was hypermethylated in 24% (95% confidence

ª 2016 The Authors Colorectal Disease ª 2016 The Association of Coloproctology of Great Britain and Ireland. 18 (Suppl. 1), 44–125

Poster Abstracts interval: 19; 31) of CRC patients and in 15% (8; 23) PC patients (P = 0.059). Only 3% (0; 6) of patients with pancreatitis, 5% (2; 11) of patients suspected of lower GIC, and none (0; 13) of patients suspected of upper GIC had hypermethylated SEPT9. Among stage I-III CRC 17% (12;24) had SEPT9 hypermethylation compared to only 2% (0;10) stage I-III PC (P = 0.040). In contrast, SEPT9 was frequently hypermethylated in both stage IV CRC (58% (39; 75)) and stage IV PC (31% (18; 47)) (P = 0.021). Conclusion: Frequency of hypermethylated SEPT9 in CRC was generally low, but substantially higher compared to patients without malignant gastrointestinal disease and PC.

Method: In first part 288 patients were analysed on individual partial parameters of diagnostics, surgeries and histological examination of rectal cancer. Critical points were identified and a unified follow-up protocol was suggested. In second part 600 patients were monitored parametrically focusing on the quality of the TME. Results: The proportion of patients with restaging following neoadjuvant therapy increased from 60.0% to 81.7%. The proportion of complete TME grew from 26.4% to 31.4% and of nearly complete TME from 12.0% to 29.4%. Conclusion: Parametric monitoring improved the quality of the pre-treatment diagnostics, examination of the tissue specimen and the quality of surgical procedure.

P218 Colonic stent as a bridge to surgery vs surgery alone for the treatment of left malignant colon obstruction F. Herrerıas, P. Muriel, N. Mestres, M. Santamarıa, E. Sierra, J. Escoll, M. Rufas, V. L. Palacios, M. Gonzalez, E. Cuello, M. Merichal, A. Fermi~ nan, M. C. De La Fuente, C. Gas, R. Villalobos, C. Mıas, A. Escartın & J. J. Olsina Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain

P221 Accuracy of rectal cancer staging in a district general hospital T. Hossain & A. Shukla Lincoln County Hospital, Lincoln, UK

Aim: To analyse postoperative and long-term outcomes of colonic stent as a bridge to surgery (BTS) compared to surgery alone for the treatment of malignant left colon obstruction. Method: A retrospective analysis of patients with acute malignant left colonic obstruction who underwent surgery or endoscopic stenting followed by elective surgery was performed, including May 2010 to November 2015. Patients with IV stage disease and patients not fulfilling stent indication were excluded. Postoperative (stay, morbidity and mortality), survival and recurrence were analysed. Results: 65 patients met inclusion criteria. 18 of the total (27, 7%) underwent BTS and 47 underwent surgery directly. Differences were significant in feasibility of performing laparoscopy (BTS/surgery: 8/1 patients, 44.4/2.1%, P < 0.05) and accomplishing anastomosis (BTS/surgery: 17/20 patients, 94.4%/42.6%, P < 0.05) whereas postoperative stay (10.6/11.5 days, P = 0, 5) and postoperative morbidity (18/20%, P < 0, 05) were found similar. There was no postoperative mortality. When analysed long term mortality (BTS group 45.4 months, 38.5–52.2, and surgery 49.2, 43.5–54.9, P = 0.59) recurrences (BTS/surgery: 3/16, 16.7/34%, P = 0.16) no significant differences were matched. Conclusion: Colonic stent as a bridge to surgery is a safe strategy for left colon malignant obstruction treatment, allowing laparoscopy, avoiding stoma and achieving long term classic surgery results.

P219 Routine use of on-table colonoscopy after left-sided colorectal anastomosis to reduce anastomotic bleeding M.-f. Ho1, T. W. C. Mak2 & S. S. M. Ng2 1 Prince of Wales Hospital, HKSAR, Hong Kong, 2The Chinese University of Hong Kong, HKSAR, Hong Kong Aim: Anastomotic bleeding after left-sided colorectal surgery is a small but significant problem. Perioperative endoscopic anastomotic examination, with or without haemostatic therapy, has been proposed to check staple integrity and bleeding by different groups. In our centre, it has been adopted since 2013 but the value remains uncertain. The aim of this study is to review the impact of on-table colonoscopy to reduce anastomotic bleeding. Method: From Jan 2010 to Mar 2016, patients’ undergone elective left-sided stapled colorectal anastomosis were included. Demographics, clinical data, on-table endoscopic anastomotic assessment and postoperative complications were recorded. Results: 734 patients (Mean age 61.7 years M:F: 9:4)underwent colorectal resection with left-sided anastomosis. There was a reduction of postoperative anastomotic bleed from 2.47% (9/364) to 1.08% (4/370) after introduction of routine on-table colonoscopy but this was not statistically significant. Interestingly, there were 4 patients who developed anastomotic bleeding in the endoscopic assessment group which required further endoscopic haemostatic therapy. Conclusion: Although there was a reduction in bleeding rate in the endoscopic assessment group, the difference was not significant. Caution is required for postoperative bleeding even after endoscopic anastomotic assessment as delay bleeding can occur.

Aim: To assess accuracy of MRI compared to histopathology staging following resection of rectal cancer Method: The database of rectal cancers was retrospectively interrogated. Duplicates and those with incomplete data excluded. Where applicable post-radiotherapy MRI reports were used. Radiologist grade and speciality were extracted from MRI reports. Results: Of 582 cases (mean age 69; 365 male 217 female) those with no histology were excluded leaving 278 cases, missing staging for respective analysis were excluded. For T Staging 60 over-predicted on MRI, 36 under-predicted and 85/ 184 (46%) episodes had MRI T stage correlate with histology. A significant number did not match MRI/histology staging P = 0.046 (Mann Whitney Test). For N staging, of 197 cases, 74 over-predicted on MRI, 29 under-predicted and 94/197 were correct (48%). The number mismatching were not significant P = 0.9 (Mann Whitney). The 35 radiologists had speciality identified from scan reports or radiology department. One radiologist was identified as GI specialist, 9 from an outsourced firm, 1 trainee and the remaining non-GI radiologists. Conclusion: There is disparity between MRI staging and histopathology T staging. This instigated sub-analyses to establish whether this affected the management. Many cases were excluded and the need for consistent data recording for future studies has been noted.

P222 Follow-up with MRI of rectal cancer after transanal endoscopic microsurgery: detection of recurrence and inter-observer reproducibility B. Hupkens1, M. Maas1, M. van der Sande2, M. Martens1, W. Deserno3, J. Leijtens3, P. Nelemans4, D. Lambregts2, G. Beets2 & R. Beets-Tan2 1 Maastricht University Medical Centre, Maastricht, The Netherlands, 2Netherlands Cancer Institute, Amsterdam, The Netherlands, 3Laurentius Hospital, Roermond, The Netherlands, 4Maastricht University, Maastricht, The Netherlands Aim: The aim of this study was to evaluate the diagnostic performance and reproducibility of MRI for the follow-up after TEM (with and without neoadjuvant treatment). Method: Patients with TEM for small rectal tumours without (neo) adjuvant treatment (CRT) (group 1) and patients with a small residual tumour after CRT (group 2) were included. Patients underwent local follow-up with MRI & endoscopy. MRIs were evaluated by independent readers (n = 2). Results: 52 patients were included in group1, and 28 patients in group2. 293MRIs were performed (203DWI+). 18patients developed a recurrence. Overall AUCs for local recurrence detection were 0.71(R1) and 0.80(R2) for T2W-MRI. For DWI AUCs were 0.70(R1) and 0.89(R2). In some cases DWI showed an earlier recurrence than T2W-MRI. For nodal recurrence AUC was 0.72(R1) and 0.80(R2) for T2W-MRI. An increase in AUC was seen during follow-up for both T2W- and DWI-MRI in detecting local and nodal recurrence. Isointensity of the rectal wall was a predictive factor for local recurrence. Conclusion: Follow-up with MRI (including DWI) is a valuable tool to for follow-up after TEM. Postoperative changes at first follow-up after TEM are confusing, but during follow-up diagnostic performance and IOA increase to a level high enough for clinical decision making. DWI can be of help in identifying recurrences earlier than on T2W-MRI.

P220 Parametric monitoring of TME quality in rectal cancer multicentric Czech PRT J. Hoch1, A. Ferko2 & M. Blaha3 1 UH Motol,Charles University, Prague, Czech Republic, 2UH Hradec Kralove, Charles University, Hradec Kralove, Czech Republic, 3IBA, Masaryk University, Brno, Czech Republic Aim: To implement and standardise the quality of TME in the multicentric RCT at six departments in Czech Republic.

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Poster Abstracts P223 Pathological complete responders after chemoradiotherapy for locally advanced rectal cancer: what can be learned from MRI and endoscopy for the selection of complete responders? M. van der Sande1, M. Maas2, B. Hupkens2, M. Martens2, D. Lambregts1, R. Beets-Tan1, S. Breukink2 & G. Beets1 1 Netherlands Cancer Institute, Amsterdam, The Netherlands, 2Maastricht University Medical Centre, Maastricht, The Netherlands Aim: The aim was to identify features in operated pathological complete responders (pCR) who were missed during restaging, by MRI+DWI and endoscopy that can improve selection of complete responders. Method: Patients with pCR after CRT and surgery for rectal cancer were retrospectively selected. The MRI+DWI and sigmoidoscopy images were re-evaluated by an expert reader, after which patients were categorised into groups: residual tumour at reassessment (non-CRs) or probable/definite complete response (CRs). The presence of MRI and endoscopic features were compared between groups. Results: 21 patients were included (67%male, mean age: 69.0  9.5y). 13/21 patients were reassessed as non-CRs, 8/21 patients as CRs. Non-CRs had larger fibrosis/tumour volume (P = 0.16) and a significantly lower tumour than CRs (P = 0.001). Mixed signal intensity on T2W-MRI was seen more often in non-CRs than in CRs (69% vs 38%, P = 0.20), as well as full-thickness or spicular fibrosis (92% vs 50%, P = 0.047). Residual nodal disease was found on MRI in 4/13 nonCRs, in 3/4 patients these nodes showed spicular fibrosis. In 6 patients endoscopy showed residual adenomatous tissue, while MRI did not indicate residual tumour. Conclusion: With today’s expertise complete responders can more accurately be selected for organ-saving treatment. The CRs that are still missed with restaging show distinct imaging features compared to clear CRs. These features can help improve selection of patients for a watch-and-wait strategy.

P224 A cadaver training model for D3 extended mesenterectomy in right colectomy for right colon cancer D. Ignjatovic, K. You, K. Yang, L. Rowehl, S. Giuratrabocchetta, J. Bandovic & R. Bergamaschi State University of New York, Stony Brook, NY, USA Aim: The aim was to evaluate a cadaveric model for simulation training in D3 extended mesenterectomy (D3EM) in right colectomy for right colon cancer. Method: Each participant performed D3EM on two cadavers. D3EM included: 1) vessel loop placement on venous trunk; 2) vessel loop on SMA; 3) ICA ligation; 4) MCA ligation; 5) right branch MCA division; 6) anterior flap mobilization; 7) ICV ligation; and 8) posterior flap mobilization. D3EM were evaluated by two independent observers. Following completion of D3EM, the SMV and SMA were cannulated by independent surgeons to evaluate for vessel injury. The specimens were analysed by a blinded pathologist. The Friedman test was used for quantitative data. A post-hoc test was used to calculate the resultant power of the study. The chisquare test was used for categorical data. Results: Three participants performed D3EM in six cadavers. Time (minutes) to complete the first and second D3EM did not differ significantly (P = 0.1667). A post-hoc test revealed that the study had an overall power of 43.7%. The D3EM specimen yielded an average of 0.21 lymph nodes/cm3. Conclusion: The data demonstrate that more than two repetitions are required to achieve proficiency in D3EM in right colectomy for right colon cancer.

P225 Bacterial contamination of the peritoneal cavity during left-sided resection with closed or open rectal stump: a randomised controlled trial F. Iordache, A. P. Prodan, M. B. Beuran & R. Bergamaschi State University of New York, Stony Brook, NY, USA Aim: A randomised controlled trial (RCT) was conducted to test the null hypothesis that there is no difference in peritoneal bacterial contamination during left-sided resection for cancer with closed or open rectal stump. Method: This was a single-center RCT registered as NCT02527382. Consecutive patients with left-sided cancer were randomised to elective resection with closed or open rectal stump. Primary endpoint was peritoneal contamination defined as the quantitative measurement of colony-forming units per milliliter (CFU/ml). Two culture samples for aerobes and anaerobes were taken from the pelvis before rectal transection and at completion of the anastomosis. 13 patients were needed in each study arm to detect a difference of 300 CFU/ml and reject the null hypothesis. Results: 26 patients were comparable for demographics, operating time, and length of midline incision. Samples did not differ for aerobic (P = 0.20), (P = 0.38) and anaerobic CFU/ml (P = 0.44), (P = 0.48) bacteria. There was a positive correlation between sample collection time interval and anaerobic CFU/ml in the open stump study arm (P = 0.01, rho=0.59322). There was a correlation between operating time and number of anaerobic CFU/ml in the open stump arm (P = 0.05).

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Conclusion: The risk for peritoneal contamination by anaerobes was time-dependent when the rectal stump was open.

P226 Long term results of the patients with pathologic complete response after neoadjuvant therapy for rectal cancer Y. Iscan1, B. Batman2, D. S. Uymaz3, K. R. Serin2, S. Bademler4, N. C. Arslan2 & O. Asoglu2 1 Department of General Surgery, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey, 2Department of General Surgery, Liv Hospital, Istanbul, Turkey, 3Oncology Institute, Istanbul University Faculty of Medicine, Istanbul, Turkey, 4Department of General Surgery, Bakirkoy Sadi Konuk Training and Research Hospital, Istanbul, Turkey Aim: To assess the prognosis of patients with pathologic complete response (pCR) after neoadjuvant therapy for rectal cancer. Method: Patients who underwent curative resection for primary rectal cancer after neoadjuvant chemoradio-and/or radiotherapy were tiered into 2 groups: Group 1: patients with pCR, Group 2: patients with limited response to neoadjuvant therapy. Oncologic results of two groups were compared. Results: Of 260 patients 31(12%) were in pCR group. Groups were similar in terms of demographic and surgical characteristics, surgical margins, and integrity of mesorectum and harvested lymph nodes. No perioperative mortality was seen. Morbidity rates were not different between groups (Group 1: 16%, Group 2: 20%, P = 0.832). Median follow-up was 54(1–150) months. Local recurrence rates were 0% and 7% in Group 1 and 2, respectively (P < 0.001). One (3%) patient had bone metastasis in Group 1 whereas distant metastasis rate was 13% in Group 2. Five-year overall survival was 84% and 82% (P > 0.05); disease-free survival was 83% and 82% in Group 1 and 2 (P < 0.05), respectively. Conclusion: Compete response to neoadjuvant therapy leads to decreased local and distant recurrence rates, however effect on survival is not significant. Novel algorithms are needed in management of patients with pCR.

P227 Long term results of laparoscopic surgery in treatment of rectal cancer Y. Iscan1, B. Batman2, K. R. Serin2, D. S. Uymaz3, S. Bademler4, N. Omarov5, N. C. Arslan2 & O. Asoglu2 1 Department of General Surgery, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey, 2Department of General Surgery, Liv Hospital, Istanbul, Turkey, 3Department of General Surgery, Bakirkoy Sadi Konuk Training and Research Hospital, Istanbul, Turkey, 4Oncology Institute, Istanbul University Faculty of Medicine, Istanbul, Turkey, 5Department of General Surgery, Istanbul University Faculty of Medicine, Istanbul, Turkey Aim: To present a single-surgeon series of laparoscopic surgery for primary rectal cancer. Method: Data of 428 consecutive patients were analysed retrospectively. All patients underwent laparoscopic rectal resection for histopathologically proven primary rectal carcinoma. Results: Mean age was 57.6  13.3, M/F: 249/179, mean BMI was 25.7  2.9. Tumour site was distal rectum in 198(46.3%), mid-rectum in 110(25.7%) and proximal in 120(28%) patients. Long-course chemorariotherapy and short-course radiotherapy were given in 201(47%) and 58(13.5%) patients. Surgery was open in 57 (13.3%), laparoscopic in 313(73.1%) and robotic in 58(13.6%) patients. Sphincter preserving surgery rate was 81.8% (61% for distal tumours). Median number of harvested and metastatic lymph nodes were 23(1–165) and 2(1–48), respectively. Mesorectum integrity was complete in 43.7%, near-complete in 39.7% and incomplete in 16.6% of patients. Pathologic TNM stages were 0 in 7%, I 20.1%, II in 33.2%, III in 36.7% and IV in 4%. Three patients had perioperative mortality. Periopertive morbidity rate was 19.6%: 19(4.4%) anastomotic leak. Median follow-up was 54(1–156) months. Five-year overall and disease free survival were 88.6% and 85%, respectively. Conclusion: Treatment of rectal cancer has evaluated during recent years. Neoadjuvant setting and new technologies have led to better surgical and oncologic results.

P228 Comparison of clinical results of TME performed by one team with those simultaneously performed by two teams for very low rectal cancer M. Ito, T. Sasaki, Y. Nishizawa, Y. Tsukada & K. Okada National Cancer Center Hospital East, Kashiwa, Chiba, Japan Aim: The aim of this study was to compare the short-term results of TME performed by one team with those simultaneously performed by two-teams.

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Poster Abstracts Method: We underwent the anus-preserving operation by one team in twenty-one and one by two teams in ten for C-stage I lower rectal cancer. Pelvic side-wall dissection was not performed in this study. In the one team operation, we initially performed trans-anal TME and move to abdominal procedure. We compared intra- or post-operative results and postoperative urinary function between two groups. Results: There were no differences in clinical backgrounds. Median total operative time and blood loss was 251 min and 102 ml in one team and 128 min and 32 ml in two teams. No complications were found in TAMIS related procedures. We never had grade III or more postoperative leakages in this study. We experienced one reoperation due to postoperative bleeding in the port site in the two teams group. R0 operation was achieved in all patients. More urinary dysfunction after 7 POD was found in one teams group than in two teams (19% vs 10%). Conclusion: TME simultaneously performed by two teams was feasible. Two teams surgery for low rectal cancer could reduce operative time dramatically.

P229 ‘Extreme’ chemoradiotherapy for locally advanced and recurrent rectal cancer complicated with fistulas or peritumoural abscesses V. Ivanov, S. Gordeyev, M. Chernykh, S. Tkachev, E. Kozak, Y. Surayeva & A. Rasulov Russian Cancer Research Center named after N.N. Blokhin, Moscow, Russia Aim: The purpose of the study was to determine the toxicity and feasibility of chemoradiotherapy in patients with locally advanced or recurrent rectal cancer complicated with fistulas or peritumoural abscesses. Method: This study was based on a retrospective analysis of patients treated during 2005–2015 for complicated locally advanced or recurrent rectal cancer. Inclusion criteria were: rectal cancer patients undergoing long-course chemoradiotherapy with rectovesical, rectovaginal, anal fistulas and/or radiological signs of peritumoural abscesses in patients with fever. Endpoints included toxicity, 30 day postoperative mortality and morbidity, R0 resection rate, tumour regression. Results: 21 patients were included in the analysis: 3 with anal, 5 with rectovaginal, 2 with rectovesical fistulas and 14 with peritumoural abscesses. Grade 4 toxicity was observed in one patient, grade 3 toxicity was observed in 2 (9.5%) patients. R0 resection was performed in 16 of 18 patients (88.8%), for whom radical surgery was initially intended. Grade IIIb postoperative complications occurred in 1 patient (5.5%). 3 patients (17,6%) had complete pathological response after chemoradiotherapy. Conclusion: Chemoradiotherapy in patients with complicated locally advanced or recurrent rectal cancer is not associated with increased toxicity or morbidity and may lead to a high R0 rate.

P230 Laparoscopic vs open surgery for advanced colon cancer N. Iwama, M. Tsuruta, H. Hasegawa, K. Okabayashi, T. Ishida, Y. Asada, K. Sugiura, Y. Suzuki, Y. Tajima, J. Nakadai, Y. Yoshikawa, T. Ando, H. Suzumura, T. Tokuda, N. Toyota & Y. Kitagawa Keio University School of Medicine, Tokyo, Japan Aim: The aim of this study is to clarify the value of laparoscopic surgery for advanced colon cancer. Method: The data of patients with cT3, T4 colon cancer (cecum, ascending, sigmoid, and rectosigmoid), who underwent curative resection in our hospital from 2006 to 2013, were reviewed. Background and outcome between laparoscopic surgery (LA) and open surgery (OP) group were statistically compared. Results: Out of 249 patients, 136 were in the LA group (54.6%). The LA group showed significantly longer operation time (250 vs 203 min P < 0.001), smaller amount of blood loss (10 vs 110 ml P < 0.001), and shorter postoperative hospitalization (9 vs 10 days P < 0.001). Not significant but relative low incidence of postoperative complications was observed in LA group compared to OP group (P = 0.064). No significant difference was observed in terms of recurrence free survival rate at 1 and 3 years (97.7 vs 97.3%, 87.0 vs 88.6%) Conclusion: From our experience, short and long term outcome of LA for colon cancer with cT3 or T4 were acceptable and not inferior to OP. Therefore, LA might be a feasible strategy for advanced colon cancer.

P231 Short and long-term outcomes after laparoscopic and open resection for colorectal cancer: a propensity-matched study F. Jelenc, A. Tomazic, M. Omejc, G. Norcic, Z. Stor & R. Juvan Department of abdominal surgery, Ljubljana, Slovenia Aim: To evaluate the short and long-term outcomes after laparoscopic (LR) and open resections (OR) for colorectal cancer. Method: Retrospective analysis of the 910 patients who underwent surgery for CRC from January 2007 to December 2009. 700 patients had entered the

evaluation. Propensity score matching was performed. Mann- Whitney U test and v2-test were used for analysis of statistical significance in numerical or descriptive variables respectively. Kaplan-Meier survival analysis with long-rank test and multivariate analysis with Cox’s proportional hazard ratio model were used. Results: No statistically significant difference in the postoperative complication rate was found between both groups. The length of postoperative hospital stay in the laparoscopic group was significantly shorter than that in the open group. The overall 5-year survival rate was significantly better in the laparoscopic group (74.1%) vs the open group (63.4%) (P = 0.013, test long rank). Multivariate analysis finds laparoscopic resection as an independent prognostic factor for better survival. Conclusion: Laparoscopic surgery offers shorter hospitalizations and better 5-year overall survival rates. There was no difference in the postoperative complication rate after laparoscopic vs open approach.

P232 Learning curve in robotic rectal cancer resection: real state. R. M. Jimenez-Rodriguez, M. R. Dorado-Manzanares, J. M. Diaz-Pavon, A. M. Garcia-Cabrera, M. L. Reyes-Diaz, J. M. Vazquez-Monchul & F. De la Portilla Hospital Universitario Virgen del Rocio, Sevilla, Spain Aim: Robotic-assisted rectal cancer surgery offers multiple advantages for surgeons. This surgical approach emerges as a technique aiming at overcoming the limitations posed by rectal cancer and other surgical fields involving difficult access, in order to obtain a shorter learning curve. Method: A systematic review of the literature of robot-assisted rectal surgery was carried out according to the PRISMA statement. The search was conducted in October 2015 in PubMed, MEDLINE, and the Cochrane Central Register of Controlled Trials, for articles published in the last 10 years and pertaining to the learning curve for robotic surgery for colorectal cancer. Results: A total of 34 references were identified but only nine full texts specifically addressed the analysis of the learning curve in robot-assisted rectal cancer surgery. The mean number of cases for phase I of the learning curve was calculated to be 29.7 patients, phase II corresponds to a mean number 37.4 patients. The mean number of cases required for the surgeon to be classed as an expert in robotic surgery was calculated to be 39 patients. Conclusion: Robotic advantages could have an impact on the learning curve for rectal cancer and lower the number of cases that are necessary for rectal resections.

P233 Robotic rectal cancer resection in elderly: has this approach any influence on complications? R. M. Jimenez-Rodriguez, L. M. Merino, M. L. R. Diaz, A. M. G. Cabrera, J. M. D. Pavon, J. M. V. Monchul, M. V. Maestre & F. De la Portilla Hospital Universitario Virgen del Rocıo, Sevilla, Spain Aim: Elderly patients may be at a higher risk of postoperative complications. The laparoscopic approach has not been shown to improve this complication rate especially in infections. Maybe robotics with their new advantages could overcome these complications in elderly population after rectal cancer surgery. Method: A total of 151 patients underwent surgery due to rectal cancer between January 2008 and June 2015. We divided these patients in three groups: under 65 yo, between 65 and 80 yo, and above 80 yo. Every patient complication during surgery and postoperative period was recorded. Further variables under consideration were: BMI and use of neoadjuvant therapy. We recorded short-term follow-up regarding outcomes of resected tumour. Results: The present study included 151 patients (94 males) with an average age of 64.7  10.16 years and a BMI of 27.46  3.89 kg/m². Operative procedures included 27 abdominoperineal resections, 5 Hartmann procedures and 119 low anterior resections. There were 21 conversions. When patients were divided into groups no differences were found between the age group and complications. Nevertheless, there were statistical differences between age group and neoadjuvant therapy (oldest patients had less neoadjuvant therapy). Conclusion: Elderly patients had no more complications when they underwent rectal resection with robotics.

P234 Oncologic outcome in rectal patients with pathologic negative lymph node following concurrent chemoradiation: a comparative study between clinically negative and positive lymph node metastasis J. K. Ju1, H. D. Kwak1, J. Kim2 & S.-H. Kim2 1 Chonnam National University Hospital, Gwangju, Korea, 2Korea University Anam Hospital, Seoul, Korea Aim: Neoadjuvant chemoradiotherapy has been established as standard treatment for locally advanced rectal cancer. However, the prognostic relevance of ypN0 status

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Poster Abstracts as compared with pN0 without neoadjuvant treatment is not known. The purpose of this report was to compare the outcome with pathologically negative node between clinically negative and positive lymph nodes. Method: All patients were diagnosed with rectal cancer from February 2007 to March 2015 at a tertiary referral center. Excluding distant metastasis at diagnosis, we included the cases with R0 resection, elective operation and having a follow-up period. Our institutional indication for preoperative radiation therapy are those with positive circumferential resection margin, suspicious lymph nodes beyond total mesorectal excision, cT4, and cT3 requiring intersphincteric resection. Results: A total of 92 patients were included. The operative procedures had significant differences between the groups; most cases were intersphincteric resections in the cN0 group, whereas low anterior resection was the most common procedure in cN+ group which also had poorer differentiation. There was no difference between the groups on both recurrence-free survival and overall survival. Conclusion: Our results show clinical T and pathologic stage is more advanced in cN+ than cN0 group. Oncologic outcome was similar with regard to ypN0 between the groups.

P235 Laparoscopic colorectal surgery outcomes of patients with colorectal cancer who previously underwent abdominal surgery E. Kamer, F. Cengiz, T. Acar, E. Durak & M. Haciyanli Izmir Katip Celebi University Ataturk Training and Research Hospital, Department of Surgery, Izmir, Turkey Aim: The advantages of minimally invasive procedures in colorectal surgery are now accepted worldwide. Formerly, previous abdominal surgery was accepted as a relative contraindication for laparoscopic surgery. In this study, we aimed to present our laparoscopic colorectal surgery outcomes of patients who previously underwent abdominal surgery. Method: Laparoscopic colorectal surgery was performed in 121 patients between January 2014 and December 2015. Patients were divided into two groups; those who previously underwent abdominal surgery (PUAS, n = 34) and those who did not (PDNUAS=87). Results: The mean age of patients was 62(range: 19–84). Indications for surgery and the surgical procedures are presented in Table 1. Previous abdominal surgical procedures of the patients are presented in Table 2. Patients were most frequently encountered who suffered with respiratory complications in postoperative period (Table 3). The indication for conversion to open surgery are presented in Table 4. Conclusion: Our study showed a statistically significant difference in terms of operation time, frequency of intestinal injury, postoperative ileus and length of hospital stay in patients who underwent previous abdominal surgery, compared to patients who did not undergo previous abdominal surgery. T stage of tumour, type of surgical procedure, experience of surgeon, BMI and ASA score of patient have an important role in rates of conversion to open surgery and postoperative complications.

P236 Long-term outcomes of laparoscopic left hemicolectomy in colon cancer: comparative, retrospective analysis B. M. Kang1, G.-S. Choi2, J.-S. Park2, H. J. Kim2 & S. Y. Park2 1 Department of Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea, 2Department of Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea Aim: The aim of this study is to evaluate the oncologic outcomes of laparoscopic left hemicolectomy (LHC) compared with open LHC. Method: From January 1999 to December 2013, a total of 138 patients with radical LHC for colon cancer at two hospitals were included in this study. Clinicopathologic results and survival were compared between laparoscopic and open LHC, retrospectively. Results: Laparoscopic LHC was performed in 87 patients and open LHC in 51 patients. Baseline characteristics were well balanced in both groups. Operation time was significantly shorter in the laparoscopic group (232.8 minutes vs 146.0 minutes, P = 0.000). In two (2.3%) patients in the laparoscopic group, open conversion was necessary. The number of harvested lymph nodes was similar in both group (18.7 in the open group vs 16.4 in the laparoscopic group, P = 0.315). After 24 months of median follow-up period, 3-year disease free survival was 74.7% in open group and 88.0% in laparoscopic group (Log Rank P = 0.060) and 3-year overall survival was 91.5% in open group and 98.5% in laparoscopic group (Log Rank P = 0.055) Conclusion: Laparoscopic LHC is safe technically and oncologically in cancers located from distal transverse to descending colon.

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P237 Results of transanal total mesorectal excision L. Kazieva, E. Rybakov, S. Chernishov, O. Maynovskaya & Y. Shelygin State Scientific Centre of Coloproctology, Moscow, Russia Aim: Тo evaluate the quality of specimen after transanal total mesorectal exision (TA TME). Method: Patients with c/усT2-3N1-2M0 cancers at 7.1  2.2 (3–11) cm from the anal verge were selected for TA TME. Results: 30 (19 male) patients at mean age of 60  11.16 (40–76) years had TA TME. The mean body mass index (BMI) was 24.8  2.6 (19–30) kg/m2. Mean size of tumour was 35  12 (15–65) cm. TA TME was performed using TEO Karl Storz platform. Mean total operating time was 294.3  57 (210–400) min. TA TME took 114.3  46.88 (40–200) with minimal blood loss. Fifteen anastomosis were hand sewn. Median postoperative length of stay was 10 (7:14) days. There was no 30-day mortality. Surgical complications were anastomotic leak (n = 6), ileus (n = 6), pelvic hematoma (n = 2). In accordance with Quirke classification 17 of specimens were grade 2, 8 grade 3, 5 - grade1. Conclusion: TA TME is a feasible method for oncologic resection of mid- and low rectal cancer. Further studies are necessary to evaluate potential benefits of this surgical approach.

P238 Five year follow up of MRI directed abdomino-perineal excision K. Keogh, E. White, A. Gee, M. Osborne, N. Smart & I. Daniels Royal Devon and Exeter Hospital, Devon, UK Aim: The advent of MRI staging through the MERCURY study and more latterly the appreciation of the extra-levator technique has reduced rates of circumferential resection margin (CRM) positivity in abdomino-perineal excision (APE). We have assessed survival rates in our institution with 10 years’ experience of MRI directed resection for patients requiring an abdominoperineal excision. Method: Theatre records were interrogated to identify patients who underwent APE under two consultants. Outcomes were determined using the trusts information technology system for follow up or readmission, coroners and GP records. Medcalc software was used for survival analysis. Results: 131 patients with adenocarcinoma were identified, with 105 still alive and 26 deceased. Kaplan Meier analysis of survival following APE demonstrated 77% survival at 5 years. Extending that figure to ten years revealed 57% survival. 24% underwent radiotherapy (87.5% 5 year survival) and 29% had adjuvant chemotherapy (76% 5 year survival). Only 2 (2.2%) patients had a positive CRM. Conclusion: A small surgical team focused on patients requiring an APE, selective use of CRT based upon MRI staging translates into improved survival.

P239 Transrectal ultrasound for diagnosis of rectal cancer invasion of anal sphincter R. Khoury, A.-A. Darawshy, H. Gilshtein, D. Duek & W. Khoury Rambam health care campus, Haifa, Israel Aim: To evaluate preoperative transrectal ultrasound (TRUS) findings in determining anal sphincter invasion and type of surgical treatment. Method: Patients with low rectal cancer, 1–6 cm from anal verge, who underwent surgical treatment, between 2010 and 2015, were identified. Data pertaining to physical exam, rectoscopy and TRUS were retrieved. In patients with rectal adenocarcinoma, TRUS was performed before and after neoadjuvant radiotherapy. TRUS findings were compared with the postoperative histopathology findings. Accuracy of TRUS in diagnosing sphincter invasion was determined. Results: TRUS was performed in 56 patients. Their mean age was 64 years (13) and median tumour height 5 cm (range 1–6). Tumour site was anterior in 27 patients, posterior in 13, lateral in 8 and circular in 9. At postoperative histopathology, T stage was T4 in 4 patients (3 with anal sphincter invasion), T3 in 24, T2 in 2 and T1 in 12. TRUS sensitivity and specificity in diagnosing anal sphincter invasion were 100% and 86.8%, respectively. Its positive predictive value was 30%. In a subgroup of patients with rectal adenocarcinoma, who were treated with preoperative radiotherapy (48 patients), the specificity of post-radiation TRUS was 100%. Conclusion: TRUS overestimated sphincter involvement. Decision making as to whether to perform restorative procedure or not should be also based on operative findings.

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Poster Abstracts P240 Risk factor analysis on the anastomotic leakage (AL) after curative surgery in rectal cancer and the impact of AL on the oncologic outcome H. J. Kim, R. Yoo, B.-H. Kye, G. Kim & H.-M. Cho St. Vincent’s hospital, The Catholic University of Korea, Suwon, Korea Aim: This study aims to verify the impact of AL on the oncologic outcome of patients undergoing curative resection of rectal cancer. Method: A total of 271 patients who underwent curative resection of rectal cancer from Jan. 2009 to Dec. 2013 were assessed. Patients with AL were compared to the patients without AL on overall and disease-free survival. Variables for risk factors include age, sex, ASA class, location of recurrence, mortality, chemoradiation therapy, preoperative CEA level, clinical T and N stages as well as the necessity of combined pelvic invasion resection. Also, pathologic results were analysed. Results: 11 out of 271 patients developed an AL postoperatively. The mean disease-free survival (DFS) time for the patients without anastomotic leakage was 64.1 months, whereas that for the patients with AL was 41.2 months [P = 0.04]. The patients without AL had a 75.9  2.8% 3-year survival rate, while the equivalent figure for patients with AL was 53.8  1.3%. 3-year overall survival rates for the two groups were 95.3  1.5% for the patients without AL and 68.8  1.2% for patients with AL [P = 0.00]. Conclusion: AL was significantly associated with poor oncologic outcome. Pathologic variables as risk factor did not influence AL. However, tumour burden of the primary lesion and surgical difficulty may affect the oncologic outcome.

P241 Three ports laparoscopic right colectomy compared with conventional five ports laparoscopy for malignancy J. m. Kim1, S. J. Kwag1, S. K. Choi1, Y. T. Ju1 & J. K. Lee2 1 Gyeongsang National Univ. Hospital, Chiram-dong, Jinju-si, Korea, 2Gyeongsang National Univ. Changwon Hospital, Seongsan-gu, Changwon-si, Korea Aim: Single incision laparoscopic colectomy (SILC) for malignancy is a recent advance in minimally invasive surgical techniques. However, there were some technical difficulties with SILC. Method: Eighty-seven patients with right sided colon adenocarcinoma underwent laparoscopic right colectomy between April 2012 and March 2016. Thirty-seven of these patients underwent three ports laparoscopic surgery (TPLS) and were compared with the other 50 patients who had conventional five ports laparoscopic surgery (CPLS). Clinical characteristics, intraoperative and postoperative data were analysed. Results: The body mass index (P = 0.601), history of previous abdominal operations (P = 0.773) and presence of intraperitoneal adhesions (P = 0.610) were similar between groups. The operation time was longer in the conventional group than in the TPLS group (191  30 vs 162  31 min; P = 0.001). There were no significant differences between the two groups for open conversion rate (P = 0.520) or postoperative hospital stay (P = 0.832). The number of harvested lymph nodes (27.2  16.3 vs 20.4  10.8; P = 0.073) were not different between the groups. Postoperative morbidity was similar in both groups (P = 0.768) Conclusion: Three ports laparoscopic right colectomy is a safe and feasible procedure for right side colon cancer.

P242 Is there any difference in clinical outcome according to the tumour subsite location within the colon when performing laparoscopic complete mesocolic excision? M. K. Kim1, I. K. Lee1, H.-M. Cho2, B.-H. Kye2 & J.-G. Kim1 1 Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea, 2Department of Surgery, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea Aim: Variants of laparoscopic colectomy are different from each other according to the tumour subsite within the colon, and short-and long-term outcomes of laparoscopic complete mesocolic excision (CME) for colon cancer have never been compared based on the tumour location. Method: Clinical data of patients who received laparoscopic colectomy for primary colon cancer between April 1995 and December 2010 from a single surgeon were retrospectively reviewed. Data were analysed and compared among three groups; patients whose tumour location was between ascending and proximal transverse colon (A, n = 142), mid transverse and descending colon (TD, n = 55), and sigmoid and rectosigmoid colon (S, n = 214). Results: Female patients were more common in group A (53.5% vs 38.2% vs 39.3%, P = 0.020). Other baseline characteristics were comparable. Operative time was shorter in group S than another groups (245[145–855] vs 279[150–485] vs 295 [145–455] min, P = 0.000). There were no differences among the groups in perioperative complications and patient recovery. Local recurrence rate was comparable

among the groups (4.2% vs 5.5% vs 3.3%, P = 0.594) for the median follow up period of 73(0–120) months. Conclusion: Laparoscopic complete mesocolic excision for colon cancer can be performed with comparable short- and long-term outcomes regardless of tumour subsite except for the operative time.

P243 Higher visceral/subcutaneous fat area ratio measured by computed tomography is associated with recurrence and poor survival in patients with mid and low rectal cancer S. H. Kim, S. H. Lee, K. H. Lee & B. K. Ahn Hanyang University College of Medicine, Seoul, Korea Aim: The aim of this study was to investigate the association between visceral obesity measured by computed tomography and clinical outcomes in mid and low rectal cancer (MLRC). Another objective was to identify the obesity index that most accurately reflected clinical outcomes. Method: We investigated 125 patients who underwent curative resection for MLRC between 2004 and 2010. Visceral fat area (VFA) was defined as the intraabdominal adipose tissue area measured by CT at the umbilicus level. Body mass index (BMI), total fat area (TFA), VFA, subcutaneous fat area (SFA), and visceral/ subcutaneous fat area ratio (V/S ratio) were analysed. Results: Recurrence was detected in 28 (22.4 %) patients. Recurrence was significantly associated only with the V/S ratio (1.02  0.45 vs 0.86  0.34, P = 0.046). Stage, preoperative CEA level, V/S ratio, lymphatic, and perineural invasion were significantly associated with recurrence in univariate analysis. Multivariate analysis showed that V/S ratio (P = 0.013, 95% CI = 1.293–8.637) and perineural invasion were significant and independent risk factors for recurrence. Disease-free and overall survival of the obese group (V/S ratio > 1.0) was lower than that of the non-obese group. Conclusion: V/S ratio is an important predictive factor and the most optimal obesity index for predicting recurrence of stage I-III MLRC.

P244 Malignant colorectal polyps - a reappraisal and cost benefit analysis R. Knox1,2, K. Da Silva1, A. Kauffman1 & A. Engel1,3 1 Royal North Shore Hospital, Sydney, NSW, Australia, 2Orange Health Service, Orange, NSW, Australia, 3University of Sydney, Sydney, NSW, Australia Aim: Adenocarcinoma is found in approximately 5% of endoscopic colorectal polypectomies. Current practice around histological risk factors leads to significant overtreatment, the majority undergoing colectomy have no residual malignancy. We aimed to reassess histological predictors, with a cost-benefit appraisal, to optimise when to resect. Method: A pathology service for 7 hospitals in a major city was searched for polypectomies containing adenocarcinoma, along with subsequent colectomy where performed. 2 pathologists independently verified the histological features. A Logistic Regression model to predict a positive colectomy was constructed, and cost benefit analysis performed to determine parameters for resection. Results: Of 117 malignant polyps from 2010 to 2015, 43 underwent colectomy. 6 had nodal metastases, 4 had residual mural disease only. On univariate analysis, width of invasion was the only predictor of both LN and mural disease. Tumour budding, grade and depth were significant predictors of nodal disease. Multivariate LR predicted malignancy in subsequent colectomy (AUC of 0.836, P < 0.001). Cost-benefit analysis gave a 100% sensitive and 55% specific threshold (0.10 predicted probability) to warrant resection, reducing expected mortality from negative colectomies from 2.6% to 1.2%. Conclusion: By reinterpreting accepted criteria, the burden on individuals and health systems of unnecessary surgery might be safely reduced.

P245 Malignant colorectal polyps – external validation of a clinical decision making tool R. Knox1,2, K. Da Silva1, A. Kauffman1, I. Brown4,5 & A. Engel1,3 1 Royal North Shore Hospital, Sydney, NSW, Australia, 2Orange Health Service, Orange, NSW, Australia, 3University of Sydney, Sydney, NSW, Australia, 4Pathology Queensland, Brisbane, QLD, Australia, 5Envoi Specialist Pathologists, Brisbane, QLD, Australia Aim: Current practice regarding malignant colorectal polyps leads to significant overtreatment, the majority proceeding to colectomy having no residual malignancy. Following on from a pilot study we aimed to create a clinical decision making tool and evaluate on an external cohort. Method: From our previous study of 117 malignant polyps a multivariate Logistic Regression model to predict a positive colectomy was constructed. This model maintained 100% sensitivity but improved specificity from 13.5% to 51% for lymph

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Poster Abstracts node disease, and 6.1 to 55% for either nodal or mural disease. An external cohort was identified from a recently published study of similar demography, and a dataset of 239 patients provided by the authors for model validation. A clinical decision making tool was developed for online publication for prospective application. Results: Sensitivity for nodal disease was maintained (100%) with specificity improved from 20 to 34% using a resection threshold of 2.5% probability. Sensitivity for either nodal or mural disease improved from 92 to 100%. The expected mortality rate from false negatives / positives reduced from 2.9 to 2.3% compared with current criteria. See malignantpolyps.wordpress.com Conclusion: By reinterpreting accepted criteria, the burden on individuals and health systems of unnecessary colectomy can be safely reduced.

P246 Transanal total mesorectal excision (TaTME) in rectal surgery: effects on quality of life and function T. Koedam, G. van Ramshorst, C. Deijen, A. Elfrink, J. Bonjer & J. Tuynman VU University Medical Center, Amsterdam, The Netherlands Aim: Evaluation of quality of life and function after TaTME. Method: Prospective analysis of consecutive rectal cancer patients undergoing TaTME between March 2014 and November 2015. Patients completed EORTC QLQ-C30, EORTC QLQ-CR29, EQ5D and LARS questionnaires. A comparison was made with outcome after laparoscopic surgery described in COLOR II trial. Repeated-Measures ANOVA was used for analyses. Results: Twenty-nine patients were included (median 65 years, range 48 – 86), twenty-one males, and median follow-up 11 months (range 6–22). Median tumour distance from anal verge 6 cm (range 1–15). Twenty-one patients received neoadjuvant treatment and all patients a low anterior resection. One month postoperatively, worse scores were reported for EQ5D (P = 0.011), pain (P = 0.011), health status (P = 0.010), physical and role functioning (P < 0.001), body image (P = 0.009), fatigue (P = 0.002), and male sexual drive (P = 0.042). Scores normalised after six months. Mean preoperative LARS, faecal incontinence and frequency scores were 17 (95% CI 8, 8–25, 2), 4.8 (2.2–11.8) and 19.0 (7.2–30.9). Two months after stoma reversal, patients experienced significantly worse symptoms (P < 0.05). At 6 months, scores improved but remained worse than before surgery. Scores are comparable with laparoscopic resections. Conclusion: TaTME enables sphincter saving procedures for low rectal cancer with similar quality of life and functional outcome to laparoscopic resection.

P247 Laparoscopic approach in managing a tailgut cyst: a case report N. Kolodziejski & R. Scherer Waldfriede Hospital, Berlin, Germany Aim: Big retroperitoneal cysts rarely occur. The incidence is around 1:5750 to 1:250.000. One of the differential diagnosis is the tailgut cyst. Tailgut cysts are congenital malformations located in the retrorectal space. Middle-aged women are mostly affected. Various options for surgical treatment have been described. We would like to demonstrate the laparoscopic approach. Method: We present a case report of a 52-year old woman. Results: In February 2016 the patient came to our consultation with unclear chronic pelvic pain. In the past she had already two diagnostic laproscopies in another hospital without a clear finding. Many different diagnostic investigations were conducted (CT abdomen, sonography, endosonography, colonoscopy and MRI abdomen). The MRI demonstrated a 6, 2 x 4, 6 cm tumour in the pelvis which was retroperitoneal, left pararectal and precoccygeal, and was felt to be cystic. In March 2016 our patient underwent a laparoscopic excision of the cyst. The pathological examination revealed a tailgut cyst without any evidence of malignancy. The postoperative course was uncomplicated. Conclusion: Surgical resection is the recommended treatment for unknown retroperitoneal tumours to discover the definitive diagnosis and treat symptoms. The laparoscopic approach in managing a tailgut cyst in the upper pelvis is a safe and feasible technique.

P248 Mixed adenoneuroendocrine carcinoma of the left colon S. Qiu1, O. Warren1, S. Mills1, R. Goldin2, C. Kontovounisios1 & P. Tekkis1 1 Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London, London, UK, 2Department of Pathology, Imperial College NHS Trust, Imperial College London, London, UK

showed the presence of adenocarcinoma and high-grade neuroendocrine carcinoma consistent with MANEC. Only 8 cases of caecal MANEC has been reported and less than 40 in the stomach. This is the first report of MANEC reported of the descending colon affecting the youngest patient to date. Conclusion: MANEC is exceedingly rare and is defined as a tumour consisting of adenocarcinomatous and neuroendocrine differentiation, each component representing at least 30% of the tumour. It is aggressive and has a high propensity for local invasion and distant metastasis. As a result it is associated with a poor outcome, with overall survival from diagnosis of 21 months. There is currently no consensus on effective adjuvant oncological treatment of MANEC. Chemoradiotherapy appears to prolong recurrence free survival in localised disease. First line therapeutic regimens for adenocarcinoma and neuro-endocrine tumours seem equally effective.

P249 The role of neurotensin as a novel biomarker in the endoscopic screening of high risk population for developing colorectal neoplasia C. Kontovounisios1,2, S. Qiu1, S. Rasheed2, A. Darzi2 & P. Tekkis1,2 1 Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London, London, UK, 2Department of Colorectal Surgery, The Royal Marsden Hospital, London, UK Aim: Colorectal Cancer screening programs aim at early detection of cancer in order to reduce incidence rates and mortality. The aim of this study is to identify the role of Neurotensin in the endoscopic screening of high risk population for developing colorectal neoplasia. Method: Blood samples from patients referred for colonoscopy. Results: There were 26 patients in total. 12 were healthy and 14 had colon pathology (13 high grade dysplasia adenomatous polyps, 1 adenocarcinoma). There were no statistically significant differences in the clinical and biochemical parameters between those with colon pathology and the healthy group, except Neurotensin levels. Colonic pathology was associated with 3, 7-fold increase in NT levels. In multivariate analysis patients with pathology in colon have increased serum Neurotensin levels compared to controls adjusted for age, gender, BMI and co-morbidities. The value of 12.93 ng/dl is associated with 87.5% sensitivity and 91.7% specificity for discriminating colon pathology from normal colonic epithelium (P = 0.001). Conclusion: Neurotensin plasma values differentiate healthy people from patients suffering from colonic pathologies such as adenomatous polyps and cancer. The use of Neurotensin as a potential endoscopic screening tool for identifying high risk population for developing colorectal cancer is promising, but much has to be done before it is validated in larger-scale prospective studies.

P250 Which clinical and patient characteristics influence choice of imaging during post-operative colorectal surveillance? M. Koullouros1, J. Schneider1, C. Mackay2, G. Ramsay2, C. Parnaby2 & L. Stevenson2 1 University of Aberdeen, School of Medicine and Dentistry, Aberdeen, UK, 2 Aberdeen Royal Infirmary, General Surgery, Aberdeen, UK Aim: The optimal imaging follow-up strategy for colorectal cancer remains to be determined. We sought to identify which variables influence clinician choice of first imaging modality. Method: All patients at a single centre undergoing colorectal cancer resection in 2012 were included. A prospectively maintained pathology database was supplemented with imaging data. Our follow up protocol is alternating ultrasound and CT at six monthly intervals. Results: Of 256 patients. 66 (25.7%) had an ultrasound and 156 (60.1%) had CT as their initial scan, whilst 34 (13.2%) had neither. Younger patients (P < 0.001) and those with advanced disease (P = 0.017) were more likely to have CT on the first round of follow up. Tumour location did not influence imaging modality. On second round, CT (n = 91), 35 (38.5%) detected distant metastases, 2 (2.2%) had local recurrence and 4 (4.4%) had both. Ultrasound scans (n = 89) detected 8 (9%) distant metastases but no local recurrence on second round. Conclusion: Patients who received ultrasound scans as their initial imaging modality appear to be selected on age and stage. However, the high diagnostic yield by CT on second imaging could be due to time interval but may highlight increased sensitivity of this modality.

Aim: To add to the existing understanding of colonic mixed adenoneuroendocrine carcinoma (MANEC) by reporting a previously undocumented case of perforated MANEC of the left colon and systematic review of existing literature. Method: Report of the clinicopathological data and systematic review of literature. Results: A 27 year old woman underwent emergency left hemicolectomy for a perforated left colon cancer (stage: T4aN2bM1a). Histological analysis of the tumour

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Poster Abstracts P251 Colorectal cancer surgery in elderly in Russia: risk factors and results A. Kravchenko, D. Markaryan, P. Tsarkov & V. Nekoval First Moscow State Medical University named after I. M. Sechenov, Moscow, Russia Aim: Review the outcome of elderly patients undergoing major colorectal surgery. Method: A review of 122 patients after colorectal surgery. Comorbidities were quantified using the Charlson Comorbidity Index, ASA and CR-POSSUM scores. Outcome measures were morbidity rates, 30-day mortality rates and overall survival. Results: The average age of the patient group was 79 (range 75–95) years. The index of comorbidity was 7.5 (4–11) and 82% of patients were classified ASA III and above. The predicted mortality rate based on CR-POSSUM was 13.2%. Preoperatively treatment day - 12.7 days, 11 patients (9%) were implanted with temporary pacemakers. All operations were elective and open. Resection with primary anastomosis was performed in 106 patients (87%), APR - 11 patients (9%) and 5 patient (4%) had a Hartmann’s procedure. Postoperative complications occurred in 66 (54%) patients. The 30-day mortality was 4.9%. Cumulative 5-year survival was 67.3%, cancer specific survival – 77.1%. Everyday dependence on one’s people we revealed at the most 27% our patients needed partial help and only 4% of patients who required permanent care. Conclusion: Treatment decisions must be individualized based on each older person’s physical state. A Multidisciplinary Team decision-making process assists surgeons in achieving acceptable morbidity, mortality and survival rate in the majority of elderly patients with colorectal cancer.

P252 Laparoscopic and open complete mesocolic exision with D3 lymphadenectomy for left-sided colon cancer A. Kravchenko, P. Tsarkov, I. Tulina & A. Leontyev Sechenov First Moscow State Medical University, Moscow, Russia

confirmed (P = 0.01). We also deduced a statistically significant relationship between cancer severity in the Astler – Coller scale and OS in colorectal cancer patients (P = 0.00015). Conclusion: These operations are complex and require meticulous planning both in terms of investigation and strategy, but also in terms of time, resources and manpower. If all of these elements are carefully respected, good results can be achieved both in terms of morbidity/mortality and survival.

P255 Closing the peritoneum after laparoscopic abdominoperineal resection: is it really necessary B. Krebs, M. Kozelj, A. Ivanecz & S. Potrc UCC Maribor, Maribor, Slovenia Aim: After abdominoperieal resection (APE) the large empty space remains in pelvis. One of the most common approaches to this problem is closure of the peritoneum, the procedure which is easy in open but more challenging in laparoscopic operations. Others propose insertion of omentum in empty space, closing gap with mesh or even leaving gap open. Method: We checked the literature about recommendations how to treat the empty space after APE and asked our colleagues abdominal surgeons how they do this part of the operation on surgical social network Researchgate. We also analyse our cases after APE with special regards to postoperative obstruction due to open or closed peritoneum. Results: We didn’t find any strong recommendations about this issue in literature and between colleagues. Even more, opinions are contradictory. Our data suggest that in the cases when ideal closure is not possible it is better to leave the gap open. Major problems arose when peritoneum was only partly closed and small bowel slipped in this narrow gap. Conclusion: Although the closing of peritoneum over empty pelvis seems to be a simple step in rather complicated procedure it is very important issue which could jeopardy the whole operation and demands further investigations.

This abstract has been previously published.

P253 Matrix metalloproteinases mmp9 and mmp28 in colorectal cancer Z. Lorenc, K. Lorenc-Podg orska, W. Krawczyk, M. Majewski & M. Urszula Medical University of Silesia, Katowice, Poland Aim: To evaluate changes in the genes encoding the transcriptional activity of MMP9 and MMP28 in the colorectal cancer and an attempt to mark the value of their diagnostic and prognostic potential and also possibilities of using these genes in molecularly targeted therapy. Method: Specimens were collected during surgical resection from 28 patients with colorectal cancer that meet certain criteria. Molecular analysis was performed using the oligonucleotide microarray, for which mRNA was extracted from adenocarcinoma and healthy colon tissue. The results were validated using qRT-PCR technique. Results: Three groups were created: a control group free of neoplasm, a group of tumours with low clinical stage, a group of adenocarcinomas with a high degree of advancement. As a result of analysis of 44 mRNA encoding matrix metalloproteinases, two genes were selected, whose changes in mRNA levels can be used to differentiate healthy colon tissue from adenocarcinoma. These include genes encoding the MMP-9 and MMP-28. MMP-9 mRNA levels increases in adenocarcinoma in comparison to control, MMP-28 mRNA levels in adenocarcinoma is reduced in comparison to control. Conclusion: Changes in the concentration profiles of MMP9 and MMP28 mRNA may be a complementary marker for the diagnosis of colorectal cancer.

P254 Multiorgan resections for pelvic tumours D. Jajtner, T. Lesniak, W. Krawczyk, Z. Lorenc & M. Majewski Medical University of Silesia, Katowice, Poland Aim: To present the experience of the Regional Comprehensive Cancer Center in Bielsko-Biala with multiorgan resections for pelvic tumours, and the impact of these procedures on patient survival. Method: Clinical records of patients with pelvic tumours who underwent multiorgan “en-bloc” resections were retrospectively analysed. En-bloc, multiorgan pelvic structure resections were performed in 129 patients. Short and long term outcomes were evaluated in terms of the site of primary malignancy, histological type of neoplasms, number of “en-bloc” removed organs, early and late complications, and the impact on DFS and OS. Results: We noted a 54%, 5-year DFS and 64%, 5-year OS in one evaluated group of patients following complete en-bloc resection. The influence of the number of removed organs on OS in patients who underwent multiorgan resections was

P256 Outcomes of pelvic exenteration: a comparative study of open vs. laparoscopic or robotic approach for locally advanced rectal cancer H. D. Kwak1, J. K. Ju1, J. Kim2 & S.-H. Kim2 1 Chonnam National University Hospital, Gwangju, Republic of Korea, 2Korea University Anam Hospital, Seoul, Republic of Korea Aim: Approximately 10% of rectal cancers involve adjacent organs and require extensive surgery for complete resection. This study is designed to compare the feasibility and oncologic outcomes between open and laparoscopic or robotic approach. Method: We selected locally advanced rectal cancer fixed to adjacent pelvic organs, and resected one or more organs partly or totally including bones. Removal of any type of local recurrence was also defined as pelvic exenteration, regardless of uni- or multi-organ resection including sacrectomy and/or coccygectomy with open method. A total of 54 patients (27 patients, each group) were performed pelvic extenteration from April, 2011 to November, 2013. We analysed prospectively collected data for short- and long-term outcomes. The surgical procedures were done by experienced colorectal surgeons, urologists and gynaecologists in a tertiary referral centre. Results: There were no significant differences in patients’ characteristics and perioperative outcomes. However, intraoperative transfusion was lower in laparoscopic or robotic group than open group (P < 0.001). The first feeding day (P < 0.001) and mean hospital stay (P = 0.042) was also shorter. In oncologic outcomes there were no differences between the groups. Conclusion: Laparoscopic or robotic pelvic exenteration shows feasible and acceptable results in short- and long-term outcomes compared those of open method.

P257 Impact of obesity on total hospital costs in patients who underwent colorectal cancer surgery Y.-H. Kwon1, E. K. Choe2, D. W. Lee1, I. Song1, M. J. Kim1, J. W. Park1, S.-B. Ryoo1, S.-Y. Jeong1 & K. J. Park1 1 Seoul National University College of Medicine, Seoul, Republic of Korea, 2Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea Aim: To determine whether obesity increases hospital costs in patients who underwent colorectal cancer surgery. Method: We retrospectively collected hospital billings for 656 patients who underwent surgery for stage I-III colorectal cancer and analysed the association between obesity and hospital cost. Obesity was assessed by preoperative body mass index (BMI) and computed tomography-assessed total fat amount (TFA). Patients were classified according to their BMI (normal-BMI; 68 years).

P260 Prediction of perioperative mortality in elective colorectal cancer surgery N. V. L. Peredo1, J. M. Arevalo2, D. M. Valdezate1, V. P. Martı1, S. A. G. Botello1,2 & A. E. Macıas1,2 1 Hospital Clınico Universitario de Valencia, Valencia, Spain, 2Universidad de Valencia, Facultad de Medicina, Valencia, Spain Aim: To determine the best statistical method of predicting perioperative mortality in elective colorectal cancer surgery (PMECCR). Method: We conducted a retrospective study between 2012 and 2015. The variables studied were: age, sex, ASA status, heart disease, COPD, Charlson index, duration of surgery, need for transfusion and laparoscopic approach. Perioperative death was defined as death up to 30 days after surgery. Descriptive statistics were calculated after creating three probability prediction models based on logistic regression

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analysis (LR), classification trees (CT) and neural networks (NN). We did ROC curves and we calculated area under curve (AUC) for each prediction model. Finally, we compared ROC curves with the De Long test. Results: During the study period 693 patients were operated on an elective basis. The rate of PMECCR was 3.5. Prognostic factors identified by regression were: heart failure (P = 0.013), COPD (P = 0.007), age (P = 0.003) and use of laparoscopy (P = 0.021). The ROC AUC in LR model was 0.5, in CT model was 0.51 and in NN was 0.881. DeLong test only showed differences between NN model with respect to the other Method (P < 0.001). Conclusion: The best model of prediction of PMECCR was NN model with the best AUC (0.881).

P261 Radiofrequency ablation vs. surgical resection for metachronous isolated hepatic metastasis from colorectal cancer; Comparison of long-term oncologic outcomes after curative resection B. C. Lee, H. G. Lee, I. J. Park, S. Y. Kim, K.-H. Kim, J. H. Lee, C. W. Kim, J. L. Lee, Y. S. Yoon, S.-B. Lim, C. S. Yu & J. C. Kim Asan Medical Center, Seoul, Republic of Korea Aim: Long-term oncologic outcomes after resection and radiofrequency ablation (RFA) of metachronous isolated hepatic metastasis from colorectal cancer have not been specifically investigated. We investigated recurrence pattern and oncologic outcomes after treatment of metachronous isolated hepatic metastases according to treatment modality. Method: We retrospectively analysed 123 patients treated with hepatic resection and 82 patients treated with RFA. We compared clinicopathological data, re-recurrence pattern after the treatment of hepatic metastasis, and re-recurrence free survival (RFS) rates. Results: Two groups were similar in clinicopathological characteristics. The RFS rate after treatment of hepatic metastasis was significantly higher in resection group (P = 0.015). The size and number of hepatic metastasis, primary tumour stage, disease-free interval to hepatic metastasis, and the modality of treatment for hepatic metastasis were confirmed as associated factors with re-recurrence after treatment of hepatic metastasis. Among patients with solitary hepatic metastases of ≤3 cm, the RFS rate was not different between the resection and RFA group (P = 0.491). Conclusion: Surgical resection for metachronous hepatic metastasis showed higher RFS and lower local re-recurrence rates in the liver. However, the RFS rate in patients with a solitary hepatic metastasis of ≤3 cm was similar between two groups.

P262 Clinocopathological features and surgical options of synchronous colorectal cancer B. C. Lee, C. S. Yu, J. L. Lee, C. W. Kim, Y. S. Yoon, I. J. Park, S.-B. Lim & J. C. Kim Asan Medical Center, Seoul, Republic of Korea Aim: To investigate the clinico-pathological features and treatment options according to the distribution of synchronous cancers Method: Between July 2003 and December 2010, 217 patients (2.6%) were identified with SCRC. We performed a retrospective analysis of 217 patients according to clinicopathological characteristics and compared the outcomes of surgery. Results: The average age was 64 and more patients were male (71.9%). SCRC frequently located in the left colon was 41.9% and distributed on the different segments was 69.6%. 79 patients underwent extensive resection including total colectomy, subtotal colectomy, and total proctocolectomy, 82 underwent one regional resection, 22 underwent two regional resections, and 34 underwent one regional resection with local excision including endoscopic mucosal resection. Extensive resection and two regional resections had no differences in rate of complication, oncologic outcomes, and occurrence of metachronous cancer. However, stool frequency was significantly higher in extensive resection group (P < 0.001). Conclusion: Different treatment options were performed according to the distribution of synchronous cancers. Extensive surgery needs to be avoided based on the comparison between two regional resections and extensive resection.

P263 The early outcomes of lateral lymph node dissection using 3-dimensional laparoscope D.-W. Lee1, Y.-H. Kwon1, M. J. Kim1, J. W. Park1,2, S.-B. Ryoo1,2, S.-Y. Jeong1,2 & K. J. Park1 1 Seoul National University College of Medicine, Seoul, Republic of Korea, 2Cancer Research Institute, Seoul National University, Seoul, Republic of Korea Aim: The 3-dimensional (3-D) laparoscope has advantage of depth perception over conventional 2-dimensional (2-D) laparoscope. The aim of this study was to clarify the feasibility and efficacy of lateral lymph node dissection (LLND) for rectal cancer using 3-D laparoscope.

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Poster Abstracts Method: Between November 2015 and April 2016, 7 consecutive patients underwent 3-D laparoscopic lateral lymph node dissection for rectal cancer at Seoul National University Hospital. Short-term outcomes were evaluated. Results: Median patients age was 63 years (range 42–81). Low anterior resection was performed in six patients and abdominoperineal resection in one patient. Unilateral LLND was done in five patients and bilateral LLND in two patients. Median operation time was 297.5 min (range 225–390), and the median time required for LLND was 66 min (range 40–96). There was no case of conversion to open surgery. Median blood loss was 150 mL (range 50–200). Median number of harvested lateral LN were 8 (range 3–28) at each side. Among seven patients, lateral lymph node was positive in four patients. The median duration of postoperative hospital stay was 7 days (range 5–8). There was no postoperative mortality and morbidity. Conclusion: 3D-laparoscopic surgery appears to be a feasible and safe option in lateral lymph node dissection in rectal cancer patients.

P264 Endoscopic mucosal resection with precutting for medium-sized colorectal tumours: a single endoscopist’s experience E.-J. Lee, M.-J. Kim, J. B. Lee, D. S. Kim, D. H. Lee & E. G. Youk Daehang Hospital, Seoul, Republic of Korea Aim: Endoscopic submucosal dissection (ESD) is a very useful endoscopic technique, making it possible to perform an en bloc resection of a lesion regardless of its size. However, ESD is difficult to learn, time-consuming, and having high risk of perforation. Meanwhile, endoscopic mucosal resection with precutting (EMR- P) is easier to perform than ESD. The aim of this study is to report the outcomes of our colorectal EMR-P experience. Method: We analysed the clinical outcomes of 150 EMR-P cases and 330 ESD cases performed by a single expert endoscopist. Results: The mean resected tumour size was smaller in the EMR-P group than in the ESD group (19.8  4.2 mm vs 29.7  12.5 mm; P < 0.001). The procedure time was shorter (19.2  11.8 min vs 50.9  35.4 min; P < 0.001) and the overall en bloc and R0 resection rates were lower (83.3%/74.7% vs 98.2%/91.2%; P < 0.001) in EMR-P group. The perforation rate of EMR-P group (2.7%) was similar to that of ESD group (3.6%; P = 0.212). Conclusion: EMR-P shows considerably high en bloc and R0 resection rates, short procedure time, and tolerable perforation rate for the treatment of mediumsized (around 20 mm) colorectal tumours. EMR-P can be considered as a good treatment option to resect the medium-sized colorectal tumours.

P265 Transmissibility of the campaign for colorectal cancer awareness among Twitter users K. Lee1, H.-K. Oh1, G. Park2, S. Park2, B. Suh2, M. J. Kim1, S. I. Kang1, I. T. Son1, D.-W. Kim1 & S.-B. Kang1 1 Department of Surgery, Seoul National University Bundang Hosptial, Seongnam, Republic of Korea, 2Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea Aim: This study analysed Korean tweets regarding colorectal cancer and estimated the transmissibility of the annual colorectal awareness campaign among Twitter users. Method: Korean tweets containing keywords related to colorectal cancer were collected before and during the campaign month. Information regarding the users and the contents of the tweets was analysed, and the credibility of information-sharing tweets was evaluated. Results: A total of 10 387 tweets were shared by 1452 separate users. Regarding the users, 57.8% were individuals, and a considerable percentage of users (39.7%) were identified as spambots. In terms of tweet content, the majority of tweets were spam (n = 8736; 84.1%), followed by tweets that shared information (n = 1304; 12.6%). The credibility assessment revealed that only 80.6% of the information-sharing tweets were medically correct. After excluding the spam tweets, the information-sharing tweets increased during the campaign month (from 77.1% to 81.1%, P = 0.045). Conclusion: Most of the Korean tweets regarding colorectal cancer were commercial spam; informative public tweets accounted for an extremely small percentage. The transmissibility of the awareness campaign among Twitter users was questionable at best. To expand the reach of credible medical information on colorectal cancer, public health institutions and organizations need to consider social media.

P266 Oncologic outcomes of selective ligation of inferior mesenteric artery with D3 dissection in sigmoid colon cancer: retrospective, comparative, case matching study K. H. Lee, J. S. Kim & J. Y. Kim Chungnam National University Hospital, Daejeon, Republic of Korea Aim: It is still unclear that high ligation of inferior mesenteric artery in sigmoid colon cancer surgery improves oncologic outcomes comparing to low ligation. To evaluate oncologic outcomes of low ligation with D3 dissection and its non-inferiority to high ligation, we performed this study. Method: From January 2008 to December 2013, patients who underwent radical surgery for sigmoid colon cancer were evaluated retrospectively. After case matching by propensity score, each 106 patients were included in high and low ligation groups. Results: Operation time was significantly shorter in low ligation group, and there is no difference of complications. Length of specimen and proximal margin was significantly longer in high ligation group, but there was no difference of distal margin and retrieved lymph nodes. In high ligation group, metastatic lymph nodes were more and pathologic T/N stage was higher. However, there was no difference of overall survival, disease free survival, local and systemic recurrences between each stage in both groups. Conclusion: In early sigmoid colon cancers, we suggest that low ligation with D3 dissection can be performed with oncological safe, when it is needed.

P267 Regression grade: a new prognostic factor in rectal cancer? A. Manso, A. Oliveira, M. Rosete, M. Koch, J. Leite & F. Castro-Sousa Coimbra Medical School and University Hospital, Coimbra, Portugal Aim: Patients with complete regression after chemoradiation had better prognosis but the value of different grades of regression is less clear and this is the aim of this study. Method: We present a single-centre cohort study of advanced rectal cancer treated with neoadjuvant chemoradiation and surgery between 2000 and 2014. Tumour regression was assessed using Ryan et al modified criteria (grade 0, complete response, to 3, poor response). Results: Hundred and sixty-nine patients were included, 17 of whom (10.1%) were grade 0, 51 patients (30.2%) were grade 1, 79 patients (46.7%) were grade 2 and 22 patients (13%) were grade 3. No local recurrence occurred in grades 0 and 1. Kaplan-Meier analysis revealed 5-year overall survival rates 100%, 86%, 63% and 38% (P < 0.001); and 5-year disease-free survival 82%, 80%, 63% and 35% (P < 0.05) for grades 0, 1, 2 and 3. After adjusting for covariates including the pathologic stage, regression grade maintained an independent predictor of overall survival (P < 0.05) and disease-free survival (P < 0.05) in Cox regression analysis. Conclusion: Tumour regression grade after neoadjuvant chemoradiation in rectal cancer was an independent prognostic factor of overall survival and disease-free survival.

P268 Rectal cancer with complete regression after neoadjuvant therapy. Proposal of a monitoring vigilance protocol of a non-operative management M. Leon, T. Funes, C. Barragan, R. Cantero-Cid, J. Diez, J. Feliu & I. Prieto Hospital La Paz, Madrid, Spain Aim: To evaluate the overall survival in patients with rectal cancer who had a complete response after neoadjuvant therapy and propose a monitoring protocol in a non-operative scenario. Method: Retrospective study of 132 patients operated on for locally advanced rectal cancer who received neoadjuvant therapy from 2009 to 2014. The first outcome measure was complete regression level measured with Dworak grading. The 4 regression grades were compared for overall survival, disease free time and local or distant recurrence. Results: Of 132 patients, 92%(122) had some tumour regression, 29.5% were Dworak 1, 47% Dworak 2, 15.2% Dworak 3% and 15.2% Dworak 4. With a follow-up mean of 49 months, patients with complete regression had no local or distant recurrence. Compared with other groups, Dworak 1: 22%, Dworak 2: 20%, Dworak 3: 7% local or distant recurrence. Overall survival of patients with complete regression was the highest (P = 0.0391). Conclusion: Patients with a complete response after neoadjuvant therapy had no local or distant recurrence after surgery. We propose a monitoring e protocol of a non-operative management consisting of strict follow-up every 2 months for the first year and every 6 months thereafter.

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Poster Abstracts P269 Percutaneous management of colorectal pulmonary metastases with radiofrequency ablation; experiences of its use in a regional centre N. J. Lyons1, A. Spiers2, F. Wooton2, I. Daniels1, N. Smart1 & S. Pathak1 1 Exeter Surgical Health Service Research Unit (HeSRU), Royal Devon and Exeter Hospital, Exeter, UK, 2Department of Radiology, Royal Devon and Exter Hospital, Exeter, UK Aim: The current literature on the use of radiofrequency ablation (RFA) to treat colorectal pulmonary metastases (CRPM) case series from a handful of institutions. The aim of this study is to add our as a regional centre to the literature. Method: All patients undergoing RFA for CRPM were included in a prospective, open ended case series from October 2009 to December 2014. Primary end points included local progression, overall survival and mortality rates. Secondary outcomes included complications and follow up duration. Results: A total of 29 patients underwent RFA for CRPM with a combined total of 93 lesions ablated. Local progression was noted following 5.3% of ablations with 0% mortality at 30 days. Overall survival was 17.8 months with follow up durations of 3–48 months (mean 17.9). Complications were noted following 25 of the 92 ablations with 14 pnuemothoracies 6 of which required chest drain insertion. Conclusion: Our results are in line with those demonstrated on other centres suggesting that RFA for CRPM is a safe treatment modality. Given comparatively lower rates of mortality and serious complications associated with RFA and the equipoise in effectiveness between the two treatments, RFA should be more widely adopted.

P270 Selective use of post-chemoradiotherapy MRI can improve oncological outcomes in patients with high risk rectal cancer C. S. MacLeod1,2, C. MacKay2, G. Ramsay2, S. Yule2, G. Murray1,2 & C. Parnaby2 1 University of Aberdeen, Aberdeen, UK, 2NHS Grampian, Aberdeen, UK Aim: The utility of MRI following neo-adjuvant chemoradiotherapy (CRT) for locally advanced rectal cancer is unclear. MRI post-CRT in rectal cancer patients is used selectively in our unit in patients with involved circumferential resection margins on primary MRI. We determined the impact of its use on the management and oncological outcome of these patients. Method: All patients undergoing resection of rectal cancer in 2014–2015 were included. A prospectively maintained pathology database was supplemented with imaging data and analysed retrospectively. Results: Hundred and ten patients were included (58% Male) with a median age of 68 (31–84). 82 (75%) had neo-adjuvant therapy prior to resection, all had pre-operative MRI. 55 patients (67%) had a single pre-operative MRI, of which 12 (19%) showed complete pathological response in the resected specimen (pCR). 27 (33%) patients had a post-CRT MRI. 4 (15%) patient’s achieved (pCR). On post-CRT MRI, radiologically determined resection margins were deemed clear in 19 (70%) and uncertain in 8 (30%). Of these 8, 4 (50%) had their management altered (additional chemotherapy in 3, operative delay in 1) resulting in complete tumour excision in 3. Conclusion: Selective use of post-CRT MRI in patients with high risk rectal cancers can influence management to obtain clear resection margins.

P271 A comparison of laparoscopic and open surgical approaches to rectal cancer resection C. S. MacLeod1,2, C. MacKay2, G. Ramsay2, G. Murray1,2 & C. Parnaby2 1 University of Aberdeen, Aberdeen, UK, 2Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK Aim: Laparoscopic surgery is well established for colon cancer but its role in rectal tumours is less clear. We determined whether patient and tumour characteristics influence surgical approach and if surgical modality affects oncological outcome in rectal cancer. Method: All patients undergoing resection of rectal cancer in 2014–2015 at our institution were included. A prospectively maintained pathology database was supplemented with demographic data and analysed retrospectively. Results: Hundred and nineteen patients were included (59.6% male), with a median age of 68 (IQR 57–74). There were 42 (35%) laparoscopic and 77 (65%) open resections. Neither age nor sex influenced surgical approach. 24 (57%) patients in the laparoscopic and 47 (38%) in the open group had low rectal tumours (P = 0.31). Frequency of neoadjuvant therapy was similar between groups. Grade 3 TME was achieved in 56 (72.7%) of open and 23 (54.8%) of laparoscopic resections (P = 0.047). Median lymph node yield was equivalent between laparoscopic (18) and open (22) resections (P = 0.115). Clear resection margins were achieved in 86% of the laparoscopic and 91% of the open groups (P = 0.385). Frequencies of locally advanced T4 tumours were equivalent between groups (P = 0.419).

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Conclusion: Laparoscopic resection was associated with equivalent rates of complete excision but reduced quality of TME specimen compared with open resection.

P272 Is subtotal colectomy justified at the pathological level in patients undergoing elective surgery for splenic flexure colon cancer? An analysis of 68 consecutive patients G. Manceau1, A. Mori1, A. Bardier2, S. Breton1, J.-B. Bachet3, L. Hannoun1, J.-C. Vaillant1 & M. Karoui1 1 Assistance Publique - H^opitaux de Paris, Pitie-Salp^etriere Hospital, University Institute of Cancerology (Paris VI), Pierre & Marie Curie University, Department of Digestive and Hepato-Pancreato-Bilia, Paris, France, 2Assistance Publique - H^opitaux de Paris, Pitie-Salp^etriere Hospital, Pierre & Marie Curie University, Department of Pathology, Paris, France, 3Assistance Publique - H^opitaux de Paris, Pitie-Salp^etriere Hospital, University Institute of Cancerology (Paris VI), Pierre & Marie Curie University, Department of Gastroenterology, Paris, France Aim: There is still controversy regarding the optimal procedure to perform in case of splenic flexure colon cancer (SFCC). Segmental colectomy may be associated with a worse prognosis due to a non-optimal lymph node staging. The aim of this study was to detail the anatomical distribution of metastatic nodes in patients who underwent subtotal colectomy for SFCC. Method: Between 2000 and 2016, 68 consecutive patients were included. At pathological lymph nodes were classified into two groups: locoregional (along the marginal and left colic arteries) and distant nodes (along the middle colic, right colic and ileocolic arteries). Results: The median number of nodes examined was 21 [range: 6–55]. Only four patients (6%) had less than 12 nodes harvested. Eighteen patients (26%) were pN+, with a median of four nodes involved [range: 1–15]. Among them, 5 (28% of pN+ patients and 7% of the entire series) had invasion of distant nodes, along the right colic artery. However, these patients also had invasion of locoregional nodes. The presence of involved distant nodes did not change pN stage (1 pN1 and 4 pN2 tumours). Conclusion: In patients operated on electively for a SFCC, subtotal colectomy does not improve lymph node staging compared to segmental colectomy.

P273 Can combined prehabilitation and rehabilitation minimise postoperative risks and complications in geriatric patients undergoing major colorectal surgery? S. Mantoo, K. Y. Tan & C. Chia Khoo Teck Puat Hospital, Singapore, Singapore Aim: Role of preoperative prehabilitation related to medication, comorbidities, psychosocial illness, and physical and occupational therapy in geriatric patients undergoing major colorectal surgery has been studied. A transdisciplinary prehabilitation and rehabilitation (PRP) program was initiated to measure any enhancement in postoperative outcomes. Method: Patients from January 2007 to December 2014 were included. PRP program was initiated from January 2012 and surgical outcomes of patients managed before and after initiation of PRP were compared. Results: Seventy patients managed before implementation of PRP were compared with 77 patients managed under PRP program. There was a higher proportion of frail cases in PRP group compared to non-PRP group, 27.5% (16/58) versus 25% (12/48), P value = 0.874. Mean length of hospital stay was significantly shorter in PRP group, 8.2 days versus 10.8 days, P value = 0.029. Functional recovery at 6 weeks was higher in PRP group compared to non PRP group, 98.2% (56/57) versus 93.3% (56/60) respectively, P value = 0.189. Clavien 3 and above complications were reduced from 8.3% to 5.3%. Conclusion: Transdisciplinary PRP approach improves surgical outcomes in geriatric patients undergoing major colorectal surgery. Preoperative prehabilitation in selected patients can minimise postoperative risks and complications.

P274 Every day counts: analysis of the 62-day pathway for colorectal cancer in the UK I. Martin, I. Aslam, J. Merchant, P. Chokkarapu & P. Kang Northampton General Hospital, Northampton, UK Aim: To identify potential delays in the pathway from initial referral to diagnostics and treatment within the “62-day pathway” for colorectal cancer patients. Method: Three months of consecutive data for patients referred via the urgent two-week wait referral criteria to specialist services. Data was collected to ascertain time to initial appointment, time to first diagnostic test and time to first treatment. Results: In three months, we received 568 consecutive two-week referrals for suspected colorectal cancer. The 62-day treatment target was met in 96% of patients.

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Poster Abstracts 24 patients (4%) breached the 62-day treatment pathway target, with five patients (1%) failing to see a specialist within 2 weeks (median 12 days) and 17 patients (3%) failing to have their first diagnostic investigation within 31 days. Conclusion: The 62-day pathway for colorectal cancer provides a framework for targeting specialist services at those patients with suspected colorectal cancer. With increasing numbers of referrals pressure on finite resources is inevitable. In our analysis, delays in accessing specialist appointments within 14 days and achieving endoscopy within 31 days were the main factors contributing to target breaches. Although treatment targets are being met in 96% of patients, resources need to be targeted at improving access to outpatient appointments and endoscopy services.

P275 Intracorporeal vs extracorporeal laparoscopic ileocolic anastomoses L. Martinek, S. Giuratrabocchetta, K. You & R. Bergamaschi State University of New York, Stony Brook, NY, USA Aim: Foreshortened mesentery in Crohn’s at terminal ileum and thick abdominal wall in right colon cancer are the rationale for laparoscopic intracorporeal ileocolic anastomosing. The aim of this study was to compare intracorporeal (IC) vs extracorporeal (EC) ileocolic anastomoses in terms of complications. Method: This was a prospective non-randomised surgeon’s trial comparing consecutive patients undergoing laparoscopic ileocolic resection for Crohn’s or laparoscopic right colectomy for cancer with IC vs EC anastomosis. Propensity score-matching was used with ratio 1:1 for age, BMI, ASA, previous abdominal surgery and diagnosis. Results: A total of 453 (233 IC vs 220 EC) patients were enrolled. Propensity score-matched left 195 IC and 195 EC patients comparable for age (P = 0.294), gender (P = 0.683), ASA (P = 0.545), BMI (P = 0.079), previous abdominal surgery (P = 0.348), and diagnosis (P = 0.301). Operating time did not differ: 135 (60–360) vs 132 (70–320) min. There were no significant differences in conversion rates (5.1% vs 3.6% P = 0.457) and intraoperative complications (1% vs 2.1% P = 0.450) Anastomotic leak and re-operation rates did not differ (0.5% vs 1.5% P = 0.623) (1% vs 3.6% P = 0.106). Conclusion: Laparoscopic intracorporeal ileocolic anastomosing led to lower complication rates as compared to its extracorporeal counterpart in diagnosis-matched consecutive patients enrolled in a prospective non-randomised surgeon’s trial.

P277 Metastatic pattern of colorectal metastases – impact on surveillance strategy M. Maung, Z. Hanif, H. Abudeeb & A. Mukherjee Hairmyres Hospital, East Kilbride, Glasgow, UK Aim: Metastatic disease detected early may be amenable to curative resection. Study assesses metastatic pattern of colorectal carcinoma (CRC) in an attempt to optimise follow up management strategies .Literature evidence of lung metastases from CRC is reported to be higher for rectal cancer. Method: Retrospective analysis of prospective colorectal cancer database. Results: Six hundred and twenty CRC patients over 5 year (Jan.2007- Nov.2012) 63% colonic (n = 390) and 37% rectal (n = 230) 102 had synchronous metastases, 63 colonic (63/390, 16%; 32 Liver, 6 Lungs, 25 combined(C) and 39 rectal (39/230, 16%; 15 liver, 7 lungs, 17C) 57 had metachronous metastases, 32 colonic (12 Liver, 11 Lungs and 9C) and 25 rectal (3 liver, 13 lungsand 9C) 34%(11/32)had metachronous lung metastasis from colon vs 52%(13/32) rectal.Incidence of isolated lung metastasis 8.6%(13/151)rectal and 3.6%(11/298)colonic.Incidence of isolated liver metastasis 4%(12/298)colonic vs 1.9%(3/151) rectal. Mean time to onset of liver metastasis 2.8:2.6 years (colonic: rectal) and 2.6:3 years (colonic: rectal) lungs Conclusion: A Significant portion of patients with CRC have isolated lung or liver metastasis at presentation (16%) Metachronous lung or liver metastases following curative resection developed by 3 years. This study demonstrates higher incidence of isolated lung metastases after rectal resection at rate of more than twice that for colonic and liver metastases. Intensive surveillance in early years is invaluable to diagnose resectable metachronous metastatic disease.

Method: The study included 53 consecutive patients who underwent surgical resection of colonic carcinoma. Their CT scans were reviewed by a single radiologist to identify the presence or absence of EMV. CT findings were compared with the histology results of resected specimens. Sensitivity, specificity, negative (NPV) and positive (PPV) predictive values were calculated. Results: There were 35 male and 18 female patients. The median age was 72 years (range 46 - 93 years). CT scanning had a sensitivity of 68.75% and specificity of 48.64% in detecting EMV. The PPV was 36.67% and NPV 78.26%. Conclusion: CT is likely to remain the imaging modality of choice in the preoperative staging of colonic neoplasia. Its ability to identify poor prognostic feature of EMV can aid the selection of patients for neo-adjuvant treatment.

P279 A comparison of outcomes following pelvic exenteration for gynaecological and colorectal primaries in a consecutive singlecentre cohort study R. McLean, A. Mishreki, A. Kucukmetin & M. Katory Queen Elizabeth Hospital, Gateshead, UK Aim: To describe and compare outcomes following pelvic exenteration for gynaecological and colorectal cancers. Method: Consecutive patients in a single centre undergoing pelvic exenteration since 2007 were included. Outcomes were length of stay, readmission, complications, recurrence and death. Analysis was performed by Fisher’s exact test for categorical variables and Mann-Whitney U for continuous variables. Results: Thirty-four exenterations were undertaken, 20 for gynaecological (GO) cancer and 14 for colorectal (CLR) primaries (3 female, 11 male). The median age in the GO group was 61 years and 67 in the CLR group (P = 0.382). There were no significant differences between the GO and CLR groups for length of stay (17 vs 15.5 days respectively, P = 0.259), readmission within 30 days (30% vs 28.6% respectively, P = 0.928), or complications (75% vs 50% respectively, P = 0.133). More patients in the GO group had recurrence (n = 8 [40%]), which occurred earlier (median = 239.5 days) compared to the CLR group (n = 3 [21.4%], median = 1305 days), however this was not significant (P = 0.07). Additionally, more GO patients died (n = 7[35%]), at an earlier stage (median = 185 days) compared to the CLR group (n = 3(21.4%), median = 1993 days), which was non-significant (P = 0.425). Conclusion: Higher rates of complications, recurrence and mortality are seen in patients who undergo pelvic exenteration for gynaecological cancer compared to colorectal cancer cases.

P280 What is the best tool for transanal endoscopic microsurgery (TEM)? A case-matched study in 74 patients comparing a standard platform and disposable material D. Mege1, V. Bridoux2, L. Maggiori1, J.-J. Tuech2 & Y. Panis1 1 Beaujon Hospital, Clichy, France, 2Charles-Nicolle Hospital, Rouen, France Aim: To compare results of TEM with the TEO platform (Karl Storz, Germany) or disposable material (GelPoint Applied, USA). Method: Patients who underwent TEM for a rectal tumour were matched for gender, distance from anus, rectal location and size and divided into Group A (TEO) and B (GelPoint Applied). Results: From 2010 to 2015, 74 TEM procedures were performed, 41 in Group A and 33 in Group B. Full-thickness resection was more frequent in Group A than in Group B (100% vs 85%, P = 0.01). Adenocarcinoma was more frequent in Group A than Group B: (42% vs 27% P = 0.03). No difference was noted in median operative time (53 vs 53 minutes, P = 0.6) and peritoneal perforation rate (20% vs 6%, P = 0.17). The median length of stay was longer in Group A than Group B (5 vs 4 days, P < 0.008). No significant difference was noted for morbidity (ClavienDindo Score ≥ 3, 0% vs 12%; P = 1), R1 resection (10% vs 21%, P = 0.2), and recurrence rates (7% vs 8%; P = 0.62). At the end of follow up, no difference was noted for rectal stenosis (12% vs 3%; P = 0.22) or transit disorder rates (17% vs 12%, P = 0.74). Conclusion: Our study suggested that TEM can be performed using either the TEO platform or disposable material, with similar results.

P278 Pre-operative CT prediction of extramural vascular invasion in colonic cancer A. McAvoy, K. Gokul, A. Chiphang & D. Y. Artioukh Southport and Ormskirk NHS foundation Trust, Mersey, UK Aim: Extramural vascular invasion (EMV) is an independent prognostic factor in colonic malignancy. If detected pre-operatively it may influence the management strategy particularly with the emerging role of neo-adjuvant chemotherapy in the treatment of this malignancy. This study aimed to assess the ability of computerised tomography (CT) to predict the prognostically unfavourable feature of EMV.

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Poster Abstracts P281 Peritoneal perforation is more an expected event than a real complication during transanal endoscopic microsurgery: a report of 28 consecutive cases D. Mege, N. Petrucciani, L. Maggiori & Y. Panis Beaujon Hospital, Clichy, France Aim: To report our experience in the management of peritoneal perforation (PP) occurring during TEM. Method: Patients who underwent TEM in whom PP occurred (Group A) were compared to those without PP (Group B). Results: From 2007 to 2015, 194 TEM were divided into Groups A (n = 28, 14%) and B (n = 166). In 2 of 28 patients (7%), the diagnosis of PP was only made postoperatively during reoperation for peritonitis. In 26 patients (93%) PP was diagnosed during TEM. Laparoscopic suture of the defect was performed in 24 cases, transanal suturing was performed in two cases. In four patients, laparoscopy did not confirm a suspicion of PP. The median length of stay was longer in Group A than in Group B (7.5 vs 4 days, P < 0.0001). Predictive factors for PP by multivariate analysis were: distance from the anal verge > 10 cm (OR = 3.6), circumferential (OR = 3) and anterior tumour (OR = 2.7). There was no significant difference in postoperative and long-term morbidity and recurrence rates. Conclusion: Our study suggested that PP is not a rare event during TEM, especially in anterior, circumferential and/or high rectal tumours. Treatment of perforation through laparoscopy is feasible and safe. The occurrence of peritoneal perforation is not associated with poor oncological results.

P282 C-reactive protein 24 hours after surgery, an early predictor of anastomotic leakage? M. Monteleone, D. Merlini, T. D’Aponte & E. Morandi ASST-Rhodense, Rho, Milan, Italy Aim: To evaluate the role of C-reactive protein (CRP) in predicting anastomotic leakage 24 hours after colorectal surgery. Method: Hundred and fifteen consecutive patients, 69 male (60%) and 46 female (40%), mean age 71 years, who underwent elective colorectal surgery for cancer (laparoscopic and laparotomic) with primary anastomosis, were prospectively recruited. The following data were collected: demographics, type of surgery, ASA grade and morbidity. CRP levels, leukocytes, and vital signs were evaluated 24 hours after surgery. Results: Twelve patients (10.4%) developed a major anastomotic leakage (need for drainage or reoperation). CRP levels were significantly higher (>12 mg/dL) 24 hours after surgery in patients who developed anastomotic leakage, whereas the white blood cell count was not. A CRP cut-off value of 12 mg/dL 24 hours after surgery yielded a sensitivity of 80%, a specificity of 95%, and a negative predictive value of 95% for the detection of anastomotic leakage. Conclusion: This is a preliminary study and requires a larger sample of patients, however our results indicate that increased CRP levels 24 hours after colorectal surgery are an early, sensitive, and reliable biomarker of anastomotic leakage.

P283 Neutrophil-lymphocyte ratio and C-reactive protein – two prognostic tools of anastomotic leak in colorectal cancer surgery? M. Mik, L. Dziki, M. Berut, R. Trzcinski & A. Dziki Department of General and Colorectal Surgery, Medical University Of Lodz, Lodz, Poland Aim: To assess the prognostic value of C-reactive protein (CRP) and the neutrophil-lymphocyte ratio (NLR) in predicting anastomotic leak (AL) in patients after surgery for colorectal cancer. Method: We included patients operated on between 2010 and 2014. We analysed factors associated with the risk of AL and determined the sensitivity, specificity, positive (PPV) and negative predictive values (NPV) of CRP and NLR on the 4th postoperative day (POD4) in predicting AL and mortality. Results: Seven hundred and twenty-four patients were analysed. AL was diagnosed in 33 (4.6%). BMI < 30 (OR 0.43 [95%CI, 0.19–0.92], P = 0.032) and ASA grade I or II OR 0.41 [95%CI, 0.18–0.92], P = 0.031) decreased the risk of AL. CRP levels on POD4 were higher in patients who died (239  24 mg/L vs 199  41 mg/L, P = 0.034. The accuracy of CRP in detecting AL at a cut-off value of 180 mg/L was 0.83 (sensitivity 75%, specificity 91%, PPV 52%, NPV 87%). The NLR on POD4 was higher in the AL group (9.03  4.13 vs 4.45  2.25, P = 0.0012. At a cut-off value of 6.5, the sensitivity of the NLR in predicting AL was 69%, specificity 78%, PPV 49% and the NPV 88%. The NLR was higher in patients who died (10.71  2.08 vs 8.65  4.67, P = 0.029). Conclusion: CRP and NLR can be used as simple tools to predict mortality and the risk of AL. Their high NPV could help to identify patients with a low risk of AL and reduce hospital stay.

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P284 The impact of timing to initiate postoperative chemotherapy on oncologic outcome after rectal cancer surgery B. S. Min, K. T. Roh, N. K. Kim & K. Y. Lee Yonsei University Health System, Seoul, Republic of Korea Aim: To identify the timing of post-operative chemotherapy (POCT) initiation and investigate its impact on oncologic outcome in rectal cancer. Method: A total of 997 patients who underwent curative resection and received POCT for rectal cancer from January 2006 to December 2012 were enrolled. Patients’ medical records including survival data were analysed retrospectively. Survival was compared between groups of patients who started POCT before and after several cut-off points in time, taking into account whether patients had undergone preoperative chemoradiotherpy (CRT) or not. Results: The calculated cut-off point of POCT initiation for the whole cohort was the 20th postoperative day (POD). Disease free survival (DFS) was significantly different between starting POCT ‘after’ versus ‘before’ POD 20 (5-year DFS: 64.8 vs 75.8%, P = 0.01). There was no significant difference in toxicity. For those without preoperative CRT, the cut-off point of the initiation of POCT was POD 19. DFS was significantly different between ‘after’ versus ‘before’ POD19 (5-year DFS: 65.7 vs 78.5%; P = 0.01). For those with preoperative CRT, the cut-off was POD 56, which was associated with no difference in DFS nor OS. Conclusion: Initiation of POCT beyond 3 weeks after surgery in rectal cancer was associated with poor oncological outcome, especially in DFS. In the patients who received preoperative CRT, POCT could be delayed until 8 weeks without impact on oncologic outcome.

P285 Anterior resection of rectum with loop ileostomy vs Hartmann’s procedure in patients with acute malignant bowel obstruction A. Minasyan & R. Sargsyan Yerevan State Medical University, Yerevan, Armenia Aim: To improve the results of surgical treatment of acute large bowel obstruction caused by rectal cancer and shorten the postoperative recovery period. Method: The study included 71 consecutive patients who underwent a Hartmann’s procedure, who were compared to a matched group of 73 patients who underwent anterior resection with loop ileostomy. Before creating a primary anastomosis (using an Autosuture circular stapler) we performed closed intraoperative decompression of the colon. A protective loop ileostomy was performed. Groups were matched for age and Charlson comorbidity index. Outcome measures included morbidity, operation time, stoma reversal rate and time to reversal. Results: The Charlson score in both groups was 8. The reversal rate in the Hartmann’s group was 60% compared with an ileostomy closure rate of 90% in the anterior resection group. Time to stoma reversal in the Hartmann’s group was 190 days vs 58 days for the anterior resection with ileostomy group. Conclusion: The strategy of anterior resection with intraoperative decompression, primary anastomosis and loop ileostomy formation used in our unit improves outcome and significantly reduces the time to full recovery.

P286 Shotgun lipidomic analysis of colorectal cancer via DESI imaging mass spectrometry reveals morphology-dependent alterations in fatty acid biosynthesis and metabolism R. Mirnezami, N. Strittmatter, K. Veselkov, L. Poynter, J. Kinross, R. Goldin, E. Holmes, J. Nicholson, A. Darzi & Z. Takats Imperial College London, London, UK Aim: In this study, spatially-resolved profiling of lipid signatures in colorectal cancer (CRC) tissue was performed using desorption electrospray ionisation imaging mass spectrometry (DESI-MSI). The aim was to comprehensively define the CRC ‘lipidome’ and to assess lipid signatures in histological regions of interest, specifically peri-tumoural epithelium (PT-e) and tumour stroma (T-s). Method: Tissue sections from 42 patients with confirmed CRC were subjected to negative-ion mode DESI-MSI analysis. Mass spectra in the 200–1000 m/z range were collated from histologically verified CRC epithelium (CRC-e), PT-e, T-s and healthy tumour-remote epithelium (TR-e). Results: DESI-MSI revealed increased levels of very-long chain fatty acids (VLCFAs) in CRC-e relative to TR-e (AUC = 0.99) with corresponding increased expression of lipogenic enzymes (FASN and ELOVL1) confirmed on immunohistochemistry. Electron microscopy was performed to evaluate peroxisomal distribution in CRC-e, as these organelles b-oxidize VLCFAs to negligibly low levels in healthy cells. No difference was observed in peroxisomal distribution or abundance between CRC-e and TR-e.

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Poster Abstracts Conclusion: De novo VLCFA is enhanced in CRC through upregulation of lipogenic enzymes and impaired peroxisomal b-oxidation. Increases in VLCFAs primarily accounted for the difference observed between PT-e and TR-e on multivariate analysis (AUC = 0.89), indicating that upregulated VLCFA biosynthesis and peroxisomal functional inefficiency may represent important steps in peri-tumoural field cancerisation.

P287 Plasma YKL-40: a new potential sierological biomarker in anal cancer M. Mistrangelo1, E. Ugliono1, V. Testa1, P. Cassoni2, T. Manetta3, L. Idda1, M. Goia2, G. Mengozzi3 & M. Morino1 1 Department of Surgical Sciences, Centre of Minimal Invasive Surgery, University of Turin, Citta della Salute e della Scienza di Torino Hospital, Chief Prof Mario Morino., Turin, Italy, 2Department of Biomedical Sciences and Human Oncology, University of Turin, Citta della Salute e della Scienza Hospital, Turin, Italy, 3Clinical Biochemistry Laboratory, Citta della Salute e della Scienza University Hospital, Turin, Italy Previously published in Tech Coloproctol (2015) 19:757–791, DOI 10.1007/s10151015-1385-3.

P288 Faecal calprotectin as an early biomarker of anastomotic leakage M. Monteleone, E. Morandi, M. Castoldi, G. A. Vignati & D. Merlini ASST-Rhodense, Rho, Milan, Italy Aim: To determine whether faecal calprotectin (FC) is a predictor of anastomotic leakage in colorectal surgery. FC is employed to assess active inflammation in patients with inflammatory bowel disease and colorectal cancer but its role to predict anastomotic failure has not been described previously. Method: The study was performed on 100 consecutive patients with diagnosed colorectal cancer admitted for operation. During the first 4 postoperative days FC, Creactive protein, leukocytes, and vital signs were evaluated. Results: Nine patients developed a major anastomotic leak (need for reoperation); two patients needed abdominal drainage. 4 days after surgery FC was significantly higher (> 300 lg/g; normal value 140 g/dL developed recurrence, compared with 12 of 38 with a pre-treatment Hb of 1 mm) in the TaTME group and one case of the TME group was less than 1 mm. Conclusion: These results support the view that TaTME is a feasible and oncologic safe technique for patients with lower rectal cancer.

P306 Long term results of laparoscopic right hemicolectomy with complete mesocolic excision N. Omarov1, B. Batman2, K. Serin2, Y. Iscan3, N. C. Arslan2, D. S. Uymaz4, H. Altun2 & O. Asoglu2 1 Department of General Surgery, Istanbul University Faculty of Medicine, Istanbul, Turkey, 2Department of General Surgery, Fatih Sultan Mehmet TraininDepartment of General Surgery, Liv Hospital, Istanbul, Turkey, 3Department of General Surgery, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey, 4 Department of General Surgery, Bakirkoy Sadi Konuk Training and Research Hospital, Istanbul, Turkey, 5Oncology Institute, Istanbul University Faculty of Medicine, Istanbul, Turkey Aim: To present the long term oncologic outcome of laparoscopic complete mesocolic excision (LCME) for right-sided colon cancer. Method: Data of the patients with right-sided primary colon cancer who underwent LCME between 2006 and 2016 were analysed retrospectively. All surgeries were performed according to principles of CME by a single colorectal surgeon (OA). Results: Eighty-two patients were included in the analysis. Mean age was 60  13.7. Mean body mass index (BMI) was 25.6  2.2. Conversion to open occurred in 5(6.1%) patients. Mean operative time was 155 (90–260) minutes. Median number of harvested and metastatic lymph nodes were 33 (11–72) and 5 (1–37), respectively. There was no perioperative mortality. Perioperative complications were seen in 7 (8%) patients. Mean hospital stay was 5  7.1 days. Histopathologic examination revealed Stage 0 disease in 2(2.4%) patients, Stage I in 8(9.8%), Stage II in 42(51.2%), Stage III in 27(32.9%) and Stage IV disease in 3(3.7%) patients. Local recurrence has occurred in 3(3.6%) patients and 4 (4.8%) patients had distant metastases. Median follow up was 64 (1–121) months. Overall and disease free 5-year survival rates were 83% and 70%, respectively. Conclusion: Laparoscopic CME which has been considered as a relatively complicated technique can be safely performed with favourable oncologic results.

P307 Pre-operative staging of primary colorectal cancer by PET-CT: impact on surgical management M. Mogoll on, M. Dominguez, R. Conde, I. Segura, F. Huertas & P. Palma University Hospital CHUG, Granada, Spain

Method: Data were prospectively recorded. All patients underwent both 18FDGPET/CT and colonoscopy as part of the preoperative staging. Additional lesions both colonic and extracolonic were recorded. The maximum standard uptake value (SUVmax) was analysed for prediction of tumour size (Spearman coefficient), UICC stage (Kruskal-Wallis test) and tumour recurrence (Mann-Whitney U-test). Results: Four hundred and thirty-four patients were included. Tumour localisation upon surgery correlated better with 18FDG-PET/CT (74.2%) as with endoscopy (65.6%) (Kappa index 0.709 and 0.583, respectively). Out of 181 incomplete colonoscopies a second 18FDG-PET/CT colonic involvement was detected in nine cases. Synchronous extra colonic malignancies were diagnosed in 14 patients. Consequently, surgeons modified the surgical approach in 20.2% patients. SUVmax correlated with tumour size (0.354, P < 0.001) and tumour depth of invasion along with the UICC stage (P = 0.006 and P = 0.023, respectively). No significant correlation was found between preoperative SUVmax and tumour recurrence. Conclusion: Routine use of 18FDG-PET/CT did impact on surgical-decisionmaking, improving the localization of the lesion and detecting synchronous colonic and extracolonic lesions. However, SUVmax has not been found as a reliable preoperative predictor of recurrence.

P308 A systematic review of gastrointestinal toxicity after radiotherapy for anal cancer Y. B. Pan1,2, Y. Maeda1, R. Glynn-Jones3 & C. J. Vaizey1 1 St.Mark’s Hospital, London, UK, 2Longhua Hospital Shanghai University of Chinese Medicine, Shanghai, China, 3Mount Vernon Hospital, London, UK Aim: To elucidate the incidence and mechanism of long-term gastrointestinal consequences after chemoradiotherapy for anal cancer. Method: A systematic literature review. Results: Two thousand seven hundred titles (excluding duplicates) were identified through the search; 124 articles were included in this review. The overall incidence of late gastrointestinal toxicity was reported to be 3 - 64.5%, with grade 3 and above (classified as severe) up to 33.3%. The most commonly reported late toxicity was faecal incontinence (up to 44%), diarrhoea (up to 26.7%), and ulceration (up to 22.6%). Diarrhoea, faecal incontinence and buttock pain correlated with lower scores in radiotherapy specific quality of life scales (QLQ-CR29, QLQ-C30, QLQCR38) compared to healthy controls. Anorectal manometry showed lower resting (33–50%, P < 0.05) and maximum squeeze pressures (43–80%, P < 0.05) compared to healthy controls. Neither age nor status of HIV positivity affected the occurrence or severity of late toxicity. Intensity-modulated radiation therapy appears to reduce late toxicity as 5 out of 6 studies showed no grade 3 and above late toxicity. Conclusion: Late gastrointestinal toxicity is common with severe toxicity seen in one-third of the patients. These symptoms significantly impact on patients’ quality of life. More prospective studies with control groups are needed to elucidate long-term toxicity.

P309 Male patients have better urogenital function preservation following robotic rectal surgery when compared to laparoscopy S. Panteleimonitis1,2, J. Ahmed2, M. Ramachandra2, M. Farooq2, N. Siddiqi2 & A. Parvaiz1 1 University of Portsmouth, Portsmouth, UK, 2Queen Alexandra Hospital, Portsmouth, UK Aim: Urological and sexual dysfunction are recognised risks of rectal cancer surgery, however, there is limited evidence regarding urogenital function comparing robotic to laparoscopic techniques. This study aim to investigate this in male patients. Method: Urological and sexual functions were assessed using validated standardised questionnaires. Questionnaires were sent a minimum of 6 months after surgery and male patients were asked to report their urogenital function pre and post-operatively, allowing changes in urogenital function to be identified. The response rate was 80%, 35 of the responders had robotic and 49 laparoscopic surgery. Of those 13 were sexually active in the robotic and 36 in the laparoscopic group. Results: Patients in the robotic group deteriorated less in five out of six components of urological function (frequency, P = 0.002; nocturia, P = 0.002; incontinence, P < 0.001; poof flow, P = 0.002; incomplete bladder emptying, P = 0.017) and across all components of sexual function (libido, P = 0.001; erection, P < 0.001; stiffness for penetration, P < 0.001; orgasm/ejaculation, P < 0.001). Composite urological and sexual function scores change from baseline were better in the robotic cohort (P < 0.001). Conclusion: Robotic rectal cancer surgery offers better postoperative urogenital outcomes compared to laparoscopic surgery in male patients. Larger scale, prospective randomised control studies are required to validate these results.

Aim: To evaluate the clinical utility of 18FDG-PET/CT in preoperative setting of primary colorectal cancer (CRC) and its prognostic value to predict tumour recurrence.

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Poster Abstracts P310 Long-term outcomes of repeated debulking operations and systemic chemotherapy for pseudomyxoma peritonei J.-H. Park1, S.-B. Ryoo1, J.-K. Kim1, Y.-H. Kwon1, D. W. Lee1, I. Song1, M. J. Kim1, J. W. Park1,2, S.-Y. Jeong1,2 & K. J. Park1 1 Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea, 2Colorectal Cancer Center, Seoul National University Cancer Hospital, Seoul, Republic of Korea Aim: Cytroreductive surgery (CRS) and intraperitoneal chemotherapy (HIPEC) may not be feasible in all cases of pseudomyxoma peritonei (PMP), and repeated debulking surgery and systemic chemotherapy may still have a role in these situations. Method: In our institution, 124 patients (median age, 56 years, M:F = 50:74) underwent debulking surgery for PMP, including 82 patients with high grade PMP in whom R2 resection was only possible. Results: Total of 218 debulking operations were performed with 41.2% of patients receiving more than 2 repeated operations. Adjuvant systemic chemotherapy, mostly fluorpyrimidine based (81.9%), were used in 72 (58.1%) patients. Overall 3- and 5year survival (OS) rate were 77.0% and 64.4%. Five-year survival rate was significantly longer with low grade (92.9%) compared with high grade PMP (49.1%, P < 0.001). Multivariate analysis for OS in patients with high grade PMP revealed peritoneal carcinomatosis index (PCI) as the only significant factor (for PCI≥25, hazard ratio of 7.44 (CI95 3.49–15.9, P < 0.001)). Number of operations (≥3, 5-year OS, 62.8% vs 44.1%, P = 0.448), and operative complications (5-year OS, 56.4% vs 44.9%, P = 0.562) had no effect on survival. Conclusion: Our results indicate that repetitive debulking surgery and systemic chemotherapy still has a role in cases where HIPEC is not feasible.

P311 CXCL2 gene expression in colorectal cancer and adenomatous polyps – is it a putative biomarker? A. Patel1, A. Murphy2, P. McTernan2, N. Williams1 & R. Arasaradnam1,2 1 University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK, 2 Warwick University, Coventry, UK Aim: Field cancerisation occurs when somatic mutations develop in histologically normal mucosa rendering it susceptible to malignant transformation. CXCL2 is a chemokine that modulates leukocyte migration. This study aimed to determine gene expression levels of CXCL2 in macroscopically normal mucosa (MNM) of patients with colorectal polyps and cancer. Method: Eighty-two age and sex matched patients were recruited. Serum CXCL2 and tissue CXCL2 gene expression was measured in the macroscopically normal mucosa (MNM) adjacent to CRC (n = 30), adenomatous polyp (n = 23) and at the resection margin (RM) and compared with 29 controls. Results: CXCL2 was upregulated in tumour, adjacent MNM and RM of CRC patients compared to controls (60-fold, 4-fold and 5-fold respectively, all P < 0.001). It was 2.4-fold upregulated in MNM adjacent to polyps compared to control subjects (P = 0.013). No differences were found in serum CXCL2 concentration across the three groups (mean concentration (CRC) 401.7  46.8 pg/mL and (polyps) 402.5  70.0 pg/mL versus (controls) 376.0  54.6 pg/mL, P = 0.73 and P = 0.77, respectively). Conclusion: CXCL2 gene expression is upregulated in the MNM of patients with CRC and polyps and could function as a tissue biomarker or could be utilised for chemoprevention.

P312 Change in bowel habit as a sole symptom present on referral for suspected colorectal cancer: a retrospective analysis of 719 patients K. Patel, T. Athisayaraj, G. Matthews & A. Mishra West Suffolk Hospital, Bury St Edmunds, UK Aim: Change in bowel habit (CIBH) is a red flag symptom for colorectal cancer. We aim to evaluate what proportion of patients referred via a suspected colorectal cancer pathway with CIBH as a sole symptom have a malignancy and the potential effect of implementing a straight-to-test referral pathway. Method: We retrospectively analysed all patients referred with CIBH only to colorectal rapid access clinic in our UK institution between 2013 and 2014. Information collected included diagnostic cancer yield and oncological management. Results: Thousand eight hundred and thirty-one patient referrals were made during our study time 719 (39.3%; median age 72 years, IQR: 65–79.5) were identified with CIBH as a sole symptom on referral. Investigations performed included flexible sigmoidoscopy (178/719, 24.8%), colonoscopy (291/719, 40.5%) and computed tomography (251/719, 34.9%). Overall, 27 patients (3.8%) were diagnosed with cancer of which 18 were colorectal malignancies (2.5%). 8 (44.4%) underwent curative resections and 3 (16.7%) palliative procedures. Had patients been sent directly for flexible sigmoidoscopy, 27.8% (5/18), colonic cancers would have been missed.

Conclusion: CIBH alone yields a 3.8% malignancy rate from primary-secondary rapid access referrals. If implemented as a direct-access investigation, flexible sigmoidoscopy would miss a proportion of cancers and thus a surgeon’s initial clinical assessment is essential.

P313 Emergency first presentation of colorectal cancer: a comparison of outcomes between young under-50 and older over-50 patients K. Patel, T. Doulias, L. Deacon & A. Mishra West Suffolk Hospital, Bury St Edmunds, UK Aim: Emergency presentation of colorectal cancer is associated with unfavourable outcomes. It is speculated that younger patients may present with more advanced disease. Aim were to compare incidence and clinical outcomes in emergency presentations of colorectal cancer in two groups: those under-50 years of age and those over-50. Method: Data were collected retrospectively from all patients with emergency first presentations of colorectal cancer between 2005 and 2013. Results: Three hundred patients over-50 (median age 77 years, IQR 67-84) and 22 patients under-50 (43 years, IQR 35–46) presented with colorectal cancers as emergencies. Fewer young patients presented with obstructing tumours (18.1% vs 40.7%; P = 0.04). More young patients received operative management following presentation (95.5% vs 77.0%; P = 0.04). Oncological staging and histology demonstrated no significant differences between the two groups. There were no significant differences with respect to in-hospital mortality (4.7% vs 8.0%; P = 0.55), overall one-year survival (31.8% vs 41.7%; P = 0.36) and median survival to death or time of study date (27.1 months vs 19.6 months; P = 0.13). Conclusion: Emergency colorectal cancer has comparable outcomes between young under-50 and older over-50 subgroups. Younger patients were more likely to undergo operative intervention, but overall survival was comparable to older patients in our study.

P314 Repeat suspected cancer pathway urgent referrals for colorectal cancer in the UK – are they appropriate? K. Patel, T. Hoad, S. Patel & A. Mishra West Suffolk Hospital, Bury St Edmunds, UK Aim: National guidelines recommend indications for suspected cancer pathway referrals to secondary care colorectal surgeons. Patients are often re-referred via the same pathway with similar symptoms. Aim were to identify incidence and cancer yield of repeat urgent referrals. Method: All referrals made from primary care to our institution for suspected colorectal cancer under the two-week referral pathway between December 2008 and December 2015 were retrospectively analysed. Indications for referral, investigations performed and management of diagnosed cancers were evaluated. Results: 5018 referrals were made over our 7-year study period of which 128 (2.6%, median age 73 years, IQR 67–79) were repeat referrals. Median time to repeat referrals was 869 days (IQR: 640–1235). The diagnostic yield of cancer from repeat referrals was 5.5% compared to initial referral yield of 7.4% (P = 0.41). 60 repeat referrals (46.9%) reported the same symptoms present at initial referral, none of which were subsequently found to have colorectal malignancies. Conclusion: This is the largest study to date examining repeat urgent colorectal referrals and cancer incidence, which we report as low but comparable to initial referral incidence. Repeat referral for the same symptoms yielded no malignancies. Updated national guidance last year may impact on future repeat referral cancer yield.

P315 Changes in gene expression indicates effectiveness of neoadjuvant therapy in rectal cancer patients H. Pauzas, T. Latkauskas, P. Lizdenis, S. Svagzdys, U. Gyvyte & A. Tamelis Lithuanian University of Health Sciences, Kaunas, Lithuania Aim: The aim of this study was to evaluate the impact of neoadjuvant therapy for VEGFA, COX2, HUR, CUGBP2 gene expression and its predictive value. Method: We examined rectal cancer and healthy rectal mucosa tissue for VEGFA, COX2, HUR, CUGBP2 expression by quantitative real-time polymerase chain reaction. Biopsies were taken twice: before neoadjuvant therapy and 6–8 weeks after neoadjuvant therapy. Forty-nine patients were included. Genes expression was compared between rectal cancer and healthy rectal mucosa tissue. Clinical parameters were compared with the outcome of neoadjuvant therapy and genes expression between responders and non-responders group. Results: VEGFA, COX2 and HUR expression was found to be significantly greater in cancer tissue comparing to healthy rectal mucosa tissue (P < 0.05). VEGFA, HUR, CUGBP2 expression significantly decreased after neoadjuvant therapy (P < 0.05). VEGFA expression predicts response to neoadjuvant therapy

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Poster Abstracts according to T stage downstaging (P < 0.05). Responders demonstrated a significantly higher VEGFA and COX2 expression decrease after neoadjuvant therapy than non-responders (P < 0.05). Conclusion: VEGFA, COX2 and HUR genes are important in rectal cancer pathogenesis. VEGFA expression in pre-treatment biopsies could be predictive value to neoadjuvant treatment according to T stage. Decrease of VEGFA and COX2 expression indicates effectiveness of neoadjuvant therapy in rectal cancer patients.

P316 Design and realization of an advanced nanotechnology-based assay platform for circulating cancer markers detection in colorectal cancer G. Pellino1, A. Capo2, M. Milone3, U. Malapelle4, A. Fusco5, F. Selvaggi1, G. Troncone4, S. D’Auria2 & P. Pallante5 1 Unit of Colorectal Surgery, Department of Medical, Surgical, Neurological, Metabolic and Ageing Sciences, Second University of Naples, Naples, Italy, 2Institute of Food Science, CNR, Avellino, Italy, 3Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Naples, Italy, 4Department of Public Health, University of Naples “Federico II”, Naples, Italy, 5Institute of Experimental Endocrinology and Oncology (IEOS), National Research Council (CNR), Naples, Italy Aim: To implement a nanotechnology-based device to detect the cancer-related HMGA1 protein in blood samples from colorectal cancer (CRC) patients with high specificity and sensitivity. Method: We used nano-structured metallic surfaces to covalently immobilise the synthetic HMGA1 protein in a nano-array format. HMGA1 antibodies were used to assemble the cartridge detection assay. Blood specimens from patients have been obtained at surgery, at discharge from hospital, and at scheduled follow-up. Blood samples were collected from non-CRC controls. Results: We developed a nano-diagnostic device based on the surface plasmonic resonance and tested it for dynamic range of response, sensitivity, reproducibility and stability. By analysing plasma specimens from patients, nano-biosensor was able to detect a 4-fold increase of HMGA1 protein levels in comparison to the baseline of healthy people. The nano-biosensor detected only a 3-fold increase of HMGA1 protein levels in the plasma obtained from the same patients after 7 days from surgery, indicating the decrease of HMGA1 protein levels after the removal of the primary mass. Conclusion: The development and use of this device opens the perspective to perform early and minimally invasive screening to diagnose CRC based on the detection of HMGA1 protein in the blood.

P318 Results of 2nd look surgery for colon cancer patients at high risk for peritoneal disease  Serrano, E. P. Viejo, I. Manzanedo, M. Hernandez, B. Martınez & F. Pereira A. Hospital Universitario Fuenlabrada, Madrid, Spain Aim: To analyse the impact of 2nd look surgery with HIPEC in colorectal cancer at high risk of peritoneal surface disease. Method: Prospective study of 33 patients operated from 2012 to 2016 after adjuvant chemotherapy following primary tumour surgery at risk for peritoneal disease (pT4, pN1c, positive cytology, primary tumour perforation, low volume peritoneal disease at primary surgery) with no evidence of disease. Results: 30.3% had in fact peritoneal disease at the time of 2nd look. pT4 was the only factor to predict relapse after 2nd look (P = 0.037). The overall survival of this group of patients was 16 months. Conclusion: Systematic 2nd look surgery helps to diagnose peritoneal surface disease in early stages so that the treatment is more efficient.

P319 Postoperative complications after cytoreductive surgery and HIPEC for the treatment of peritoneal surface disease from colon cancer in a reference centre  Serrano, I. Manzanedo, F. Pereira, M. Hernandez & B. Martınez E. P. Viejo, A. Hospital Universitario Fuenlabrada, Madrid, Spain Aim: Early peritoneal surface disease diagnosis is not easy. PCI is the main prognostic factor. Its treatment with cytoreductive surgery (CS) and HIPEC has important postoperative complications. We aimed to analyse the predictive factors for postoperative complications. Method: We analysed 123 patients treated for peritoneal surface disease due to colon cancer with CS and HIPEC from June 2006 to December 2015. We correlated post-operative Clavien-Dindo grade III-V complications (38) with different variables including median PCI, technical items (rectal resection, number of anastomosis, numerous implant resection), and the drug used for the HIPEC. Results: Median PCI was 8.45 in patients with major complications and 3 in patients with no complications (P = 0, 0002). This was the only statistically significant factor. Conclusion: There is a clear relationship between PCI and postoperative complications; besides, the bigger the PCI, the less the OS, so there is a need for individual valoration of every case for the risk-benefit.

P317 Major discrepancies between the guidelines of ESMO and NCCN in the management of patients with locally advanced and oligometastatic colon cancers G. Pellino1, D. Ojo1, S. Qiu2, O. Warren2, S. Mills2, S. Rasheed1, P. Tekkis1,2 & C. Kontovounisios1,2 1 Department of Colorectal Surgery, Royal Marsden Hospital, London, UK, 2 Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, UK

P320 Peritoneal carcinomatosis of colorectal origin: impact of ovarian metastases A. Pinto1, L. Ghouti1, S. Kirzin1, J. Selves3, R. Guimbaud2 & G. Portier1 1 Colorectal and Oncological Surgery Department, Purpan University Hospital, Toulouse, France, 2Medical oncology department, Rangueil university hospital, Toulouse, France, 3Pathology department, University cancer institute, Toulouse, France

Aim: Authoritative Societies have developed guidelines for colon cancer (CC) management, with some discrepancies. Method: We compared the European Society of Surgical Oncology (ESMO) and NCCN guidelines. Results: NCCN describes cancerous polyps and CC workup. Only NCCN stratifies resectable CC according to presentation and suggests the use of stents as bridgeto-surgery. Both indicate minimally-invasive surgery based on surgeon experience, no locally-advanced CC or perforation, whereas only ESMO suggests prior major abdominal surgery to be an exclusion criteria. Both do not advise adjuvant chemotherapy (CT) in T1/T2N0M0, and recommend CT in selected T3N0M0. ESMO addresses high-risk features and timing/duration of CT. Both recommend CT in T4N0. NCCN favours Capecitabine or 5FU, whereas ESMO suggests 5FU+/-oxliplatin. FOLFOX is agreed in anyTN+, but ESMO suggests also to use XELOX, and does not include capecitabine. Only NCCN addresses surveillance. NCCN recommends synchronous/staged CC and liver/lung resection in oligomestatic disease as first choice, considering FOLFIRI or FOLFOX or other agents  biological drugs, whereas ESMO suggest perioperative FOLFOX rather than resection, without directions on tumour biology. ESMO felt adjuvant CT questionable in these patients. Conclusion: Major discrepancies included adjuvant treatment and resectable, metastatic CC. These should be considered when developing future guidelines, and reliable trials may be needed.

Aim: To compare survival and morbidity in women treated by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) for colorectal peritoneal carcinomatosis with or without ovarian metastases (OM). Method: A prospectively maintained database was analysed to identify women treated by CRS-HIPEC between 2009 and 2015. Results: Among 62 included women, 39 had ovarian metastasis (63%) with comparable PCI (10 vs 7 P = 0.15). OM patients experienced more frequent grade III/IV postoperative morbidity (56.4% vs 30% P = 0.04), and postoperative haemoperitoneum (23.1% vs 4.3% P = 0.07) leading to more frequent reoperation (36 vs 21.7% P = 0.2). Among OM patients, 20 (52%) had undergone ovariectomy previously to CRS-HIPEC procedure. Haemoperitoneum (30% vs 15% P = 0.4) and reoperation (45% vs 26% P = 0.2) were more frequent if previous OM resection had been performed as compared to synchronous. The 36-month survival (94.7% vs 61.7%) was significantly impaired by OM (P = 0.007) and 36-month survival without recurrence was better when ovariectomy was performed during CRS-HIPEC (24% vs 5.5%, P = 0.4). Conclusion: Survival and morbidity of patients with CRS-HIPEC for colorectal peritoneal carcinomatosis were impaired by the presence of OM and previous OM resection.

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Poster Abstracts P321 Deferring surgery for rectal cancer up to six months post neoadjuvant chemoradiation does not adversely affect outcomes A. Plastiras1, M. Sideris1, A. Gaya2, A. Haji1, J. Nunoo-Mensah1, A. Haq1 & S. Papagrigoriadis1 1 King’s College Hospital, London, UK, 2Guy’s and St. Thomas’ Hospital, London, UK Aim: Evaluate the optimal time for surgical treatment of rectal cancer. Method: We conducted a retrospective review on 65 consecutive patients with locally advanced rectal cancer who underwent preoperative CRT followed by surgical resection. Results: We used several groupings for analysis; patients who underwent surgery up to 6 weeks from CRT (n = 28), those who had surgery 6 weeks or more (n = 27) after CRT, patients who were operated within 3 months (n = 39) and those who underwent surgical resection later than 3 months following CRT (n = 16). There was no statistical association between period of post CRT waiting and radiological down staging (P = 0.199, P coefficient = 0.161). Also there was no association between pathological perineural invasion, recurrence, or cancer related death with the period of waiting (P > 0.05 for all associations). Overall, there was no statistical significant relationship in our analysis with regards to the outcomes of Cancer Related Death, Downstaging as defined by difference in the radiological and pathological TNM stage, Recurrence, pNI, and risk of positive lymphadenopathy. Conclusion: Waiting up to 6 months post neoadjuvant chemoradiotherapy does not have any adverse outcome on pathological response, recurrence rate, disease free survival rate and cancer related death in patients regardless of overall response to CRT.

P322 Neuromodulating as immunity activating mechanism in colon cancer patients M. M. Pliss1 & M. G. Pliss2,3 1 St.Lucas hospital, St.Petersburg, Russia, 2St.Petersburg State medical univercity I.P.Pavlov, St.Petersburg, Russia, 3North-West Almazov federal medical center, St. Petersburg, Russia Aim: Colon cancer induces a cascade of physiological, biochemical and immunological changes in the body. Laparoscopic surgery for colon cancer is less invasive, but there is still a need to improve on postoperative enhanced recovery. Melatonin, a kind of universal neuro-hormone with profound peripheral effect on many targets, especially on the immune system. This study aimed to evaluate effects of preoperative utility of melatonin on postoperative care, short-term clinical outcomes and immune response in postoperative period. Method: Thirty-eight patients, (age 43–78 years) with colon cancer underwent surgery (open or lap). Half of them were in blind manner treated by an oral administration of melatonin 3 mg/day. Pro- and anti-inflammatory interleukines-IL-2, 6, 10 were analysed for blood samples collected preoperatively and postoperatively on 1, 3 and 7 days. Patients were divided into 4 groups; open surgery (group 1) and laparoscopic surgery (group 2), open surgery + melatonin (group 3), laparoscopic surgery + melatonin (group 4). Results: Clinical data showed that for groups 1–4, time periods for return of intestine motility were 120.1  9.4, 71.1  5.7, 4.2  3.1, and 14.6  2.1 hours. And time periods for first bowel movement were in 124.1  8.2, 76.1  5.4, 64.1  2.1 and 12.2  2.2 hours. In the melatonin preconditional group the hospital stay was 60% shorter due to faster normalisation of intestine function. IL-2, 6, 10 levels in postoperative period correlated with the extent of operation trauma, but their normalisation was very short for patients in melatonin preconditioning group (up to 2 times). Interleukin postoperative profile reflected the grade of operational trauma and immune response. Conclusion: Preoperative neuromodulation is associated with different visceral effects, including direct action on intestinal function recovery.

P323 Diagnostic importance of determination of 2 markers for occult blood in colorectal cancer screening S. Vasiliev1,2, E. Smirnova1,2, D. Popov1,2, A. Semenov1,2 & E. Savicheva1 1 The 1st Pavlov State Medical University of St.Petersburg, Saint Petersburg, Russia, 2 City Center of Coloproctology, Saint Petersburg, Russia Aim: To show a benefit of determination of two markers in detection of faecal occult blood. Method: A cohort of 300 patients referred for colonoscopy was examined by two tests for FOB: ColonView (CV) (FIT test for hemoglobin and hemoglobin/haptoglobin complex) and Hemoccult SENSA (HS). Three faecal samples were tested and all participants were examined by diagnostic colonoscopy with biopsy verification. The performance indicators (sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV) and area under the curve (AUC))

were calculated for both tests using three endpoints (adenoma (A), adenoma/carcinoma (A/AC) and carcinoma (AC)) Results: Colonoscopy disclosed normal results in 114 (38.0%) subjects, A in 91 (30.3%) cases and AC in 95 (31.7%) patients. For the combined A+AC endpoint, the HS test had SE of 58.3% and SP of 96.5%, while the CV test had 97.2% SE and 85.8% SP (P = 0.0001). For the A endpoint, the difference between HS and CV was more significant (P = 0.0001). For the AC endpoint, the HS test had SE of 85.3% and SP of 96.5%, while the CV test had 100.0% SE and 85.1% SP (P = 0.0001) Conclusion: The CV test can be represented as an effective test in the screening for colorectal cancer.

P324 Colorectal cancer invasion into adjacent pelvic organs: do radiological findings approximate the truth? S. Y. Pow1, R. Tiwari1, N. Y. Lee2, H. H. Huang1, J. L. Ng1 & M. H. Chew1 1 Singapore General Hospital, Singapore, Singapore, 2National University of Singapore, Singapore, Singapore Aim: This study aim to correlate pre-operative radiological findings of adherence and invasion into adjacent pelvic organs in locally advanced colorectal cancer with intra-operative surgical findings and histological results. Method: Retrospective analysis of 53 patients undergoing colorectal resection with concomitant bladder and/or gynecological organ resection for locally-advanced primary colorectal cancer in a tertiary referral centre from 2007 to 2012 was performed. Resected specimens were examined by gastrointestinal histopathologists. Pre-operative CT and/or MRI were reviewed by investigators blinded to the intraoperative and histological results and correlated with these primary outcomes. Logistic regression studies were performed to determine predictive accuracy (PA), sensitivity and specificity. Results: Imaging suggestive of invasion was strongly correlated with both intraoperative (P < 0.05, PA 96.2%, sensitivity 100%, specificity 0%) and histological (P < 0.05, PA 67.9%, sensitivity 67.7%, specificity 68.2%) findings of invasion for both bladder and gynecological organs. Conversely, imaging that suggested adherence without invasion was poorly correlated with intra-operative findings of adherence (P = 0.533). Overall, imaging findings was congruent to intra-operative findings in 45.3% of cases, and congruent to histology in 67.9% of cases. Conclusion: Pre-operative imaging can closely predict colorectal cancer invasion but not adherence into adjacent pelvic organs.

P325 Temporary ileostomy closure with prophylactic mesh reinforcement of closure site. Is there more risk of infection? I. Pros, A. Gil, C. Ribera, V. Marcilla, J. Otero, W. Martinez, G. Sugra~ nes & J. Rius Hospital Sant Joan de Deu, Martorell, Barcelona, Spain Aim: To assess the risk of surgical wound infection for patients undergoing closure of temporary ileostomy and had their stoma site reinforced with a prophylactic mesh. Method: We retrospectively reviewed 58 consecutive patients undergoing surgery between 2008 and 2016. Since 2013, prophylactic mesh was placed. Patients were divided into two groups: simple closure (SC) and prophylactic closure reinforcing mesh (MC). Surgical Technique involved; spindle shaped peristomal incision, 57 hand-sewn and 1 stapled anastomosis. Stoma site sheath closure involved; polidesoxanone suture (PDS), polypropylene mesh (PPE) in the MC group fixed with PDS00. Wounds were washed and subcutaneous wound closed with poliglic olic 00, Scarpa fascia with PPE00 and a Penrose drain was inserted. Preoperative antibiotic prophylaxis (Gentamicin+Metronidazole) was used. Surgical wound infection suppuration culture was considered positive if suppuration positive culture occurred despite no debridement. Results: Of 58 patients was carried out in 27 SC and 31 CM. Both groups were comparable for age (64.1 vs 67.9), sex (21V/23V vs 6M/8M) and associated pathology. 2 patients in the CS group had surgical wound infection (Enterococcus faecalis and mixed flora) and 3 in MC group (E. coli, Klebsiella and Enterococcus). The incidence of infection showed no statistically significant differences between two groups. Conclusion: Prophylactic placement of mesh to close the ileostomy does not increase surgical wound infection and may prevent further herniation, so consider it a recommended technique.

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Poster Abstracts P326 Is there any relation between the value of CRP in the first postoperative day and the development of sepsis complications in elective colorectal resections? Y. Rajjoub1, N. Saffaf2 & M. Peacock1 1 Cheltenham General Hospital, Cheltenham, UK, 2Warwick Hospital, Warwick, UK Aim: To find out if CRP level on the first post-operative day is a good diagnostic tool for post-operative sepsis complications. Method: Retrospective study on patients who underwent elective colorectal resections between 01/01/2013 and 01/01/2016. Patient data was collected from notes; from date of surgery until 1 month follow up. ROC analysis were performed to assess the diagnostic accuracy of CRP. XLSTAT program was used for statistical analysis. Results: Two hundred and seventy-two patients were included (M = 143, F = 129). Modes of surgery were; laparoscopic 130 (48%), open surgery 124 (46%), laparoscopic converted to open 13 (4%) and laparoscopic assisted 5 (2%). Sepsis related complications occurred in 59 patients (22%). These included; anastomotic leak (6), intra-abdominal collection (8), pneumonia (12), wound infection (19) and others (4). The mean value of CRP on post-operative day 1 was 79.98 mg/L (normal range 66 and sex, were able to differentiate CRC form CHC (AUC = 0.854). Importantly, the model differentiated stage I/II CRC from CHC with a similar performance

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(AUC = 0.836). Using a 0.8 cut-point the model had a sensitivity of 66.8% and a specificity of 90.2%. Conclusion: A model including eight hypermethylated promoter regions has a diagnostic performance similar to the immunochemical faecal occult blood test for CRC screening.

P329 Enhanced recovery after colorectal cancer surgery: short-term outcome A. Rasulov, S. Gordeyev, A. Ovchinnikova & Y. Kovaleva N.N.Blokhin Russian Cancer Research Center, Moscow, Russia Aim: The aim of this study was to investigate safety and efficacy of enhanced recovery after surgery (ERAS) in colorectal cancer patients. Method: During October 2014 - March 2016 patients age 18–75, ECOG0.80 on which sensitivity, specificity, positive predictive value and negative predictive value was calculated. Results: We observed that CRP, procalcitonin, platelets, leukocytes, neutrophils, coagulation markers and GPT have a significant relationship with the occurrence of infectious complications after rectal surgery; only the CRP on days 4 and 5 demonstrated the necessary characteristics to be useful as a diagnostic test with AUC>0.80. Conclusion: The use of lower cut-off points of the CRP is an excellent tool for ruling out infectious complications and making safe discharges after rectal surgery.

P339 Analysis of hemodynamic differences generated in open (Coliseum) and closed HIPEC techniques for treatment of peritoneal carcinomatosis of colorectal cancer origin C. R. Silva, F. J. M. Ruiz, J. C. Campos, A. T. Garcıa, I. G. Poveda, M. R. L opez, J. A. T. Mata, S. M. Velasco & J. S. Santoyo HRU Carlos Haya, Malaga, Spain Aim: Peritoneal carcinomatosis is the leading cause of mortality in colon cancer cases. Cytoreductive surgery and HIPEC offer a revolutionary alternative. While there are two main widely accepted treatment methods, the superiority of one over the other has not been demonstrated. Method: A retrospective study, between 2011 and 2015, in patients with peritoneal carcinomatosis secondary to colon cancer, where cytoreductive surgery and HIPEC using open and closed techniques were performed. During the procedure hemodynamic parameters and intra-abdominal temperature were recorded. Results: There were 29 patients in the series. 66.7% were women and the median age was 52. The closed technique was performed on 37.5% and the “coliseum” technique on 62.5%. No statistically significant differences were detected in terms of hemodynamic alterations except for a trend in favour of the open technique which has a more positive effect on diastolic blood pressure (P = 0.09) and central venous pressure (P = 0.08). Analysing intra-abdominal temperatures, we detected statistically significant differences in favour of the closed technique (P = 0.009). Conclusion: Both techniques are excellent HIPEC surgery treatment methods, characterised by slight differences in hemodynamics during the procedure. The closed technique demonstrates greater stability intraoperatively of the intraabdominal temperature.

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P340 Prolonged treatment interval between short course radiotherapy and surgery in rectal cancer patients A. Rombouts1, N. Hugen1, M. Elferink2, I. Nagtegaal3 & H. de Wilt1 1 Department of Surgery, Radboud university medical center, Nijmegen, The Netherlands, 2Comprehensive cancer centre the Netherlands (IKNL), Enschede, The Netherlands, 3Department of Pathology, Radboud university medical center, Nijmegen, The Netherlands Aim: Patients with locally advanced rectal cancer are usually treated with neoadjuvant chemoradiation (CRTX) followed by surgery. In elderly or unfit patients, short-course radiotherapy (SCRT) followed by surgery after a prolonged treatment interval is an alternative treatment. Our goal was to evaluate and compare the effects of these treatment regimens. Method: All stage I-III rectal cancer patients who were diagnosed between 2006 and 2011 and received SCRT (5 9 5 Gy; N = 205) or CRTX (25 9 2 Gy + 5FU; N = 1360) followed by surgery after a treatment interval of 5–15 weeks were retrieved from a nationwide cancer registry. Results: Median follow-up was 49 months (range 2–109). Mean age for patients treated with SCRT was 71 years compared to 62 years in patients treated with CRTX (P < 0.001). Patients treated with CRTX had clinically more advanced tumours compared to SCRT treated patients (cT3-4 tumours 84.7% vs 66.8%). Complete pathologic response (ypT0N0) was found in 9.8% of patients after SCRT and 16.5% after CRTX (P = 0.013). A near complete pathologic response (ypT01N0) was found in 20% of patients after SCRT and 22.2% of patients after CRTX (P = 0.477). Conclusion: Prospective trials are needed to establish the difference between these two treatment regimens and the impact on organ preserving strategies.

P341 MELD score prediction is the hepatic metastases in colorectal cancer? € A. Sapmaz, A. S. Karaca & B. Ozkan Ankara Numune Education and Research Hospital, Ankara Numune Education and Research Hospital, Turkey Aim: Colorectal cancer (CRC) is the most common hematogenous metastasis is the liver. In our study, preoperative calculated MELD (Model FR Endstag Liver Disease) score, we investigated the role of the prediction of liver metastases. Method: CRC liver metastases intraoperatively in patients who were operated with the diagnosis determined by the patients (group 1) and metastasis-smoking patients (group 2) were divided into 2 groups. Results: Four hundred and thirty-two patients with a mean age of 62.6  11.9 were male / female ratio was 1:48. 295’s of patients (68.2%) tumour mass while seated rectosigmoid junction, in the 95’s (21.9%) were located in the right colon. The MELD score between the groups studied was found to be significantly higher in Group 1 of the MELD score (P = 0.007). Intergroup MELD score cut-off value to 7.5, based on the sensitivity of the 65.2%, specificity when it was 55.0% and independent of age, sex, and concomitant diseases of the MELD score, we reached the conclusion may predict liver metastasis (P < 0.0001). Conclusion: MELD score may be effective in the detection of liver metastases.

P342 Does liver ultrasound have any additional benefit to computerised tomography in the follow-up surveillance of patients undergoing potentially curative colorectal cancer resection? J. Schneider1, M. Koullouros1, G. Ramsay2, C. Mackay2, C. Parnaby2 & L. Stevenson2 1 University of Aberdeen, Aberdeen, UK, 2Aberdeen Royal Infirmary, Aberdeen, UK Aim: Evidence regarding optimal surveillance protocols following colorectal cancer resection is lacking. We offer alternating liver ultrasound (US) and computerised tomography (CT) every 6 months for 3 years. US is aimed as an adjunct to detect liver metastases between interval CT scans. We determined the diagnostic yield of adjunctive US in patients following potentially curative colorectal cancer resection. Method: All patients at our centre following colorectal cancer resection in 2012 were included. A prospectively maintained pathology database was supplemented with imaging data for retrospective analysis. Results: Two hundred and fifty-six patients (55% males) with a median age of 70.8 (IQR 78.7–63.6) years were studied. 222 (88%) patients had post-operative imaging surveillance, with a median follow up period of 23.3 months (IQR 25.4–18.4). 266 US scans were performed, detecting metastatic disease in 5 (1.8%) patients (liver n = 4 and spleen n = 1). Adjunctive imaging was required in 3 to confirm findings. Tumour stage was Dukes A in 1, B in 1, and C in 3 patients. 418 CT scans were carried out detecting metastatic disease in 125 (30%) and local recurrence in 25 (6%) patients. Conclusion: Our data suggests that the diagnostic yield of liver ultrasound is low and offers little additional benefit to CT-based surveillance.

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Poster Abstracts P343 The assessment of local lymph nodes after neoadjuvant treatment in rectal cancer D.-V. Scripcariu1,2, M.-G. Anitei1,2, I. Radu1,2, I. Hutanu1,2, B. Filip1,2 & V. Scripcariu1,2 1 Regional Institute of Oncology - Oncologic Surgery I, Iasi, Romania, 2University of Medicine and Pharmacy, Iasi, Romania

P346 Outcomes of robotic-assisted colorectal surgery: results from a single centre following a structured training programme T. Sian, H. Park, G. Tierney, J. Lund, N. Hurst, H. Al-Chalabi, W. Speake & S. Tou Department of Colorectal Surgery, Derby Teaching Hospitals NHS Foundation Trust, Derby, UK

Aim: The aim of this study is to evaluate the lymph node status in mid-low rectal cancer and to establish correlations between the lymph node status on the one hand and neoadjuvant treatment and tumour regression grade on the other hand. Method: Data from 309 patients with mid and low rectal adenocarcinoma treated by a single surgical team was collected prospectively over a period of 4 years (May 2012–April 2016). 141 of these patients were treated with neoadjuvant radio (chemo) therapy. Tumour staging was done using pelvic MRI. Pathological assessment was performed by a single pathological team and tumour response was evaluated using Dworak tumour regression score. Chi-squared, Mann-Whitney and Fisher exact tests were used for statistical analysis. Results: The mean number of lymph nodes retrieved in the neoadjuvant treatment and upfront surgery batch was 17.32(range 2–56) and 23.52(range 3–59), with a mean number of 0.97(0–10) and 3.72(0–43) positive lymph nodes respectively (P < 0, 01). Of the 36 patients considered “responders” to neoadjuvant treatment (TRG3-4), 30(83, 3%) were N0, while only 6(16.6%) were N+. In the “nonresponder” group (TRG0-2), 59(56, 19%) were N0 and 46(43, 8%) were N+ (P < 0.001). Conclusion: The number of lymph nodes is influenced by neoadjuvant therapy and is correlated with Dworak tumour regression score.

Aim: Two surgeons undertook robotic training through the European Academy of Robotic Colorectal Surgery (EARCS). One surgeon had no formal minimally invasive training. We present our short-term results. Method: First 30 consecutive robotic colorectal procedures from a prospectively maintained database between November 2014 and January 2016. Results: Of the 30 patients, 14 were male. Mean age 62.2 years (range 36 – 82) with BMI of 26.8 (range 20–32.5). Procedures: 18 high anterior resection, 5 low anterior resection, 3 APER, 3 right hemicolectomy and 1 suture abdominal rectopexy. There were no intra-operative complications with one conversion to open surgery. Post-operative complications: one wound infection and one pelvic collection managed conservatively. Two patients required re-operation: one wound dehiscence, one for bleeding. Mean post-operative stay was 6 days (range 1 - 26). There were two 30-day re-admissions: small bowel obstruction managed conservatively and pneumonia. All cancer procedures (n = 24) had clear resection margins with mean node harvest 19.1 (range 9 – 38). For all low anterior resection TME grade was 3. Conclusion: Our case series demonstrates that successful robotic colorectal services can be established for benign and oncological resection after formal structured robotic training, even for surgeons without formal training in minimally invasive surgery.

P344 Early distal rectal cancer: local excision or TME? S. Vasiliev1,2, A. Semenov1,2, D. Popov1,2 & E. Savicheva1,2 1 The 1st Pavlov State Medical University of St.Petersburg, Saint Petersburg, Russia, 2 City Center of Coloproctology, Saint Petersburg, Russia

P347 An audit comparing the reporting of staging MRI scans for rectal cancer with The London Cancer Alliance (LCA) Guidelines M. Siddiqui1,2, F. Raja3, P. Tekkis4, G. Brown4 & A.-M. Abulafi1 1 Croydon University Hospital, Surrey, UK, 2Imperial College London, London, UK, 3 London Cancer Alliance, London, UK, 4Royal Marsden Hospital, Surrey/London, UK

Aim: Assess the comparison and the efficacy of local excision (LE) and total mesorectal excision (TME) in the treatment of early distal rectal cancer. Method: We analysed a data for 76 patients with confirmed early rectal cancer operated between 2010 and 2015. The present clinical trial includes both genders with mean age of 68  8 years (range 45–86 years), distal rectal localization, uTisT1. There were two groups: LE – 36 (47%) patients and TME – 40 (53%) patients. Results: Average distance from the anal verge was 40  20 mm (range 10– 60 mm); mean operating time was 45  18 min (range 30–70 min) for group of LE and 140  60 min (range 90–220 min) for TME. Median hospital stay was 3  1 days (range 1–7 days) and 9  3 days in LE and TME, respectively. Postoperative complications were encountered in 2.7% of patients after LE and 15% after TME (P < 0.05). Mean following-up was 24  8 months (range 4–68). There were no 30-day or 12-month mortalities. There are no local recurrences in both groups. Conclusion: LE is associated with quicker recovery, shorter hospital stay and lower complication rate than major surgery. There were no significant differences for recurrence in both groups of patients.

P345 Laparoscopic versus open liver resection for metastatic colorectal cancer: A comparative study J. K. Shin, H. C. Kim, W. Y. Lee, S. H. Yun, Y. B. Cho, J. W. Huh & Y. A. Park Samsung Medical Center, Seoul, Republic of Korea Aim: This study compared the short and long term outcomes between laparoscopic and open colorectal resection for patients undergoing simultaneous resection for liver metastases. Method: Sixty-seven patients who underwent combined laparoscopic resection of colorectal cancer and synchronous colorectal liver metastases between 2008 and 2015 were compared to 307 patients treated by open during the same period. The analysed variables included patient and tumour characteristics, short-term and longterm outcomes. Results: Demographic features and pathologic outcomes were similar in both groups. A rectal resection was required in 61.8% and 41.8% of open and laparoscopic procedures, respectively (P = 0.022). There was no difference in hospital stay (P = 0.536), transfusion rates (P = 0.562), and bowel function return time (P = 0.387). The operation time in the laparoscopic group was significantly longer (362 vs 298 min; P = 0.001) than in the open group. The operation-related complication rate was lower in the laparoscopic group (28.4 vs 32.2%; P = 0.032). The laparoscopic group differ significantly in terms of 3-year overall survival rate (98.4 vs 74.6%; P = 0.004) and disease-free survival rate (50.8 vs 39.6%; P = 0.015). Conclusion: Laparoscopic colorectal resection with simultaneous resection of liver metastases has same short-term outcomes compared with the open approach, and excellent long-term oncologic outcomes.

Aim: Standardised proforma reporting may improve quality of reports and uptake may be facilitated by endorsement from regional and national organistaions. This article audits clinical practice before and after guidelines to help improve report completion. Method: London Cancer Alliance (LCA) guidelines served as an intervention. Phase 1 was a 3 month assessment of MRI reports on rectal cancer in the LCA region between April and June 2014. Phase 2 was a 3 month re-assessment between April June 2015. This was 6 months after LCA guidelines. Results: Fourteen out of 15 hospitals responded to our audit proposal. There was a doubling of proforma reporting after the guidelines and this was statistically significant [z = 4.1896, P < 0.05]. Before the introduction of guidelines, overall reporting using prose versus proforma reporting styles showed that completion was better in the proforma group [Mean difference = 0.302 (0.366, 0.238), t = 9.351, P < 0.05]. After the intervention the overall reporting comparing prose versus proforma reporting styles showed completion was better in the proforma group [Mean difference = 0.322 (0.381, 0.264), t = 10.939, P < 0.05]. Conclusion: Incorporation of standardised reporting in official guidelines improves the uptake of proforma based reporting. Proforma based reporting captures more MRI reportable items compared to narrative summaries.

P348 Prognostic implications of rectal tumours with more versus less than 5 mm extension beyond the muscularis propria on post neoadjuvant therapy MRI scans M. Siddiqui1,2, S. Balyansikova1, N. Battersby1, A. Wale1, J. Bhoday1,3, P. Tekkis1,2, A.-M. Abulafi3 & G. Brown1,2 1 Royal Marsden Hospital, Surrey/London, UK, 2Imperial College London, London, UK, 3Croydon University Hospital, Surrey, UK Aim: This article investigates overall survival in patients with rectal cancer that extends beyond the muscluaris propria for greater than 5 mm compared to tumours with less invasion identified on post-treatment MRI. Method: A retrospective cohort study between 2011 and 2014 of rectal cancers with tumour extension beyond the muscularis propria identified on the post-neoadjuvant scan. Results: There were 129 patients. There were 40 deaths giving an overall mortality rate of 31%. 4 year overall survival showed an average survival of 1199 days (95% CI: 1117–1282, SE: 41.9) in patient with less invasive tumours compared to 954 days (95% CI: 827–1080, SE: 64.5) in tumours with more than 5 mm of extramural invasion. This difference was statistically significant on the Log-Rank (Mantel-Cox) statistic (Q = 11.63, P = 0.001). Regression analysis found less invasive tumours (5 mm) tumours [HR: 2.59, CI: 1.18–5.73, P < 0.05].

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Poster Abstracts Conclusion: MRI scans can sub-classify rectal tumours into those with more than 5 mm invasion beyond the muscularis propria and identifies a sub-group of patients who have a worse 4-year overall survival. This risk is more than 2.5 times the risk associated with less invasive tumours. Sub-classifying T3 tumours should be a reporting requirement in post-treatment MRI scans.

P349 A meta-analysis assessing the survival implications of sub-classifying T3 rectal tumours M. Siddiqui1,2, C. Simillis1, J. Bhoday1,2, N. Battersby1, P. Tekkis1, A.-M. Abulafi2 & G. Brown1 1 Royal Marsden Hospital, Surrey/London, UK, 2Croydon University Hospital, Surrey, UK, 3Imperial college London, London, UK Aim: Although T3 tumour sub-classifications has been linked to prognosis, its mandatory adoption in histopathological reports has not been incorporated. The aim was to report survival outcomes in patients with T3 rectal cancer and more than or less than 5  1 mm invasion beyond the muscularis propria Method: A meta-analysis of all studies up to March 2016, without language restriction were identified. Hazard ratios were extracted directly from the studies or from survival curves using the technique described by Parmar. Quality assessment was performed using the Newcastle-Ottawa scale. Results: Data were analysed according to meta-analytical techniques using comprehensive meta-analysis. Tumours with invasion less than 5  1 mm from the muscularis propria had significantly better overall survival [Fixed effects:0.714 (0.489, 0.939), P < 0.001] and there was no significant heterogeneity (Q = 1.541, df = 3, P = 0.673, I2 = 0).There was significantly better disease free survival in less invasive tumours [Fixed effects: 0.670(0.50, 0.84), P < 0.001] and cancer specific survival [Fixed effects:0.817 (0.544, 1.090), P < 0.001]. Overall survival in patients who had neoadjuvant therapy was higher in patients with less invasion [P < 0.01] Conclusion: Sub-classifying T3 rectal tumours into more than 5  1 mm invasion beyond muscularis propria identifies patients who have worse overall survival, disease free survival and cancer-specific survival. The T3 sub-classification of tumours should be a reporting requirement in histopathology reports.

P350 The role of cell free circulating tumour DNA (ctDNA) defined by KRAS mutations in the assessment of colorectal cancer: a diagnostic test meta-analysis M. Siddiqui1,2, J. Bhoday1, M. Chand3, P. Tekkis2,4, A.-M. Abulafi1 & G. Brown4 1 Croydon University Hospital, Surrey, UK, 2Imperial College London, London, UK, 3 University College London, London, UK, 4Royal Marsden Hospital, Surrey/London, UK Aim: Circulating tumour DNA may be beneficial in prognostication however sensitivity and specificity has not been explored. This study investigates the diagnostic utility of circulating tumour DNA as defined by KRAS mutations for recurrence after surgery Method: A meta-analysis of all studies up to December 2015, reporting on circulating tumour DNA as defined by KRAS mutations in patients with colorectal cancers were included. Quality assessment was performed using QUADAS criteria. Results: Data were extracted and analysed according to meta-analytical techniques using meta-disc. The combined sensitivity and specificity of blood KRAS for predicting recurrence were 0.56 (CI: 0.469–0.652) and 0.84(CI: 0.797–0.884) respectively with a pooled AUC of 0.82 and diagnostic odds ratio (DOR) of 5.7(CI: 2.7– 12.2). There was significant heterogeneity between studies (Q = 21.67, df = 8, P = 0.006, I2 = 63.1). Only 2.2% of the healthy individuals had KRAS mutations. Conclusion: Tumour mutations in DNA can be readily identified in the circulation. Pre-operative KRAS mutations appear to be an independent prognostic factor for identifying recurrences in metastatic disease. They are likely to be prognostic for non-metastatic disease. Routine testing could be used to risk stratify and counsel patients pre and post operatively. Circulating tumour DNA may be useful in the post-operative setting for early detection of recurrences but further studies are required.

Method: This is a case control study where we compared 10 early Rectal Cancers that had recurred, with 19 cases with no recurrence, total 29 patients (age = 28.25 – 86.87, mean age = 67.92 years, SD = 14.91, Male, N = 18, Female, N = 11). All patients underwent TEMS for radiological Stage I rectal cancer (yT1N0M0 or yT2N0M0). Results: From 29 specimens analysed, 19 were KRAS wild type (65.9%) and 10 mutant (34.5%). Recurrence of the tumour was noted in 10 cases (34.5%) from which 60% were pT1 (N = 6) and 40% pT2 (N = 4). There was a statistically significant association between KRAS mutant status and local recurrence (N = 6, P = 0.037). P16 expression greater than 5% (mean = 10.8%, min = 0, max = 95) is linked with earlier recurrence within 11.70 months (N = 7, P = 0.004). Membranous b-catenin expression (N = 12, 48%) was also related with KRAS mutant status (P = 0.006), but not with survival (P > 0.05). BRAF gene was found wild type in all cases tested (N = 23). Conclusion: KRAS/p16/b-catenin could be used as a combined biomarker for prediction of local recurrence and stratification of the risk for further surgery

P352 KRAS mutant status, membranous b-catenin and p16 expression may be considered as a distant recurrence predictive tool in Rectal Cancer Patients M. Sideris, J. Moorhead, S. Diaz-Cano, I. Bjarnason, A. Haji & S. Papagrigoriadis King’s College London, London, UK Aim: To identify the prognostic value of common biomarkers (KRAS, BRAF, p16, b-catenin, MSI, MMR and MGMT) in rectal cancer Method: We retrospectively collected data from a cohort of 135 consecutive Rectal Cancer Cases who underwent radical excision in a tertiary centre between 2011 and 2014 (M = 87, F = 48, Age 22–89, mean = 64, 67, SD = 13.40). Results: The mean follow up was 39.21 months (5–83, SD = 21.34). 28 cases were Stage I (20.9%), N = 30 Stage II (22.4%), N = 45 Stage III (33.6%) and N = 31 Stage IV (23.1%). 40 specimens were KRAS mutant (mt) (37.4%) while N = 67 (62.6%) wild type (wt). Membranous (m) expression of b-catenin was associated with distant recurrence (N = 6, P = 0.092), and potentially KRAS mt status, as out of 27 specimens with m expression N = 17 were KRAS mutant (P = 0.058). Mean % p16 expression was 12.62% (0–70, SD = 15.33). Stage I Early Cancer Subgroup analysis showed that KRAS mt status is linked with distant recurrence of disease (N = 4, P = 0.045) and m b-catenin (N = 3, P = 0.098) Conclusion: B-catenin membranous expression, KRAS mt status and p16 trend may have a role in the prediction of distant recurrence, especially in early rectal cancer. Further prospective studies may clarify this assumption.

P353 Endo-luminal vacuum therapy as a salvage therapy after rectal anastomotic leak P. Sileri1, M. Shalaby1,2, S. Quaresima1, G. Lisi1, E. Aronadio1 & G. Milito1 1 University of Rome Tor Vergata, Rome, Italy, 2Mansoura University, Mansoura, Egypt Aim: Anastomotic leak jeopardizes colorectal surgery with increased morbidity, mortality and risk of permanent stoma. We report our experience with Endo-luminal Vacuum Therapy (EVT) as salvage therapy for the anastomosis. Method: Nineteen patients with anastomotic leakage following anterior resection between January 2016 and January 2016 were suitable for EVT. EVT was performed endoscopically after cavity irrigation with saline. An open-pore polyurethane sponge was inserted in the cavity and tailored according to its size then connected to the negative suction device. Results: All patients had anastomosis within 8 cm from the anal verge with faecal diversion at initial surgery. Leaks were confirmed by CT/rectal contrast after a median of 8 days (range 3–21). Before EVT any pelvic collection was drained (4 surgically, 12 radiologically). Median EVT duration was 32 days (range 6–87) with a median of 4 sponges per patient (range 3–14). Two patients (11%) experienced complications - 1 bleeding (discontinued EVT) and 1 anastomotic stenosis. One patient died. The success of the EVT was defined by cavity closure confirmed endoscopically in all remaining patients and stoma reversal in 17 patients (94%). Conclusion: EVT allows for anastomotic salvage within a relatively short period of time thus reducing the impact of a permanent stoma.

P351 KRAS mutant status, p16 and b-catenin expression may predict local recurrence in patients who underwent Transanal Endoscopic Microsurgery (TEMS) for Stage I Rectal Cancer M. Sideris, J. Moorhead, S. Diaz-Cano, I. Bjarnason, A. Haji & S. Papagrigoriadis King’s College London, London, UK

P354 Emergency presentation of colorectal malignancy remains stubbornly high R. Kadaba1, I. Silva1, S. Renshaw1, A. Hotouras2, C. Bhan1 & J. Wilson1 1 Department of Surgery, The Whittington Hospital, London, UK, 2Department of Surgery, Whipps Cross Hospital, London, UK

Aim: We aimed to study the effect of biomarkers in local recurrence for Stage I rectal cancer following TEMS plus or minus radiotherapy.

Aim: To audit the prevalence and impact of emergency presentation of colorectal cancer (CRC).

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Poster Abstracts Method: Prospective collection of data on patients undergoing major resection for CRC over a 12 month period. Results: Forty-six patients (28 males; median age 68) in total underwent resection (30% as emergency). In the elective group, 63% of patients were attempted laparoscopically (conversion rate 20%) in comparison to 37.5% laparoscopically with 60% conversion in the emergencies. Curative resections were carried out in 88% of elective patients with R0 89.5% (R1 7.9%; R2 2.6%), while the emergency group had 64% with R1/2 rate of 21%. Major complications occurred in 20% with an anastomotic leak rate of 12.9% in the elective group. Emergency resections had a higher complication rate of 31.3% and a leak rate of 25%. Overall 90-day readmission rate was 28.6% compared to 43% in the emergency group. Observed 90-day mortality in the elective group was 6% compared to 14% in the emergency group. Conclusion: Emergency presentation of CRC remains stubbornly high with associated poorer outcomes despite recent public awareness campaigns. The explanation is multifactorial. Further national directives should consider geographical variation and underlying causes to facilitate improvement.

P355 Clinical outcome measures of patients with brain metastases secondary to colorectal cancer I. Silva1, A. Hotouras2, J. Wilson1, J. Murphy3, C. Bhan1 & S. Wexner4 1 Department of Surgery, The Whittington Hospital, London, UK, 2Department of Surgery, Whipps Cross Hospital, London, UK, 3Department of Surgery and Cancer, St. Mary’s and Hammersmith Hospital, Imperial College London, London, UK, 4 Department of Colorectal Surgery, Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA Aim: Literature review assessing the treatment options for patients with brain metastasis (BMs) from colorectal cancer (CRC). Method: PubMed literature search in English language (1995–2015) for: ((Colorectal Cancer) OR (colorectal carcinoma) OR (colorectal adenocarcinoma)) AND ((Brain metastases) OR (Brain metastasis)). Results: Fourty articles were screened (1 not available, 16 irrelevant) with 23 included. BMs were diagnosed on average 28.9 months after the primary tumour. The median survival time after BM diagnosis was 5.3 months. Surgery (with or without associated radiotherapy), stereotactic radiosurgery, whole brain radiotherapy, and best supportive care resulted in median survival periods of 10.4, 6.4, 4.4 and 1.8 months, respectively. On average the 1-year overall survival rate for patients with BMs from CRC regardless of the treatment performed was 24%. Conclusion: The prognosis of patients who develop BMs from CRC is dismal. However because these lesions are rare, an optimal strategy has not yet been established. Surgery may increase survival but the additional benefit of peri-operative radiotherapy cannot be ascertained due to a lack of data. Further work will be required in future to develop clinical strategies for patients who require aggressive treatment of BM.

P356 Pelvic exenteration for locally advanced recurrent gynaecological malignancy S. Smolarek, R. Radvan, M. Evans, P. Bose, M. Davies, D. Harris, J. Beynon & K. Lutchman-Singh Abertawe Bro Morgannwg University Health Board, Swanse, UK Aim: This study analysed outcomes of pelvic exenteration for recurrent gynaecological malignancy. Method: All patients undergoing pelvic exenteration for recurrent gynaecological malignancy between March 1999 and October 2015 were included in this retrospective study. Results: Forty-one patients underwent pelvic exenteration. The median age was 66 years (range 27–79). 5-year survival was observed in 44.1% of patients. The survival time after R0 and R1 was 36.16 months (range 0.4–178.4) and 9.97 months (range 1.2–15.1), respectively (P < 0.05). There were 13 anterior, 5 posterior and 23 total pelvic exenterations. There was no difference in survival related to the type of exenteration (P = 0.70). The most common cancer was endometrial (53.7%) followed by cervical (29.7%), vulvar (7.3%), vaginal (7.3%) and one ovarian cancer (2.4%). There was no difference in survival in relation to cancer origin (P = 0.27), nodal status (P = 0.07) and the presence of LVSI (P = 0.41). There was a trend towards longer survival after postoperative radiotherapy, but this did not reach statistical difference (P = 0.06). Postoperative morbidity and mortality were 51% and 2.4% respectively. 34.1% had plastic surgical perineal reconstruction. Conclusion: Pelvic exenteration for gynaecological tumours is associated with 44.1% 5-year survival. Poor outcome was associated with an R1 resection.

P357 Comparative analysis of complications of en bloc-resections for locally advanced colorectal cancer M. Sokolov1, S. Maslyankov1, K. Angelov1, M. Vasileva1, M. P. Atanasova2, D. Tobova2 & G. Todorov1 1 Department of Surgery, Medical University, University Hospital Alexandrovska, Sofia, Bulgaria, 2Department of Anesthesiology and Intensive care, University Hospital Alexandrovska, Sofia, Bulgaria Aim: To evaluate the type, frequency and severity of intra- and postoperative complications in combined resection of locally advanced colorectal cancer (LACRC), standard (single organ resection) and palliative surgery. Method: A retrospective cohort study of 1298 patients with established colorectal cancer who underwent surgery during 2002 and 2015. 349 patients were staged cT4M0. 110 patients underwent enbloc resection. Results: Surgical postoperative complications not requiring re-operative surgery (Clavien-Dindo-classification Grade I- IIIa) - were 7.8% in the combined resection group and did not demonstrate a significant difference compared with standard and palliative operations (8.8%). In terms of major surgical complications (ClavienDindo-IIIb - IVab) data showed significantly higher frequency in multivisceral resection (6.8%) compared with palliative surgery (1.6%; P = 0.02) but no significant difference between combined resections and standard single organ resections (P = 0.45). The average survival in the “potentially curative” multivisceral resections group was 33 months while in palliative group 17.2 months – P < 0.05. Conclusion: Adequate patient selection is essential for optimal results. Extended neoplastic syndrome and comorbidities may play a decisive role in the immediate outcome of surgery. The expertise of the surgeon is critical in the evaluation of the individual circumstances and appropriate choice of a more aggressive or more limited procedure.

P358 Lymph node harvest in colorectal cancer: a comparison between laparoscopic and open approaches R. Spence, A. Spence, A. Neill & D. McKay Craigavon Area Hospital, Craigavon, UK Aim: Lymph node harvest is important for staging colorectal cancer. It determines the requirement for adjuvant chemotherapy and predicts survival. The aim of this study is to investigate lymph node harvest in colorectal cancer resections comparing laparoscopic and open approaches. Method: Data were obtained from a prospectively maintained database for all patients who underwent surgery for colorectal adenocarcinoma over a 4-year period (2011–2015). Resections were grouped into right-sided (right hemicolectomy; extended-right hemicolectomy); left-sided (left hemicolectomy; sigmoid colectomy; Hartmann’s); rectal (anterior resection; APR). Results: There were 178 resections over the 4-year period with 169 cases eligible for inclusion (M:F 113:65) and a mean age of 71 years (range 43–89). 122 laparoscopic and 47 open resections were performed with mean node harvest for laparoscopic of 18.9 nodes and for open 19.5 nodes (P = 0.63; CI-3.06-1.87). There were 71 right-sided resections (53 laparoscopic;18 open) with mean node harvest for laparoscopic of 20.3 nodes and open 20.1 nodes (P = 0.92; CI-4.03-4.47). 26 leftsided resections were recorded (19 laparoscopic, 7 open) with mean laparoscopic node harvest of 16.4 nodes; open 19.3 nodes (P = 0.50; CI-12.40-6.56). 72 rectal resections were performed (50 laparoscopic; 22 open) with mean node harvest for laparoscopic of 18.3 nodes; open 19.0 nodes (P = 0.68; CI-4.13-2.70). Conclusion: There was no statistically significant difference demonstrated in nodal harvest between open and laparoscopic surgery for all types of colorectal cancer resections.

P359 The role of integrated petct in the evaluation of paraneoplastic syndromes C. Stavrou, L. Gould, R. Dunne, G. Maurer, M. Chand & A. Engledow University College Hospital, London, UK Aim: Cancers, including colorectal, may present in a variety of ways; most commonly with symptoms from the primary or secondary disease. Paraneoplastic syndromes may, however, be the only presenting symptom. The role of FDG PET-CT in these patients was investigated. Method: A prospective database was maintained of all patients presenting with paraneoplastic syndromes to our tertiary institution between Jan 2012 until Oct 2014. Demographic data and investigation results (conventional imaging  endoscopy) including PETCT were recorded. Results: There were 209 patients in total (115 male). Median age of 64 (range 18 88). 191 patients did not have evidence of a malignancy after conventional investigations and PET-CT. Of the 18 patients in which a malignancy was confirmed, 16 were found with conventional investigation. All 16 primaries were confirmed on subsequent staging PET-CT. 2 patients had their primary disease on PET-CT only.

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Poster Abstracts Conclusion: The majority of suspected paraneoplastic syndromes do not in fact reveal an underlying malignancy. Conventional investigations will commonly reveal the primary site. PET-CT acts as a useful adjunct but, in our experience, the diagnostic yield is low – 2 out of 209 cases. PET-CT should be considered if current standard investigations are negative.

P360 The incidence of colorectal neoplasia among patients with gallbladder polyps: a systematic review K. Stergios1,2, M. Frountzas1, V. Vijay2 & D. Perrea1 1 National and Kapodistrian University of Athens, Athens, Greece, 2The Princess Alexandra Hospital NHS Trust, Harlow, Essex, UK Aim: Colorectal neoplasia is one of the most frequent malignancies in western societies. Colorectal cancer and gallbladder polyps share common risk factors. We perform a systematic review to identify any correlation between the two entities. Method: We used Medline (1966–2016), Scopus (2004–2016), ClinicalTrials.gov (2008–2016), Cochrane Central Register of Controlled Trials CENTRAL (1999– 2016) and Google Scholar (2004–2016) search engines in our primary search together with reference lists from included studies. Keywords: polyp; gallbladder; colon; colorectal; cancer. All observational prospective and retrospective studies were eligible for inclusion. Results: Four studies were included in our review. Kahn suggested that the presence of gallbladder disease was significantly associated with colorectal polyps (P < 0.001). Jeun found that gallbladder polyps were associated with colorectal adenoma (Odds ratio = 1.796 P = 0.055). Hong studied 4626 individuals reporting that gallbladder polyps were associated with an increased risk of developing colorectal neoplasia (P = 0.032). Lee analysed 44 220 participants and found that this association was not significant (P = 0.304). Conclusion: There is evidence to support the hypothesis that gallbladder polyps might adequately predict future risk of colorectal neoplasia. Further studies are necessary before recommending a screening method.

P361 Ultra-low anterior resection and colo-anal anastomosis for low rectal cancer: reappraisal by anal function K. W. Suh, S. Y. Oh & M. Chun Ajou University School of Medicine, Suwon, Republic of Korea Aim: We aimed to elucidate the quality of life in terms of anal function in patients with low rectal cancer, who unerwent ultralow anerior resection and hand-sewn coloanal anastomosis + loop ileostomy (ULAR-CAA). Method: From 2008 to 2014, 51 ULAR-CAAs were performed (mean age 66.5 with 35 males) in our hospital. Mean distance from dentate line was 1.6 cm (1.0– 3.0 cm). Twenty five patients received preoperative chemoradiation (PCRT). Intersphincteric resection was performed in five cases. Wexner’s incontinence scores were recorded each year following ileostomy closure. Results: Average incontinence scores in each year were 13.4, 10.1, and 7.5, respectively (P < 0.001). In five patients (9.8%), permanent ileostomy was re-created within one year after ileostomy closure. When the results were analysed by possible contributing factors, it was found that PCRT, old age (>70), and male sex were the poor functional prognostic factors. Conclusion: In patients with low rectal cancer undergoing ULAR-CAA, anal functions improved significantly year by year. However, most patients still experience moderate faecal incontinence 3 years after surgery. Early cancer, old age, male, and patients receiving PCRT showed worse functional outcomes. It is not clear that quality of life after sphincter preserving surgery is good.

P362 Management of colon perforation after anorectal manometry for low anterior resection syndrome: report of three cases Y. H. Sul1, J. Y. Kim2 & K. H. Lee2 1 Chungbuk National University Hospital, Cheongju, Republic of Korea, 2Chungnam National University Hospital, Daejeon, Republic of Korea Aim: There is lack of literature evaluating colon perforation and its management after anorectal manometry. There were few cases reported but most of them were accompanied by complications or mortality. Method: Three patients presented with colon perforation and were treated by prompt surgery. Results: The first patient underwent laparoscopic intersphincteric resection 3 years prior and pelvic irradiation for prostate cancer. We found a 3 cm perforation and performed a Hartmann’s operation. The second patient had undergone laparoscopic low anterior resection after neoadjuvant chemoradiotherapy 3 months prior. We found a 3 cm perforation and segmental resection with loop colostomy was performed. The third patient had undergone laparoscopic ultra-low anterior resection

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3 weeks prior. We found a 4 cm perforation and primary repair with loop colostomy was performed. All patients were discharged without any complication. Conclusion: When colon perforation occurs after anorectal manometry for low anterior resection syndrome, defect and faecal spillage tends to be large and extensive. We suggest performing measurement of rectal compliance carefully or delaying it. When a perforation occurs, prompt surgical intervention is necessary due to high possibility of extensive faecal peritonitis.

P363 Narrow band imaging in the treatment of minimally invasive of colon tumours Y. Bereznytskyy, V. Sulyma, R. Duka & G. Astakhov Dnipropetrovsk Medical Academy, Dnipropetrovsk, Ukraine Aim: The aim of this study was to determine the effectiveness of narrow band imaging (NBI) in the endoscopic treatment of patients with operative coloproctology. Method: Intraoperative imaging was performed using an Image 1 SPIES (Karl Storz) platform, which provides lighting in the white-light Spectra A and B modes. 20 patients with colorectal cancer stage T2b-3aN0M0 were included. Results: Using Spectra A and B mode allows for a clearer differentiation of mesenteric vessels, which provides improved anatomical accuracy and planning of surgical intervention. In 65% patients with colorectal cancer additional lesions were identified, which corresponded to mucosal lesions. Conclusion: Application mode Spectra A and B improves the visualization of anatomical structures and improves the laparoscopic treatment of colon tumours.

P364 Prognosis of early recurrence after resection of colorectal liver metastasis N. Sung, W. Choi, I. Choi, D. Yoon, S. Lee, J. Moon, K. Chun, H. Lee & S. Park Konyang university hospital, Daejeon, Republic of Korea Aim: To evaluate the prognosis and risk factor of early recurrence after curative resection of colorectal liver metastasis. Method: We analysed a total of 47 patients who underwent liver resection with curative intention for colorectal liver metastasis from May 2000 to October 2014 in our department. The 5-year overall survival rate between the early recurrence group (ER) within 1 year and non-early recurrence group (NER) were compared using Kaplan-Meier and log-rank tests. Results: Early recurrence was observed in 19 (40.4%) patients. There were no significant differences in the 5-year overall survival rates (49.1% and 34.1% (P = 0.745)) between non-early recurrence and early recurrence patients. We analysed the clinic-pathological variables in terms of TNM stage, lympho-vascular invasion, perineural invasion, resection margin status, and operative technique preoperative CEA level, but there was no significant risk factor related to early recurrence except operative technique. Open resection had an odds ratio of 4.286 (P = 0.022). Conclusion: The prognosis following early recurrence after curative resection of colorectal liver metastasis is not worse than later recurrence. Therefore, we could improve the survival rates through early detection and appropriate additional treatment for early recurrence.

P365 Significance of CRP for predictive factor of anastomotic leakage after laparoscopic colectomy S. Suzuki, S. Yamagishi, Y. Tanaka, K. Nakatsutsumi, R. Nakamoto, Y. Shimizu, S. Yamamoto, H. Makino, M. Ueda & A. Nakano Fujisawa City Hospital, Fujisawa, Kanagawa, Japan Aim: The aim of this study was to investigate whether post-operative serum Creactive protein (CRP) levels and white blood cell count (WBC) can be used to predict the risk of post-operative anastomotic leakage in patients undergoing laparoscopic left-sided colorectal surgery. Method: A total of 224 patients who underwent elective resection for left-sided colorectal cancer between 2010 and 2015 were included in our retrospective study. CRP levels and WBC were evaluated on postoperative day (POD) 1, 3 and 6. All patients had a pelvic drain which was removed on POD4. The diagnostic accuracy of CRP levels and WBC were analysed by receiver operating characteristics (ROC) curve analysis with anastomotic leakage group and non-anastomotic leakage group as the outcome. Results: The overall incidence of anastomotic leakage was 5.8%. CRP level on POD3 was a good predictor of anastomotic leakage. The best cut off value was 10.1 mg/dl (sensitivity, 0.76; specificity, 0.85; positive predictive value, 0.25; negative predictive value, 0.98).

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Poster Abstracts Conclusion: CRP measurement on POD3 is useful in predicting an anastomotic leak, but is much more useful as criteria for removing the drain because of high ratio of negative predictive value.

P366 Cranial to caudal approach is appropriate for complete mesocolic excision in laparoscopic colectomy for transverse colon cancer Y. Tajima, M. Tsuruta, H. Hasegawa, K. Okabayashi, T. Ishida, Y. Asada, K. Sugiura, Y. Suzuki, J. Nakadai, Y. Yoshikawa & Y. Kitagawa Department of Surgery, Keio University School of Medicine, Tokyo, Japan Aim: Accomplishing complete mesocolic excision (CME) in laparoscopic transverse colectomy (LTC) is quite difficult because of anatomical variations of feeding vessels and the risk of injury to the pancreas or duodenum. The aim of this study is to clarify the feasibility of a cranial to caudal approach (CRA) for CME in LTC, in which the bursa omentalis is first opened and the anterior lobe of transverse mesocolon is then dissected at the inferior edge of pancreas and sequentially the lymph nodes at the route of middle colic artery (LNMCA) is dissected in the same approach. Method: In our institute, 11 patients underwent CRA in LTC from 2013 to 2015. We compared their surgical short-term outcomes with that of 27 patients who underwent LTC by the conventional caudal approach (CAU). We evaluated the number of harvested LNMCA and the area of mesocolon of excised specimen as the value of CME. Results: The two groups were matched. CRA demonstrated greater area of mesocolon compared to CAU (170 vs 134 cm2, P = 0.009), and a greater number of harvested LNMCA (4 vs 2, P = 0.024). Conclusion: Cranial approach might be feasible for CME in LTC though further investigation should be performed for long-term outcome.

P367 Self-expandable metallic stent insertion markedly increases plasma level of cell-free DNA in patients with obstructive colorectal cancer G. Takahashi, T. Yamada, M. Koizumi, S. Shinji, Y. Yokoyama, T. Iwai, K. Takeda, K. Hara, K. Ota & E. Uchida Nippon Medical School Hospital, Digestive Surgery, Tokyo, Japan Aim: Self-expandable metallic stent (SEMS) insertion has been reported to improve short-term outcomes in patients with obstructive colorectal cancer (OCC). However, the effects of SEMS insertion on long-term survival remain unclear as do the mechanisms of action of SEMS insertion. Circulating cell-free DNA (ccfDNA) is a biomarker for various clinical conditions, including malignancy and trauma. This study investigated ccfDNA levels in OCC patients before and after decompression using SEMS or trans-anal decompression tubes (TDT). Method: Plasma was obtained from 25 patients before and at 1, 4, and 7 days after decompression. Plasma ccfDNA concentrations and fragmentation were compared in patients who underwent SEMS (n = 17) or TDT (n = 8) insertion. Results: Mean ccfDNA level on day 1 was 3-fold higher in the SEMS than in the TDT group (P = 0.03). ccfDNA fragments 1000–10 000 bp long were more abundant in SEMS than in TDT patients on days 1 (47% vs 0%, P = 0.02) and 7 (52% vs 12.5%, P = 0.08). Conclusion: ccfDNA fragmentation to pieces 1000–10 000 bp long is greater after SEMS than TDT in patients with OCC. As ccfDNA increases are associated with neutrophil extracellular traps, which induce metastases, SEMS-associated ccfDNA fragmentation in OCC patients may correlate negatively with prognosis.

P368 Circulating cell free DNA (ccfDNA) as a biomarker for metastatic colorectal cancer K. Takeda1, T. Yamada1, S. Matsumoto2, M. Koizumi1, A. Matsuda2, S. Shinji1, Y. Yokoyama1, G. Takahashi1, T. Iwai1, K. Hara1, A. Watanabe3 & E. Uchida1 1 Nippon Medical School Hospital, Digestive Surgery, Tokyo, Japan, 2Nippon Medical School Chiba-Hokusou Hospital, Surgery, Chiba, Japan, 3Nippon Medical School, Department of Biochemistry and Molecular Biology, Tokyo, Japan Aim: Carcinoembryonic antigen (CEA) is a commonly used biomarker for advanced colorectal cancer (CRC) but it is negative in 30% of such patients. These patients may have delays in diagnosis and treatment. Therefore, an alternative biomarker is required. In this study, we evaluated the utility of KRAS mutation allele in the ccfDNA of patients with metastatic CRC. Method: We enrolled 15 patients with metastatic CRC with KRAS mutation in their primary tumours. We compared the value of CEA and KRAS mutation allele in patients in which chemotherapy were effective. Additionally, we evaluated whether we could extract KRAS mutation allele in CEA-negative patients. Results: Four patients were CEA-positive and 11 were CEA-negative. We detected KRAS mutation allele in all four CEA-positive patients. These four patients

underwent successful chemotherapy. Both CEA and KRAS mutation allele decreased after chemotherapy. In two of these four patients, once the tumour showed progression, the KRAS mutation allele elevated more sensitively than CEA. Additionally, KRAS mutation allele was detected in 7/11 CEA-negative patients. In three of the four patients in whom it was not detected, complete responses with chemotherapy was achieved. Conclusion: KRAS mutation allele could be a novel biomarker in patients with metastatic CRC.

P369 Efficacy of the preoperative chemotherapy for borderline resectable rectal cancer with T4b or lateral lymph node metastases N. Takiguchi, H. Soda, T. Tonooka, Y. Nabeya, A. Ikeda, H. Arimitsu, H. Yanagibashi, T. Chibana, K. Sasaki, W. Takayama, S. Chiba, T. Hoshino & Y. Hanzawa Division of Gastroenterological Surgery, Chiba Cancer Center, Chiba, Japan Aim: Survival time is increasing due to the chemotherapeutic improvement for metastatic colorectal cancer. Preoperative chemotherapy for borderline resectable rectal cancer with T4b or lateral lymph node metastases has been performed to increase the resectability and to control local recurrence and systemic metastasis. We evaluated the utility of this treatment. Method: Preoperative chemotherapy protocol was XELOX with bevacizumab for 3 months. Thirty patients were enrolled. We examined the clinical and histopathological effects of preoperative chemotherapy on survival. Results: According to pre-treatment TNM classification, there were 22 T4b, 18 N2, 9 M1 and 10 lateral node positive patients. The serum CEA reduction rate was 56.9%. The reduction rate of tumour diameter was 33.8%. There were 16 extended resections combined with involved organs including 5 total pelvic exenterations. Curability was diagnosed as 20 in R0, 7 in R1, and three patients in R2. Yp stage were three patients with pCR, 10 stage II, 5 stage IIIa, 5 stage IIIb, and seven patients with stage IV disease. Cumulative 5-year survival rate was 71.2%. Conclusion: Preoperative chemotherapy using XELOX with bevacizumab is a promising treatment for borderline resectable rectal cancer with T4b or lateral lymph node metastases.

P370 The laparoscopic abdominoperineal resection of the rectum R. Aiupov1,2, D. Feoktistov1,2, N. Tarasov2, R. Agliullin2, N. Suleimanov2 & Y. Akmalov2 1 Bashkir State Medical University, Ufa, Russia, 2Republican Oncological Clinical Dispensary, Ufa, Russia Aim: Laparoscopic surgery is one of the ways of treatment of low rectal cancer. Method: We have studied 88 cases of laparoscopic abdominoperineal resection of the rectum (LAPR) made in the Republican Oncology Clinic from 2010 to 2015. The main goal was to evaluate the preoperative condition of the patient, time of operation, blood loss, stage of disease and postoperative course. Result: Eighty-eight laparoscopic APR were performed. The location of all tumours were within 5 cm from the anus. All patients had preoperative radiotherapy before surgery. The average age of the patients was 56.7 years (39–79). The body mass index was 25 (18–42.6). Average operative time was 212.4 minutes (135–360). Blood loss in the laparoscopic stage was 92 ml (20–250 ml). Length of stay was 12.6 days (6–19 days) after surgery. Seventy-five patients (85.2%) had stage II and 13 patient’s stage III disease. Postoperative complications such as suppuration of perineal wounds were observed in 2 (2.3%) cases. There was no mortality after LAPR. Conclusion: The results show the possibility of laparoscopic abdominoperineal resection on patients of any age group with good postoperative recovery.

P371 Laparoscopic right colectomy versus laparoscopic-assisted colonoscopic polypectomy for endoscopically unresectable polyps: a randomised controlled trial C. Tarta, K. Yang, K. You, C. Taut & R. Bergamaschi State University of New York, Stony Brook, NY, USA Aim: An RCT was conducted to test null hypothesis that there is no difference in complication rates and length of stay (LOS) between laparoscopic right colectomy (LRC) and laparoscopic-assisted colonoscopic polypectomy (LACP) for endoscopically unresectable right colon polyps. Method: Single-centre RCT (NCT01986699). Patients with right colon polyps deemed non-resectable by gastroenterologists underwent repeat colonoscopy with biopsy by interventional endoscopists and were allocated to LRC or LACP. Patients with non-lift sign, dysplasia, adenocarcinoma, IBD, or FAP were excluded. Study was powered to detect 73% difference in LOS requiring 17 patients in each arm.

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Poster Abstracts Results: Thirty-four patients were comparable for demographics and previous abdominal surgery. There was no difference in preoperative morphology, location, size, and histology of polyps. LRC patients had longer operating time (179 vs 95 min, P = 0.001), required more IV fluids (3.1 vs 2.1 L, P = 0.025), took longer to pass flatus (2.88 vs 1.44, P < 0.001), resume solid food (3.94 vs 1.69, P < 0.001), and leave the hospital (4.94 vs 2.63, P < 0.001). Postoperative complications (P = 0.656), readmissions (P = 0.5), and reoperations (P = 0.5) did not differ. Final size and histology of polyps did not differ. Conclusion: LACP and LCR had similar complication rates but LOS was shorter after LACP.

P372 Short term outcomes of pressurized intraperitoneal aerosol chemotherapy (PIPAC) in patients with peritoneal carcinomatosis H. T. Farinha, A. Kefleyesus, F. Grass, N. Demartines & M. H€ubner Centre Hospitalier Universitaire Vaudois, CHUV, Lausanne, Switzerland Aim: Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) has been suggested as novel treatment for peritoneal carcinomatosis. Preclinical data showed homogenous distribution and deep tissue penetration of chemotherapeutic agents. The available clinical experience showed high histological response rates and promising survival data. We analysed our cohort one year after implementation. Method: PIPAC was started in January 2015. This retrospective analysis included all consecutive patients operated in 2015 with emphasis on surgical feasibility and early postoperative outcomes. Results: Thirty-four patients (M:F = 6:28, median age 65 (39–87) years) with 72 PIPAC procedures in total (14:39, 10:29, 10:19) were analysed. Abdominal accessibility rate was 91% (34/36). Median initial Peritoneal Carcinomatosis Index (PCI) was 9 (IQR 5–17). Median operation time was 93 min (88–109) with no learning curve observed. One patient died of arrhythmia 4 days after PIPAC #3 without intra-abdominal organ injury at autopsy. One patient experienced postoperative ileus and 2 had urinary retention (Clavien II) giving an overall morbidity of 4%. Median postoperative hospital stay was 3 days (2–4). Conclusion: Repetitive PIPAC is feasible and safe in most patients with refractory carcinomatosis of various origins. Intra-operative complications and postoperative morbidity rates are low. This encourages for prospective studies assessing oncological efficiency.

P373 Quality of life (QoL) after pressurized intraperitoneal aerosol chemotherapy (PIPAC) in patients with peritoneal carcinomatosis H. T. Farinha, A. Kefleyesus, F. Grass, N. Demartines & M. H€ubner Centre Hospitalier Universitaire Vaudois, CHUV, Lausanne, Switzerland Aim: Quality of Life (QoL) preservation is pivotal for patients with peritoneal carcinomatosis. Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) is a novel minimal-invasive repeatable treatment modality. We analysed QoL in our cohort one year after implementation. Method: QoL was measured (EORTC QLQ-C30) prospectively in all patients before and 4 weeks after every PIPAC. This retrospective analysis included all patients operated in 2015. Results: Thirty-four patients (M:F = 6:28, median age 65 (39–87) years) with 72 PIPAC applications were analysed. Twenty-four patients received at least 2 PIPAC and 14 received 3. Before PIPAC#1, overall QoL was decent at least in 30 patients (88%) and very good in 13 (38%). Prominent complaints were diarrhoea (50%), constipation (38%), and nausea (12%). Overall QoL was decent or better in 83% of patients after PIPAC#1 (P = 0.57), 89% (P = 0.89) after PIPAC#2, and 84% after PIPAC#3 (P = 0.58). Diarrhea (39%, 42% and 25%, P = 0.31) and constipation (32%, 26% and 32%, P = 0.76) remained stable during PIPAC treatment. Nausea was stated by 32% after PIPAC#1 (P = 0.04), but returned to pre-treatment baseline of 10% and 17% after PIPAC#2 and 3 (P = 0.66). Conclusion: Overall QoL is surprisingly good in patients with carcinomatosis justifying ambitious treatment approaches. PIPAC had no negative impact on overall QoL and main symptoms.

Method: We retrospectively evaluated all the anastomotic leaks following low anterior resection for rectal cancer that took place in our centre between October 2007 and May 2015. Results: Three hundred and twenty-three colorectal anastomoses were performed in 452 patients with rectal cancer (71.4%). 26 leaks (8%) were diagnosed; 15 EAL (57.7%) and 11 LAL (42.3%). LAL statistically differed from EAL as they occur in younger patients (P = 0.096), with higher CLS scores (P = 0.017), in lower tumours (P = 0.001), lower anastomoses (P = 0.042) and when an ileostomy was performed (P = 0.002). Although no clear statistical significance was detected, LAL appeared to be more frequent when more aggressive treatment was performed (P = 0.987) and LAL was associated with a higher definitive stoma rate (P = 0.233). Conclusion: LAL comprised 42% of all anastomotic leaks. They were related to a high definitive stoma rate, chronic pelvic sepsis and may worsen the published standards and QoL scores.

P375 Validation of the historical indication transition from open to laparoscopic colorectal cancer surgery T. Tonooka, N. Takiguchi, Y. Nabeya, W. Takayama, A. Ikeda, H. Soda, S. Chiba, I. Hoshino, H. Arimitsu, H. Yanagibashi, T. Chibana, Y. Hanzawa & M. Nagata Chiba Cancer Center, Chiba City, Chiba, Japan Aim: The aim of this study was to evaluate the validity of the historical indication for transition from open to laparascopic colorectal cancer surgery. Method: Seven hundred and thirteen laparoscopic colorectal resections (LAP) and 1596 open colorectal surgery (OP) were performed between 2000 and 2015. We divided those patients according to the era - early period (A period; 2000~2004, 443 cases), middle period (B period; 2005~2009, 783 cases) and latter period (C period; 2010~2015, 1083 cases). Clinico-pathological characteristics, perioperative outcomes, and the oncological outcomes were compared. Results: The percentage of LAP increased from 11.1% in period A to 23.5% in period B, and up to 44.3% in period C. The number of cases for anatomically difficult tumour locations and more advanced cases gradually increased with time. Operative time and total blood loss improved gradually along with the learning curve. The 5-year survival rates of p-stage II/III LAP cases were better than those OP cases compared by the era (89.0% to 82.0% for period A, and 95.1% to 79.3% for period B) according to the selection bias. Conclusion: LAP was safely introduced for more advanced staged patients or more complicated cases. The maturation of the procedure led to favourable results.

P376 Clinical and genetic characteristics of the Russian patients with Lynch syndrome A. Tsukanov, S. Achkasov, V. Shubin, A. Vardanyan, D. Semenov, S. Frolov, V. Kashnikov, Y. Shelygin & N. Pospekhova State Scientific Centre of coloproctology, Moscow, Russia Aim: To this moment there have been no studies investigating the clinical and genetic characteristics of Russian patients with Lynch syndrome. Method: Patients suspected of Lynch syndrome were investigated for microsatellite instability and germline mutation in MMR genes. As study material we took clinical data of 25 patients with confirmed Lynch syndrome. Results: Patients (n = 25) with Lynch syndrome have mutation frequency in MLH1 gene of 52% (13/25), in MSH2 – 40% (10/25), and in MSH6 – 8% (2/25). One mutation in the MLH1 (c.1852_1854del) was found in 3 unrelated patients; one in the MSH2 (c.942 + 3A>T) was found in 2 unrelated patients. 11 first presentation tumours were localised in the left colon; 8 in the right colon and 6 in the rectum. 84% (21/25) of patients had T1-4N0M0 disease. Metachronous colorectal cancer occurred in 16 patients. A third cancer developed in three patients. There were two time periods for metachronous tumours occurrence: 1–8 and 18–28 years. Conclusion: Genetic and clinical characteristics of Russian patients with Lynch syndrome are: high frequency of MLH1 mutations, predominantly left side of colorectal cancer and two separate time intervals for metachronous tumours.

P374 Late and deferred anastomotic leakage after low anterior resection for rectal cancer: a warning on long term consequences A. Timoteo, G. Elorza, C. Placer, J. M. E. Navascues, Y. Saralegui, N. Borda, J. A. M ugica & J. L. El osegui Donostia University Hospital, Donostia - San Sebastian, Spain Aim: To assess the impact of late anastomotic leaks on long term results for the treatment of rectal cancer and to detect differences between early anastomotic leaks (EAL - within 30 days postoperatively) and late anastomotic leaks (LAL - after 30 days postoperatively).

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Poster Abstracts P377 Impact of neoadjuvant chemotherapy in locally advanced rectal cancer: a single center retrospective study using a propensity score analysis K. Uehara1, T. Oshiro1, T. Kamiya1, T. Mukai1, H. Yatsuya2, Y. Li2, T. Ebata1 & M. Nagino1 1 Division of Surgical Oncology, Department of Surgery, Nagoya Graduate School of Medicine, Nagoya, Japan, 2Department of Public Health, Fujita Health University School of Medicine, Toyoake, Japan Aim: The efficacy of neoadjuvant chemotherapy (NAC) alone for locally advanced rectal cancer (LARC) has not been fully discussed. The aim of this preliminary study was to evaluate the effectiveness of NAC on the prognosis of LARC. Method: Seventy Japanese patients who started treatment for clinical stage II/III LARC between 2007 and 2014 were retrospectively studied. 46 patients received NAC (FOLFOX/XELOX  bevacizumab) followed by surgery (NAC group) and the other 24 patients underwent ‘upfront’ surgery (S group). The impact of NAC on progression-free survival (PFS) and local recurrence-free survival (LRFS) were analysed using propensity score analysis. Results: The median follow-up time was 43 months. In the NAC group, the maximum tumour size was larger compared to the S group (54 vs 40 mm, P < 0.001). Clinical T- and N- stage were more advanced in the NAC group. The pN0 rate was higher in the NAC group than in the S group (85% vs 59%, P = 0.020). Cox model with weighting for inverse probability of the propensity score showed that NAC significantly improved PFS [hazard ratio (HR) 0.39 (0.18–0.85), P = 0.018] and LRFS [HR 0.10 (0.02–0.48), P = 0.004]. Conclusion: NAC alone could be a promising option that might improve survival for LARC.

P378 The surgeon is not a risk factor for overall mortality after colorectal cancer resection H. Urquhart, M. Schnitzler, J. Evans, J. Percy, S. Pillinger, S. Pincott, A. Gill & A. Engel Royal North Shore Hospital, Sydney, Australia Aim: This study aimed to look at differences between trained colorectal surgeons and oncological quality of resection and overall survival after colorectal cancer resection. Method: All 7 surgeons underwent a minimum of 2 years specific colorectal training. From 2006 onwards all patient were discussed at an MDT. Surgical pathology database containing patient specific data, tumour specific data (including immunohistochemistry), surgeon data, overall survival (minimum follow up 3 years) from 1999 to 2011 in a mixed public and private setting. Univariate analysis, analysis of variance and Chi square were performed on data. Results: 2140 patients (mean age 69.4, 49.6% female), were included. Overall survival was 68% (St I-III, 78%). There was no difference in stage (P = 0.51), site of surgery (P = 0.38), resected nodes (mean 17.3, P = 0.18), positive nodes (mean 1.8, P = 0.87), apical node positivity (8.3%, P = 0.23) or more than 12 harvested nodes (P = 0.87) between surgeons. There was differences in patients’ age (P = 0.01), sex (P < 0.001), and MSI status (P = 0.01) between surgeons. In univariate analysis; age, stage, tumour differentiation grade, and MSI status were all significantly related to overall survival (P < 0.001). Surgeon was not (P = 0.29). Conclusion: Colorectal surgeons are able to eliminate poor oncological quality of resections as risk factor for poor overall survival.

P379 Long term results of laparoscopic surgery for colorectal cancer in elderly patients D. S. Uymaz1, S. Bademler2, N. Omarov3, Y. Iscan4, B. Batman5, K. Serin5, H. Altun5, N. C. Arslan5 & O. Asoglu5 1 Department of General Surgery, Bakirkoy Sadi Konuk Training and Research Hospital, Istanbul, Turkey, 2Oncology Institute, Istanbul University Faculty of Medicine, Istanbul, Turkey, 3Department of General Surgery, Istanbul University Faculty of Medicine, Istanbul, Turkey, 4Department of General Surgery, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey, 5Department of General Surgery, Liv Hospital, Istanbul, Turkey Aim: The mean life expectancy in Turkey is 71. This study presents the long term oncologic outcome of laparoscopic surgery in geriatric patients (≥75) with colorectal cancer. Method: Data of patients older than 74 who underwent radical laparoscopic resection for colorectal cancer between 2005 and 2015 were reviewed. Results: Thirty-six colon and 38 rectal cancers were included. ASA score was III in 53 (71.6%) patients. In-hospital mortality rate was 2.7% (n = 2). Perioperative morbidity was seen in 13 (17.6%) patients. Two patients each in both groups underwent reoperation for surgical complications (3 anastomotic leak, 1 intraabdominal haemorrhage). Mean hospital stay was 6.8  5 and 8.6  7.7 days in colon and

rectal cancer patients, respectively. Median survival was 41.3 months in rectal cancer group: 10 patients died due to other comorbidities, one patient died due to recurrent disease and 25 patients are alive without disease. In colon cancer group, median survival was 50.5 months: four patients died due to recurrent disease and 30 are alive without disease. Conclusion: Radical oncologic surgery is controversial in elderly patient groups. A laparoscopic approach may provide similar oncologic outcomes to younger populations without increasing perioperative mortality and morbidity rates.

P380 Laparoscopic en-block resection of cT4 colorectal tumours invading bladder D. S. Uymaz1, Y. Iscan2, B. Batman3, S. Bademler4, N. Omarov5, K. R. Serin3, H. Altun3, N. C. Arslan3 & O. Asoglu3 1 Department of General Surgery, Bakirkoy Sadi Konuk Training and Research Hospital, Istanbul, Turkey, 2Department of General Surgery, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey, 3Department of General Surgery, Liv Hospital, Istanbul, Turkey, 4Oncology Institute, Istanbul University Faculty of Medicine, Istanbul, Turkey, 5Department of General Surgery, Istanbul University Faculty of Medicine, Istanbul, Turkey Aim: This report presents the surgical outcome of total laparoscopic resection in patients with cT4 colorectal cancer directly invading bladder. Method: Between 2001 and 2016, seven patients underwent laparoscopic en-block resection of colon/rectum and bladder. Results: Mean age was 69.9  9.8. Three patients were female. Etiology was rectosigmoid tumour in four patients, right colon tumour in 2 and proximal rectum in one patient. All patients underwent curative resection with partial bladder resection. Mean operative time was 181.4  55.8 minutes. Mean number of harvested lymph nodes was 25.3  12.1. Surgical margins were negative in all patients. No perioperative mortality was seen. One patient with a rectosigmoid tumour had anastomotic leak which was managed with percutaneous drainage. During a median follow-up of 41 (18–65) months, all patients are alive without any evidence of local or distant recurrence. Conclusion: Multivisceral resection is one of the challenging issues in laparoscopic approach in colorectal surgery. En-block resections can be performed safely with adequate experience.

P381 Laparoscopic-monitored colonoscopic polypectomy: a single-centre retrospective study M. van der Valk, F. C. Bekkering, T. J. Tang, W. A. Bode, P. G. Doornebosch, E. J. R. de Graaf, M. M. M. Bruijninckx & M. Vermaas IJsselland hospital, Capelle a/d IJssel, The Netherlands Aim: Endoscopic polypectomy of colorectal adenoma can be prohibited by size, bowel fixation and/or angulation, often resulting in a surgical colonic resection. Laparoscopy-monitored colonoscopic polypectomy (LMCP) is a hybrid endoscopic and laparoscopic technique which has the potential to prevent colonic resections. Method: A single-centre retrospective study was performed. All patients who underwent LMCP in the period 2006–2016 for polyps not amenable to colonoscopic removal were included. Results: Of the 44 patients included, 48% had an abdominal surgical history with related adhesions/ bowel-angulation. Laparoscopic bowel mobilisation was performed in 57% and extensive abdominal adhesiolysis in 41%. Median duration of the procedure was 60 minutes and the median hospitalisation was 2 days. In 86% LMCP was successful. Reasons for conversion to colonic resection were suspected malignancy, colon perforation or true technical endoscopic irresectability. One patient needed additional resection due to a high risk pT1 adenocarcinoma. Postoperative complications occurred in 7%, without any mortality. Conclusion: LMCP enabled safe endoscopic removal of initially endoscopic irresectable colorectal adenoma in the vast majority of patients. This technique prevented colonic resection in 86% of patients, thereby reducing risks of postoperative complications, and minimising length of stay.

P382 Intracorporeal versus extracorporeal anastomosis in right hemicolectomy: a systematic review and meta-analysis S. van Oostendorp1, A. Elfrink1, W. Borstlap2, C. Sietses3, J. Meijerink1 & J. Tuynman1 1 VU Medical Center, Amsterdam, The Netherlands, 2Academic Medical Center, Amsterdam, The Netherlands, 3Gelderse Vallei Hospital Ede, Ede, The Netherlands Aim: Laparoscopic right hemicolectomy for colon cancer is associated with substantial morbidity despite the introduction of enhanced recovery protocols. The current standard technique includes an extracorporeal anastomosis with mobilization of the

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Poster Abstracts colon, mesenteric traction and an extraction wound located in the mid/upper abdomen. An intracorporeal anastomosis (IA) could lead to a decrease in postoperative morbidity and faster recovery. Method: A systematic review of PubMed and Embase databases was performed. Primary outcomes were short-term morbidity and length of stay. For quality assessment the MINORS-instrument was used. Meta-analysis was performed using a random effects model, and a subgroup analysis was made for data regarding short-term morbidity and length of stay in studies published after 2012. Results: From 2692 papers, 12 non-randomised comparative studies were included. Short-term morbidity decreased significantly in favour of intracorporeal anastomosis (OR 0.68, 95% CI 0.49–0.93; I2 = 20%). Length of stay was found to be significantly decreased in subgroup analysis for papers published after 2012 (MD 0.77 days, 95% CI 1.17 to 0.37; I2 = 4%). Conclusion: This meta-analysis of non-randomised, comparative studies suggests an intracorporeal anastomosis in laparoscopic right hemicolectomy is associated with reduced short-term morbidity and decreased length of hospital stay.

P383 The impact of an ostomy on older colorectal cancer patients: a cross-sectional survey N. Verweij, M. Hamaker, D. Zimmerman, T. van Loon, F. van den Bos, A. Pronk, I. B. Rinkes & A. Schiphorst Diakonessenhuis, Utrecht, The Netherlands Aim: Ostomies are placed in 35% of patients after colorectal cancer surgery. As decision-making regarding colorectal surgery is challenging in the older patients, it is important to have insight in the potential impact of ostomies in this cohort. Method: An internet-based survey was sent to all members with registered email addresses of the Dutch Ostomy Patient Association. Results: The response rate was 49%. 932 cases were included of whom 526 were aged 30 kg/m2) patients with colorectal diseases undergoing laparoscopic (LPS) right colectomy. Method: A case matched study was conducted. Sixty-four IA patients were matched for age, BMI, ASA score and year of surgery with sixty-four EA patients. Results: Conversion to open surgery occurred in four patients in the IA and 11 patients in the EA (P = 0.05). In the IA group operation time was on average 12 minutes longer (P = 0.14). The overall 30-day morbidity rate was 27% in both groups. A similar incidence of non-infectious complications was observed (P = 0.54). However a trend towards a lower wound infection rate was observed in the IA group (P = 0.09). Anastomotic leak occurred in 4.6% of patients in the IA group vs 9.3% in the EA group (P = 0.30). An earlier recovery of mean bowel function was observed in the IA group (P = 0.01). No differences were observed with respect to overall length of stay or reoperation rate. In the EA group a higher re-admission rate was observed (P = 0.001) Conclusion: Intracorporeal anastomosis in obese patients is safe and produces similar short-term outcomes when compared to extracorporeal anastomosis.

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P385 Comparing three modes of rectal dissection for cancer: open vs laparoscopic vs transanal total mesorectal excision M.-P. Bernardi1,2, A. Warwick1,2, L. Davies3 & A. Stevenson1,2 1 Royal Brisbane and Women’s Hospital, Brisbane, Qld, Australia, 2Holy Spirit Northside Hospital, Brisbane, Qld, Australia, 3NHMRC Clinical Trials Centre, Sydney, NSW, Australia Aim: Transanal total mesorectal excision (taTME) has emerged as a new technique in rectal cancer surgery. We compared the pathological outcomes of taTME with open and laparoscopic rectal cancer surgery. Method: A single surgeon performed all procedures. Pathological outcomes from a prospective database of patients who underwent taTME for rectal cancer was compared to open and laparoscopic groups taken from the ALaCaRT data set. Successful resection was defined as: (1) complete TME, (2) clear circumferential resection margin (CRM) (≥1 mm), and (3) clear distal margin (≥1 mm). Results: Thirty-two patients had open surgery, 31 laparoscopic, and 29 patients had taTME. Successful resection was achieved in 29 patients (90.6%), 25 patients (80.6%) in open and laparoscopic surgery groups respectively, and in 25 patients (86.2%) in taTME group. A complete TME was achieved in 29 (90.6%) open, 27 (87.1%) laparoscopic and 26 (89.7%) in the taTME group. The CRM was clear in all patients in the open surgery group, 30 patients (96.8%) in the laparoscopic group, and in 28 patients (96.6%) in the taTME group. The distal margin was clear in all patients in the open and taTME groups and 96.8% patients in the laparoscopic group. Conclusion: Pathological outcomes in taTME compare favourably with open and laparoscopic surgery.

P386 Lung-metastasectomy after curative resections of colorectal cancer H. Støen1, H. H. Wasmuth2, J. Nauman1 & P. M. Haram3 1 Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway, 2Departement of Colorectal Surgery, St Olavs Hospital, University of Trondheim, Trondheim, Norway, 3Department og Thoracic Surgery, St Olavs Hospital, University of Trondheim, Trondheim, Norway Aim: The aim of this study was to explore survival among colorectal cancer (CRC) patients undergoing lung metastasectomy. Method: National criteria for metastasectomy are: patients should tolerate lung resection; primary tumour under control, and no other distant metastases except resectable liver-metastasis should be present. In 1999–2014, patients operated for lung-metastasis in a catchment area of 700 000 were identified. Factors affecting survival including; time to metastasis, tumour distribution, reoperation, prior successful liver resection, gender, age, tumour stage and size were analysed. Results: From a total of 7470 CRC patients (range 481–595 per year), 155 patients undergoing lung metastasectomy were included (range 1–18 per year). 5396 patients underwent a curative primary resection (4104 colonic tumour, 1292 rectal tumour). Resected lung metastases were from a colonic primary in 54, and rectal primary in 61. 42 patients had liver metastasectomy, of which 32 patients had synchronous lung metastasis. The estimated ratio for metachronous lung metastasectomy was 83/294. There were 163 procedures; 128 wedge resections, 30 lobectomies, and 5 segmentectomies, with one postoperative death. Five-year estimated overall survival after metastasectomy was 61%; no significant predictors were identified. Conclusion: The survival after lung metastasectomy is high. No risk factors were found. This indicates that the criteria for metastasectomy might be too strict.

P387 A proposed new radiological classification of perineal hernia following extralevator abdominoperineal excision and biologic mesh reconstruction of the pelvic floor E. White1,2, K. Ho1,2, K. Keogh2, N. Smart2 & I. Daniels2 1 University of Exeter Medical School, Exeter, UK, 2HeSRU, Royal Devon & Exeter Hospital, Exeter, UK Aim: To describe a new radiological classification of perineal hernia following elAPE. Method: Retrospective data were collected on consecutive patients who underwent elAPE with biologic mesh reconstruction to treat rectal cancer between 01/01/2007 and 31/12/2014 in a single UK institution. All postoperative MRI and CT scans performed before 31/12/2015 were analysed by two authors. The pubococcygeal (PC) line was used as a dichotomous marker between normal and abnormal. Bulging of the mesh below the PC line, akin to mesh eventration, or anterior mesh detachment were considered to be pseudo-herniae (Type 1). A true perineal hernia was defined as a defect in the biologic mesh that allowed penetration of bowel, uterus, bladder, vagina or omentum (Type 2). Results: Sixty patients were included. Median time to final radiological follow up was 23.5 months (range 0–92 months). Fifteen (25%) patients had a pseudo-hernia

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Poster Abstracts (type 1), and ten (17%) patients had a true hernia (type 2). Five patients have had perineal hernia repair, of which three were type 2 herniae. Conclusion: Radiological evidence of perineal hernia and pseudo-hernia is common after elAPE.

P388 Prevalence of incidental squamous cell carcinoma in presumed benign excised perianal lesions R. White1, J. Ogg1, P. Tekkis2,1, C. Kontovounisios1, O. Warren1 & S. Mills1 1 Chelsea and Westminster Hospital, London, UK, 2The Royal Marsden Hospital, London, UK Aim: The incidence of anal squamous cell carcinomas (SCCs) is very low but certain populations have higher rates of incidental anal SCC in excised presumed benign lesions. PPWT guidelines mandate that excision of benign perianal lesions will only be funded if they meet strict criteria. This study looked at rates of incidental anal SCCs and identified risk factors for malignant change. Method: A retrospective study of our database was performed for excisions over a one year period. The histology from all presumed benign lesions was analysed. Factors predisposing to malignancy were examined. Results: Hundred and twenty perianal skin lesions were excised, 10% (n = 12) contained histological evidence of anal SCC. Of the 12 anal SCCs found; male to female ratio was 2:1, median age was 52.5 years, 8 had HIV, 3 had a history of anoreceptive sex, 10 had previous or current HPV related warts, 3 were previously known to have AIN and were in a surveillance programme and 1 had lichen sclerosus. Conclusion: 10% of presumed benign lesions in a high risk population contained anal SCC. In high risk populations there should be a lower threshold for removing benign looking skin tags as the prevalence of incidental malignancy is high.

P389 Frequency of microsatellite instability tumours was low, but frequency of Lynch syndrome was not low in Japanese colorectal cancer T. Yamaguchi, M. Takao-Amaki, S. Natsume, T. Iijima, R. Wakaume, Y. Nakayama, K. Takahashi, H. Matsumoto, D. Nakano, H. Kawamura, K. Koizumi & M. Miyaki Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, Tokyo, Japan Aim: Microsatellite instability (MSI) is useful for screening of Lynch syndrome (LS). It is reported that 2–5% of colorectal cancer (CRC) patients is LS. Here, we report frequencies of MSI tumours and LS in Japanese CRC patients. Method: We consecutively selected 1005 CRC patients in our hospital from 2008 to 2013 after obtaining informed consent. Results: MSI status was ascertained in 1004 of the 1005 patients. Of the 1004 tumours, 62 (6.2%) were MSI tumours. Of the 62 MSI tumours, 24 showed BRAF mutation, 32 showed hypermethylation of MLH1, and 25 showed CIMP. As a result, 27 patients (2.7%) were suspected to be LS. However, one MSI CRC patient with family history of LS-associated tumours demonstrated MSH6 gene mutation. Moreover, three patients who met the ‘Amsterdam criteria I’ but whose tumours did not show MSI did not have cancer family history excluding CRC, and were considered to be Familial colorectal cancer type X (FCCTX). Conclusion: Frequency of MSI tumours was low, but frequency of LS was not low in Japanese CRC. MSI analysis helped the screening of LS and the distinguishing of LS and FCCTX.

P390 Prognostic factors of early recurrence after surgery for colorectal liver metastases S. S. Yang, B. K. Ko, Y. C. Im, K. Y. Kim, S. B. Park & G. H. Bae Ulsan University and Ulsan University Hospital, Ulsan, Republic of Korea Aim: Though surgical resection is the standard therapy in the treatment for colorectal liver metastases (CRLM), most patients experience recurrence after curative hepatic resection, the majority within the first 2 years. The objective of this study were to assess the risk of early recurrence after liver resection for CRLM and to identify early recurrence predictive factors. Method: Patients who underwent complete liver resection between 2001 and 2012 were reviewed. Early recurrence was defined as any recurrence that occurred within 12 months after resection. Clinicopathologic data, recurrence patterns, and 5-year overall survival rate were analysed. Results: A total of 98 patients were included; 62(63.6%) had recurrence, including 19(19.2%) early recurrences. Early recurrence was mainly intra-hepatic (64.5 vs 35.5% for late recurrences; P = 0.003). Independent risk factors of early recurrence were resection margin postitive (P = 0.013) and degree of tumour differentiation

(PD, Muc) (P = 0.004), respectively. Early recurrence negatively affected prognosis: 5-year survival 19.6 vs 34.4% for the late recurrence group (P < 0.0001) Conclusion: Early recurrence risk is enhanced for extensive disease after poor preoperative disease control and inadequate surgical treatment. Independent risk factors for recurrence after an initial hepatectomy for CRLM can be helpful in making decisions for treatment

P391 Work-change patterns of people with colorectal cancer and their caregivers in Singapore X. Yang1, S. S. Soon2, W. K. J. Chia3, M. H. Chew1,4, W. S. Tan1 & H. L. Wee2 1 Singapore General Hospital, Singapore, Singapore, 2National University of Singapore, Singapore, Singapore, 3National Cancer Centre of Singapore, Singapore, Singapore, 4Duke-NUS Graduate Medical School, Singapore, Singapore Aim: Colorectal cancer (CRC) can adversely impact work participation. We aim to understand changes in work patterns of people with CRC and their caregivers. Method: In this cross-sectional survey conducted at the National Cancer Centre Singapore and Singapore General Hospital, we characterised change in work patterns between men and women with CRC, and between those with colonic and rectal primaries, using descriptive statistics. Results: Of 274 people with CRC, 109 (39.8%) had caregiver support. (mean age: 63.5 (95% CI: 62.3–64.7) years; men: 59.1%; Chinese ethnicity: 85.8%; Stage I-II: 29.6%, III: 35.0%, IV: 35.4%). Of the 146 patients who were employed at diagnosis, 83.6% stopped work (temporary or permanent) and 31.5% experienced work changes post-diagnosis. Reductions in work-hour (65.2%) and physical work demands (23.9%) were the most common work changes. Permanent work cessation was higher in rectal than colon cancer (27.8% vs 12.2%, P = 0.031). Women took longer sick leave than men before first return-to-work (median duration of sick leave (months): 3.0 vs 1.0, P = 0.023). Among the caregivers who are working (n = 58, 49%), 62% (36/58) took paid leave (median: 16 days/year) in providing caregiving support. Conclusion: CRC has significant impact on economic productivity of both patients and caregivers.

P392 Retrorectal tumours - 20 years’ experience N. Yaramov1, I. Batashki1, V. Yaramova2, A. Batashki3 & H. Yaramova2 1 Medical Institute - Ministry of Interior, Sofia, Bulgaria, 2Medical University Sofia, Sofia, Bulgaria, 3Medical University Plovdiv, Plovdiv, Bulgaria Aim: Tumours occurring in the retrorectal space are heterogeneous and uncommon. The utility of newer imaging techniques has not been extensively described, and operative approach is variable. This study examined the diagnosis, treatment, and outcome of retrorectal tumours at a tertiary referral centre. Method: Patients with primary, extramucosal neoplasms occurring in the retrorectal space were identified using a retrospectively maintained, procedural database of all adult colorectal surgical patients (1995–2015). Exclusion criteria included inflammatory processes, locally advanced colorectal cancer, and metastatic malignancy. Medical records, radiology, and pathology reports were reviewed retrospectively. Results: Forty-five patients with retrorectal tumours were treated. Malignant tumours comprised 28%. Older age, male gender, and pain were predictive of malignancy (P < 0.05). All benign tumours were resected with normal histological margins and none recurred. Eleven patients with malignancy had recurrence, or recrudescence of their disease. Conclusion: Retrorectal tumours remain a diagnostic and therapeutic challenge. Pain, male gender, and advanced age increase the likelihood of malignancy. Various imaging modalities are useful for planning resection but cannot establish a definitive diagnosis. Whereas benign retrorectal tumours can be completely resected, curative resection of malignant retrorectal tumours remains difficult.

P393 Should we personalise ERAS for elderly patients? N. Yassin1,2, J. Ng2, M. Zilvetti2, A. Patel2, B. Reddy2, R. Lovegrove2, S. Lake2, D. Nicol2 & S. Pandey2 1 The University of Birmingham, Birmingham, UK, 2Worcestershire Royal Hospitals, Worcester, UK Aim: Enhanced recovery after surgery (ERAS) may reduce morbidity after colorectal surgery and reduce overall hospital length of stay (LOS). Published studies provide inconsistent morbidity and hospital stay data which may reflect differences in study populations. We aimed to evaluate the clinical outcomes of our elderly cohort of patients within an ERAS programme. Method: Prospectively collected data were collated as part of the ERAS database between January 2011 and February 2015. Outcome data were analysed for the elderly cohort.

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Poster Abstracts Results: A total of 779 patients were identified, 507 of those were ≥ 65 years old (66%). 88% percent of elderly patients had median length of stay of 6 (range 1–31) days. Higher ASA grades, septic complications and stoma-related complications were associated with greater length of stay. Ileus and delayed return in gut function was noted in 76% of elderly patients. Readmission rates of 10% were seen for this group. Reasons for readmissions included stoma-related complications, obstructive symptoms, wound complications and abdominal pain. Conclusion: Elderly patients may struggle to adhere to all elements of ERAS protocols due to co-morbidities and age-related incapacities. Prehabilitation and personalisation of the ERAS protocol specific to elderly patients may reduce LOS and improve outcomes.

P394 Clinical outcomes of 3-stage Laparoscopic ELAPE procedures within an ERAS programme N. Yassin1,2, J. Ng1, M. Iglesias-Vecchio1, S. Lake1, D. Nicol1 & S. Pandey1 1 Worcestershire Royal Hospital, Worcester, UK, 2The University of Birmingham, Birmingham, UK Aim: Laparoscopic surgical techniques for low rectal surgery improve outcomes. Extra Levator Perineal Excision of the rectum improves oncological outcomes. A two-staged procedure requires the abdominal part to be completed prior to the reverse Trendelenburg position. Morbidities have been noted with regards to stoma complications and slow return of gut function. We have changed our practice to a three-staged procedure where the patient undergoes re-laparosocopy, washout and stoma formation after the perineal part is complete. We aimed to evaluate the clinical outcomes of these patients. Method: Patients undergoing laparoscopic ELAPE procedures were identified from our database (October 2011-March 2016). Results: A total of 45 patients were identified with 26 undergoing the 3-stage procedure. The M:F ratio was 3:1. Median age was 69 years (range = 52–86). Median BMI was 26 (range = 20–39). ASA grade was mostly II/III. Median length of stay was 7 days (range = 4–77). Laparoscopic resections were performed in all but three patients. A reduction in wound complications from 50% to 23% was noted when comparing 2 and 3-staged procedures. A reduction of 10% in re-admission rates was noted. Increase in operating time was 10–20 minutes for the three-staged procedure. Conclusion: Three-stage Laparoscopic ELAPE procedures reduces morbidity and improves overall outcomes.

P395 Risk factors for lymphatic metastasis in right colon neoplasms: a single-centre prospective observational study Y. Ye, Y. Cui, Z. Gao, Z. Shen & S. Wang Peking University People’s Hospital, Beijing, China Aim: To explore the lymphatic metastasis patterns of right colon neoplasms. Method: Colonic specimens were examined after complete mesocolic excision (CME) in patients undergoing resection between October 2012 and December 2014 in Peking University People’s Hospital. Specimens were dissected and classified according to the Japanese Clinical Pathological Rules. Associations between clinicopathological factors and the distribution of metastatic lymph nodes were analysed. Results: A total of 115 colonic specimens were examined. The vast majority of positive nodes were located in bowel less than 10 cm from the lesion. However, there was also lymph nodes spread to the epieolic/paracolic tissue greater than 10 cm. Lymphatic metastasis was associated with T stage and differentiation degree. The incidence of lymphatic metastasis in poor differentiated tumours was higher than that in well differentiated tumours (P < 0.05. The incidence of metastatic lymph nodes in the infrapyloric region was 2.6%. The metastasis incidence of skip lymph nodes was 14.8% Conclusion: Lymph nodes spread in CRC can be to epicolic/paracolic tissue, the intermediate mesocolon or the root of the supplying vessels, which should be dissected routinely. It is necessary to clear infrapyloric region for hepatic colon cancer. CME procedures can help regional lymph node clearance.

P396 Restaging with FDG PET-CT after chemoradiotherapy (CRT) for locally advanced rectal cancer R. Yemini1, Y. Y. Lishtzinsky1, H. Bernstine2, Y. Kundel3, B. Brenner3, H. Kashtan1 & N. Wasserberg1 1 Department of Surgery, Rabin Medical Center, Petach Tikva, The Sackler School of Medicine, Tel-Aviv University, Petach Tikva, Israel, 2Departments of Nuclear Medicine and Radiology, Rabin Medical Center, The Sackler School of Medicine, Tel-Aviv University, Petach Tikva, Israel, 3Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, The Sackler School of Medicine, Tel-Aviv University, Petach Tikva, Israel Aim: To assess the rate of metastatic disease after CRT in patients with locally advanced rectal cancer as detected by fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) before surgery. Method: Retrospective chart review of patients with locally advanced rectal cancer staged by FDG PET-CT before and after (4–5 weeks) CRT in a single institute (2007–2014). Results: Two hundred and thirty-seven rectal cancer patients received CRT for locally advanced rectal cancer during the study period. 142 patients (54% male and 46% female), with a median age of 64 (28–92), met the inclusion criteria. 128 patients (90%) underwent rectal resection, 14 patients (10%) had only CRT, of which three patients (2%) had newly diagnosed distant metastasis. 11 patients (8%) had a complete metabolic and clinical response and opted for a wait and watch approach. Among the three patients with the newly diagnosed metastasis, 1 was diagnosed with moderately differentiated adenocarcinoma (metastasis to the liver) and 2 were diagnosed with signet ring adenocarcinoma (liver, breast and bone metastasis). Conclusion: We found low rates of newly diagnosed metastatic disease between CRT and planned surgery. Overall FDG PET-CT altered the treatment plan of 2% of the patients and contributed to treatment change in an additional 8%.

P397 Septin-9 is a novel biomarker for colorectal cancer screening A. Yildiz1, S. Leventoglu1, H. G€ ob€ ut1, M. E. Y€ uksel1, M. A. Erg€ un2, A. Kubar3 & B. Aytac1 1 Department of General Surgery, Gazi University School of Medicine, Ankara, Turkey, 2Department of Genetics, Gazi University School of Medicine, Ankara, Turkey, 3Department of Genetics, G€ulhane Military Medical Academy, Ankara, Turkey Aim: The gold standard method for the diagnosis of colorectal cancer is colonoscopy. However, this has several limitations and complications. Moreover, faecal occult blood test (FOBT) and serum-based tumour markers lack specificity and sensitivity. Therefore, a novel biomarker is needed for early detection of colorectal cancer. Septin-9 is a protein which is encoded by the SEPT9 gene. SEPT9 has been detected in the blood of colorectal cancer patients. Method: The study was conducted between May-November 2014, after ethics committee approval, at the Endoscopy Unit of Gazi University School of Medicine Department of General Surgery. The results of FOBT, CEA and SEPT9 using faecal and blood samples of the patients obtained before colonoscopy were compared. Results: DNA isolation and bisulfite transformation were made from the blood samples for SEPT9. The results were obtained from the data created by real time PCR. The experimental and control groups were built up using the results of biopsy taken during colonoscopy. The specificity of SEPT9 was 95% and the sensitivity of SEPT9 was 87.5%, was statistically better than FOBT and CEA biomarkers. Conclusion: A novel biomarker, Septin-9 is a promising candidate for colorectal cancer screening.

P398 Fast track protocol for elderly patients with colorectal cancer D. Zitta, V. Subbotin & Y. Busirev Perm State Medical University, Perm, Russia Aim: This study aimed to estimate the safety and effectiveness of a fast track protocol in elderly patients with colorectal cancer. Method: For this prospective randomised study, data were collected on 138 patients who underwent elective colorectal resection for cancer. The main criteria for the patients selection was age over 70 years. 82 of these patients received perioperative treatment according to fast track protocol (FT), and 56 received conventional perioperative care. The following data points were analysed: duration of operation, intraoperative blood loss, time to first flatus and defecation, complications rates. Results: The mean age was 77.4  8 years. There were no differences in gender, comorbidities, BMI, types and duration of operations between the groups. Times of first flatus and defecation were better in the FT-group. There was no mortality in the FT-group vs 1.8% in the conventional group. Complication rates were lower in the FT-group: wound infections (3.6% vs 9%), anastomotic leakage (4.8% vs 9%),

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Poster Abstracts ileus (1.2 vs 5.4%), peritonitis (2.4% vs 3.6%), and bowel obstruction (adhesions) (6% vs 5.3%). Reoperation rate was similar (4.8% vs 3.6%). Conclusion: A fast track protocol in elective colorectal surgery is safe and effective in elderly patients. This improves restoration of bowel function and reduces risk of postoperative complications.

P399 Photodynamic therapy for the treatment of complex anal fistula: a pilot study  R. Prieto2, M. Jose´ Alcaide Quiro´s1, A. A. Sebastian1, P. M. Forcen1, M.-A. M. Mar Aguilar Martınez1, M. B. L. de Anton Bueno1, C. Dupuy3, F. C. Polo1 & R. C. Rico1 1 Elche University Hospital, Elche, Spain, 2Leon Hospital, Leon, Spain, 3Miguel Hernandez University, Alicante, Spain Aim: Photodynamic therapy (PDT) is a novel, sphincter-saving procedure for the treatment of anal fistula. This pilot study was designed to investigate the safety and effectiveness of this new technique. Method: Ten consecutive patients were treated with PDT. Intralesional 5aminolevulinic acid (ALA) 5% was directly injected into the fistula at a dose of 0.2 ml per cm3 of fistula. The internal and external orifice were closed. After an incubation period of 2 hours, the fistula was irradiated by an optical fiber connected to a red laser (MULTIDIODE 630 PDT, INTERmedic, Spain) at 1 Watt per cm3 for 3 minutes (180 Joules). Patient demographics, operation notes and complications were recorded. Results: No intra-operative and postoperative complications were reported. Median duration of follow up was 8.9 months (range: 6–14 months). Primary healing was observed in eight patients (80%). There were two patients (20%) with persistence of suppuration after the operation. No patient reported incontinence postoperatively. Conclusion: Photodynamic therapy for fistula in-ano is a safe, simple, and sphincter-saving procedure with a high rate of success.

P400 Preliminary results intervention training in primary care on proctology pathology I. Aldrey, O. Quinteiros, C. Menendez, R. S. Lloves, R. G. Conde, S. Villar & A. Paraj o Complejo Hospitalario Universitario de Ourense, Ourense, Spain Aim: Anorectal disease is common in clinical practice, and is necessary to improve the patient care pathway. In a Primary Center improvement program initiated with the support of Colorectal Surgery Unit, we performed a theoretical and practical training activity. This included implementation of anoscopy in primary care. The aim of this study was to analyse the diagnostic and therapeutic approach to pathology in anoproctology after this intervention. Method: Interventional study including patients who consulted for anorectal pathology referred to a primary care center over one year. Those who were not coded, refused involvement or had been previously diagnosed with colorectal cancer were excluded. Results: Two hundred and ten patients were consulted (mean age: 56.5, sex 95 M: 115 F). 37% had anal pain, and 32.7% rectal bleeding. A symptom guide detected pathology in 86.8%. The most frequent diagnoses were haemorrhoids (54%) and anal fissure (13.6%). Diagnostic agreement after further investigation was 71.4%. Surgical treatment was undertaken in 4.5%. 23 anoscopies were performed, with 82.6% detecting pathology. Conclusion: The most frequent proctologic pathology in primary care is haemorrhoids. A training intervention among different levels of care can obtain good results. This finding has stimulated a more ambitious prospective study to identify factors and aspects for improvement in the primary-care specialist regarding proctology circuit pathology.

P401 Modified Lord Miller procedure: effective day case surgery for pilonidal sinus L. Al-Ozaibi, A. Al-Ani, W. Hazim, H. Sawalmeh, F. Badri & A. Mazrouei Dubai Health Authority, Dubai, United Arab Emirates Aim: To assess effectiveness of modified Lord Miller procedure in management of pilonidal sinus disease in terms of wound complications, healing rate and recurrence. Method: This was a retrospective study of patients with simple and complex pilonidal sinus disease, operated with modified Lord Miller procedure from September 2011- December 2015. Patients were seen in the clinic once a week until complete healing achieved and 1 year after the surgery. Patients were observed for complications and recurrence. Results: Hundred and ten patients were included. 57% of the sinuses were complex. 53 (48%) of the patients had a history of previous surgery. All the patients were

followed for a minimum period of one year (12–48 months). 7 patients (6.3%) had wound infection. Complete healing was achieved in a mean of 3.6 weeks (2– 7 weeks). Recurrence happened in 4 (3.6%) patients. 96.4% of patients had complete cure. All patients underwent day case surgery and the majority under local anaesthesia. Conclusion: Modified Lord Miller procedure has shown to be highly effective in treating complex pilonidal sinus with low recurrence rate.

P402 Experience of ligation of intersphincteric fistula tracts in patients with trans- and supra-sphincteric anal fistulae A. Titov, I. Kostarev, O. Fomenko & I. Anosov State Scientific Centre of Coloproctology, Moscow, Russia Aim: Ligation of intersphincteric fistula tract (LIFT) is a new sphincter-preserving technique avoiding anal incontinence. The aim of this study was to evaluate the effectiveness of this procedure. Method: From January 2013 to December 2015, patients with anal fistulae with disease crossing more than 30% of external sphincter were included. Results: Forty patients met eligibility criteria (Male: 28 (70%), Female: 12 (30%). In 29 cases (72.5%) the fistula track was passing through the middle third (MT) of the external sphincter, 9 (22.5%) - through the upper third (AT), and 2 (5%) were suprasphincteric. The median follow up was 16 months (3–36 months). The healing rate was 29 (72.5%). Recurrence was seen in five patients (17.3%) with MT fistulae, 5 (55.6%) with AT fistulae, and 1 (50%) with suprasphincteric fistulae. In four patients residual intersphinteric fistula was revealed in postoperative period. After excision of this fistulae, healing occurred in all four cases. These procedures didn’t affect anal sphincter function. There were no changes in continence, evaluated by Wexner score and anorectal manometry at follow up. Conclusion: LIFT has a high success rate in MT anal fistulae. Recurrence rates are higher in AT fistulae or in suprasphinteric fistula tracts.

P403 Clinical presentation of sigmoid volvulus: experience of 990 patients over 49.5 years S. S. Atamanalp, M. I. Yildirgan, E. Disci & S. Kara Department of General Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey Aim: To investigate the clinical presentation of sigmoid volvulus in the largest single-centre series of the world. Method: The records of 990 patients, who were treated over a 49.5-year period between June 1966 and January 2016, were reviewed. Results: The mean age was 58.8 years (10 weeks–98 years), and 812 patients (82.0%) were male. Previous attack was present in 224 patients (25.2%), and 234 patients (26.3%) had comorbidities. The mean symptom duration was 38.1 hours (4 hours–7 days), and 111 patients (12.5%) were in a state of shock. The most common symptoms were abdominal pain in 879 of 889 patients (98.9%), distention in 857 (96.4%), obstipation in 818 (92.0%), and vomiting in 615 (69.2%), while the most common signs were abdominal tenderness in 879 of 889 patients (98.9%), empty rectal vault in 575 (64.7%), hypokinetic or akinetic bowel sound in 399 (44.9%), hyperkinetic bowel sound in 275 (30.9%), melanotic rectal stool in 96 (10.8%), and muscular rigidity or rebound tenderness in 74 (8.3%). Conclusion: Sigmoid volvulus is common in adult men. The disease is generally associated with recurrence, associated comorbidities, and may present in a state of shock. Abdominal pain, distention, and obstipation, which are known as classical triad, are seen in most cases.

P404 Diagnosis of sigmoid volvulus: experience of 990 patients over 49.5 years S. S. Atamanalp, E. Disci, U. Memis & R. S. Atamanalp Department of General Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey Aim: To evaluate the diagnosis of sigmoid volvulus in the largest single-centre series of the world. Method: The records of 990 patients, who were treated over a 49.5-year period between June 1966 and January 2016, were reviewed. Results: The correct diagnosis rate was 71.5% (708/990) based on the clinical findings, including abdominal pain, distention, and obstipation triad. X-rays demonstrated a dilated sigmoid colon with multiple intestinal air-fluid levels in 67.6% of the patients (567/839). When clinical findings were evaluated together with X-rays, the correct diagnosis was 82.1% (813/990), and the disease was misdiagnosed as an obstructive emergency in 163 patients (16.5%) or a non-obstructive emergency in

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Poster Abstracts 14 (1.4%). Diagnostic endoscopy presented 98.7% (149/151) correct diagnosis rate, by showing a torted lumen and or inability to insert an endoscope proximally, while misdiagnosis included colonic invagination and colonic volvulus due to colonic mass. The correct diagnosis rates of CT and MRI were 96.3% (77/80) and 95.6% (43/ 45), respectively, by demonstrating whirl pattern in sigmoid mesentery with multiple intestinal air-fluid levels, and misdiagnosis was due to the absence of the mesenteric whirl sign. Conclusion: The preoperative accurate diagnosis of sigmoid volvulus is difficult when endoscopy, CT or MRI are not used.

P405 Clinical presentation of ileosigmoid knotting: experience of 77 patients over 49.5 years S. S. Atamanalp, S. Arslan, E. Disci & R. Yavuz Ataturk University Faculty of Medicine Department of General Surgery, Erzurum, Turkey Aim: To investigate the clinical presentation of ileosigmoid knotting in one of the largest single-center series of the world. Method: The records of 77 patients, who were treated surgically over a 49.5-year period between June 1966 and January 2016, were reviewed. Results: The mean age was 47.1 years (7–92 years), and 55 patients (71.4%) were male. Previous volvulus attack was present in 18 patients (23.4%), and 14 patients (18.2%) had comorbidities. The mean symptom duration was 45.2 hours (range: 8– 120 hours), and 43 patients (55.8%) were in a state of shock. The most common symptoms were abdominal pain in 77 patients (100.0%), obstipation in 76 (98.7%), distention in 74 (96.1%), and vomiting in 62 (80.5%), while the most common signs were abdominal tenderness in 77 patients (100.0%), hypokinetic or akinetic bowel sound in 50 (64.9%), empty rectal vault in 40 (51.9%), muscular rigidity or rebound tenderness in 38 (49.4%), hyperkinetic bowel sound in 20 (26.0%), and melanotic rectal stool in 12 (15.6%). Conclusion: Ileosigmoid knotting is common in adult men. The disease is generally associated with shock. Abdominal pain, distention, and obstipation are seen in most cases.

P408 Ligation of intersphincteric fistula tract (LIFT) to treat hightranssphincteric fistula: results of modified technique S. Deimel1, D. Dajchin2 & I. Iesalnieks3 1 Marienhospital Gelsenkirchen, Gelsenkirchen, Germany, 2St. Martinus Krankenhaus D€usseldof, D€usseldorf, Germany, 3St€adtisches Klinikum M€unchen Bogenhausen, Munich, Germany Aim: To assess the long-term results of modified LIFT procedure. Method: Prospective data collection. Patients with Crohn’s disease were excluded. Some modifications of the reported technique were used: the preoperative seton placement was abandoned; a “Lone-Star” anal retractor was used to keep the wound open during the surgery and provide a better access to intersphincteric space. The intersphincteric tract was divided for a better exploration of the intersphincteric space before it was closed by figure-of-eight sutures including large portions of internal and external sphincter, respectively. Results: Between 10/2012 and 2/2016, 42 patients (27 M, 15 F) with high transsphincteric fistulae underwent LIFT surgery. Fourteen patients had received previous seton placement at other institutions, eleven patients presented after failed previous attempts to close fistula. The median duration of surgery was 34 min. Three fistula recurrences were observed in 40 patients with available follow-up information (7.5%) after mean follow-up time of 14.2 months. All recurrences occurred in female patients (recurrence rate 21% vs 0%, P = 0.037). Conclusion: The modified LIFT surgery provides promising results as a treatment of high transsphincteric fistula-in-ano. There is an increased recurrence rate in female patients.

P409 Efficacy of Sphinkeeper implantation in faecal incontinent patients: 1 year experience L. Donisi, A. Parello, F. Litta & C. Ratto Proctology Unit Catholic University, Rome, Italy

P406 Early reversal of diverting ileostomy R. Azizi Pars Hospital, Iran University, Tehran, Iran Aim: A diverting loop ileostomy is used in low rectal cancer, especially for those who received neo-adjuvant chemoradiation to minimise the consequences of anastomosis leakage. In this study, the outcome of early reversal of diverting loop ileostomy within 3 weeks after the primary operation was evaluated. Method: A randomised study was carried out at Pars Hospital, Tehran-Iran during the period 2014–2016. 48 patients with diverting ileostomy were selected, 28 were eligible for early reversal. In day before operation imaging study with transanal Meglomin was undertaken. We named this imaging a pouchogram. With a satisfactory pouchogram, second surgery was performed. Results: Twenty-eight eligible patients were operated from stomy site, 4 anastomosis hand sewn with 3(O) silk in one layer, and 24 with GIA staple side to side. One leakage occurred in hand sewn cases. All stapled cases had satisfactory results and patients were discharged in 3–4 days after the operation. Operation time in stapling cases were between 25–35 minutes, and hand sewn anastomosis took 40–50 minutes. Conclusion: In selected patients, early closure and reversal of diverting ileostomy is feasible and helps patients to continue their chemotherapy with socioeconomical benefit of significant cost saving.

P407 “Surgitron” in surgical treatment of patients with haemorrhoids, anal fissures and perianal fistulas V. Balytskyy Vinnytsia National Medical University n.a. M.I.Pyrogov, Khmelnytskyy, Ukraine Aim: To improve the outcomes of surgical treatment of patients with combined anal and perianal pathology by using “Surgitron”. Method: Two hundred and sixty-eight patients with haemorrhoids, anal fissures and perianal fistulas were operated by using “Surgitron”. 194 (72%) patients with 2 diseases, 65 (24%) with 3 diseases, 9 (4%) with 4 diseases have had combined operations. The control group included 128 patients, operated on by ordinary electrosurgical equipment. Results: Using of “Surgitron” reduced an operation lasting to 20  5 min. In the control group operations lasted 35  5 min. In the experimental group patients needed 2  1 ml of narcotic drugs for anaesthesia while in the control group patients needed 4  1 ml of narcotic drugs. The volume of bleeding in the experimental group was 20  10 ml while in the control group it was 40  12 ml. The

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period of treatment in the experimental group was 4  1 days, but in the control group it was 7  1 days. Conclusion: Application of “Surgitron” for surgical treatment of combined anal and perianal diseases reduces the duration of operations, volume of bleeding, and postoperative pain. It offers better cosmetic outcome and faster recovery of patients.

Aim: Aim of this study was to evaluate the efficacy of Sphinkeeper in the treatment of faecal incontinence. Method: Ten patients (5 female; median age 70 years [20–75]) met the inclusion criteria and were enrolled. Ten Sphinkeeper prosthesis were implanted in the intersphincteric space of the middle-upper third of the anal canal, under endoanal ultrasound guidance. Continence diary, FI scores, ability to defer defecation, need to wear pads, quality of life, endoanal ultrasound and anorectal manometry were assessed before and at follow-up. Results: No complication occurred. At 1 year follow-up there was a significant reduction of median weekly episodes of FI to soiling (7[0–49] vs 0.5[0–7]; P < 0.017), flatus (10.5[0–35]vs0.1 [0–14] P < 0.028), liquid stool (1.8[0–21]vs0[0– 14]; P < 0.028), and solid stool (0[0–7]vs 0[0–0] P = 0.068). Seven patients could not defer defecation for more than 5 min preoperatively, which reduced to three patients at follow-up (P = 0.036). Preoperatively eight patients needed to wear pads versus five patients at follow-up. Median Wexner, Vaizey and AMS FI scores significantly decreased at f.up (10 [5–17] vs 4 [0–9] P = 0.012; 13[7–19] vs 7[0–11] P = 0.012; 80 [26–114] vs 49 [0–86]; P = 0.035). Two patients were fully continent. Conclusion: Sphinkeeper seems to be a safe and effective approach to FI.

P410 Haemorrhoid energy therapy (HET): a promising outpatient treatment option for symptomatic haemorrhoids S. Eftaiha1, J. Sugrue1, V. Chaudhry1,2, F. Alsabhan1, J. Blumetti2, A. Mellgren1 & J. Nordenstam1 1 University of Illinois at Chicago, Chicago, IL, USA, 2John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA Aim: Outpatient treatment options for haemorrhoids include diet modifications, various ointments, and procedures often requiring repeated clinic visits. The aim of this prospective pilot trial is to evaluate the effectiveness of the HETTM Bipolar System (Medtronic, Boulder, CO) for the treatment of grade I-III haemorrhoids applied during a single outpatient visit. Method: The HET device is a modified anoscope equipped with a tissue clamping mechanism and a bipolar energy source. Three columns of haemorrhoids were treated with two heat energy applications per column. The primary outcome is the treatment effect on haemorrhoid symptoms of bleeding, pain, prolapse, itching, and

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Poster Abstracts soiling. This was measured with a patient completed questionnaire documenting each symptom’s frequency from 0 to 3 (i.e. 0 is < 19/month; 3 is daily) before therapy and at 3 weeks and 6 month follow-up. Results: Ten patients (six females) with median age of 58 (range, 25–82) years underwent the HET procedure. The most common symptom was bleeding (100%). Haemorrhoid symptom scores decreased from 5.6 before treatment to 1.8 after treatment (P < 0.001). Conclusion: The HET treatment, applied in a single outpatient visit, reduced haemorrhoid symptoms in all patients. Patient accrual is ongoing and further assessment in a larger cohort is needed.

P411 Solitary rectal ulcer syndrome: new hope for the patients M. Elhemaly Gastroenterology Surgical Center, Mansoura, Egypt Aim: To present different modalities of treatment for patients with solitary rectal ulcer syndrome (SRUS) which represents a challenge to coloproctologists Method: Thirty patients with a mean age of 25 years were followed up in the period between 2013 and 2016. Anorectal manometry and defecography were done to assess the functional status of the anorectum and the defecation disorders Results: Bleeding per rectum was the most common symptom, depending on the data obtained from endoscopic, defecographic & anorectal manometric findings, the suitable treatment was given. 10 patients (33.3%) were treated by excision of the ulcer area but 2 (20%) of them showed recurrent ulcer during follow-up. 10 patients (33.3%) had spastic pelvic floor and patient gained benefit from biofeedback therapy with marked symptomatic improvement at a follow-up. Conservative treatment was provided to 5 patients (16.7%) but the results were unsatisfactory in the long-term. In three patients (10%) 3rd degree intussussception was found and for whom posterior rectopexy was done with fairly good results. Finally two patients (6.7%) had polypoidal growth & low anterior resection was done, with a satisfactory outcome. Conclusion: SRUS is difficult to treat but endoscopic, proctographic & manometric findings are helpful to choose the most suitable treatment.

P412 Literature review of the role of lateral internal sphincterotomy when combined with excisional haemorrhoidectomy S. Emile, M. Youssef, H. Elfeki, W. Thabet, T. A. El-Hamed, W. Omar & M. Farid Mansoura University, Mansoura, Egypt This abstract has been previously published.

P413 Three dimensional ultrasonographic findings of external anal sphincter due to vaginal delivery I. C. Eray, A. Rencuzogullari & U. Topal Department of Surgery, Faculty of Medicine, Cukurova University, Adana, Turkey Aim: Obstetric trauma is the most common cause of faecal incontinence. Surgery may benefit these patients. In this study we aimed to detect most frequent areas of damaged external sphincter muscle by endoanal ultrasound. Method: Between March 2015 and March 2016 fourteen patients were included in the study. Patients had external sphincter muscle damages after vaginal delivery and all were suffering from faecal incontinence. The defects were recorded in terms of hours using the clock system with 12 o’clock being anterior midline point. Results: Eleven patients had episiotomy and the remaining three patients had spontaneous perineal tear The most frequently seen area of defects were between 11 and 3 o’clock for those had episiotomy (five patients) and the second most frequently seen area was between 10 to 2 o’clock (three patients). The spontaneous tears were more damaging than episiotomy (two had 9 to 2 o’clock and one had 9 to 3 o’clock) Conclusion: In Turkey, mediolateral type episiotomy is performed by physicians and midwifes. As majority of them use their right hands, the defects result in left anterior side. Uncontrolled spontaneous tears may cause more complicated damage to the external anal sphincter.

P414 Quality of life index after anorectal operations E. Ahmadova, A. Saday & A. Eldar Azerbaijan Medical University, Baku, Azerbaijan This abstract has been previously published.

P415 Surgical management of traumatic cloaca: operative and functional outcome without faecal diversion P. Talento, G. Ferreri & S. Maggiore Pelvic Floor Center, Surgical Department, Franchini Hospital, Montecchio Emilia, Italy Aim: Traumatic cloacal deformities usually occur after a fourth-degree perineal laceration. The aim of the study was to report operative and functional outcome in women with traumatic cloaca after surgery without faecal diversion. Method: Eight women, median age 31, 37  6, 25, had complete repair with external and internal sphincteroplasty combined with anterior levatorplasty, without defunctioning colostomy. All patients were evaluated preoperatively with anal manometry, endoanal ultrasound, and pudendal nerve terminal motor latency. Wexner incontinence score was collected. In the postoperative period a total parenteral nutrition was carried out for 14 days. Results: After surgery patients were observed at 1, 3 and 6 months. Three postoperative wound infections occurred in relation to the tension of the tissues in the perineal space and one case of rectovaginal fistula was recorded. After six months, there were four cases of vaginal stenosis treated with dilatation. Wexner score decreased from a mean preoperative value of 17.25  1, 03 to 2.62  0.9 postoperatively. Conclusion: Surgical repair of traumatic cloaca is associated with low morbidity and improved faecal continence. Faecal diversion can be avoided using a long period of total parenteral nutrition.

P416 Normal values of anal sphincter pressure measured with nonperfusion water sphincterometer Y. Shelygin, O. Fomenko, A. Titov, V. Veselov, S. Belousova & D. Aleshin A.N. Ryzhikh state scientific center of coloproctology of Ministry of Healthcare of Russia, Moscow, Russia Aim: To develop normal values for resting and squeezing anal pressure measures with non-perfusion water sphincterometer S4402 by MSM ProMedico GmbH. Method: Seventy-three patients with colonic adenomas before polypectomy underwent sphincterometer. All patients had no complaints of faecal incontinence and outlet obstruction (0 points by Wexner incontinence scale and 0 points by local clinical scale for outlet obstruction). There were 28 males (38, 4%) with a mean age 56.2  10.2 years and 45 females (61.6%) with a mean age 54.9  13.7 years. Results: Values recorded for male subjects were: average resting anal pressure 52.1  19.8 mmHg, maximum resting anal pressure 60.3  21.9 mmHg, average squeezing anal pressure 118.2  41.5 mmHg, and maximum squeezing anal pressure 174.2  56.8 mmHg. Values recorded for female subjects were: mean resting anal pressure 37.1  15.3 mmHg, maximum resting anal pressure 43.8  15.5 mmHg, average squeezing anal pressure 75.1  29.5 mmHg, maximum squeezing anal pressure 99.1  39.7 mmHg. Conclusion: This study presents values of anal pressures sing a non-perfusion water sphincterometer. To perform comprehensive evaluation of this sphincterometer elaboration of new software is required.

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Poster Abstracts P418 Clinical long-term results of closure of fistula-in-ano with diode laser (FiLaC) P. Giamundo & M. Valente Department of General Surgery, Hospital S.Spirito, Bra, ASLCN2 - Region Piemont, Italy Aim: ‘FiLaC’ is a sphincter-saving treatment of anal fistulas which consists of sealing fistula tracts by means of a diode laser. The procedure has proved to be successful in the short- and middle-term. The current study evaluated the results and failures in the long-term. Method: Seventy-five patients operated with ‘FiLaC’ were prospectively evaluated. Patients and fistula characteristics, previous treatments, healing rates, failures, incontinence and quality of life were reviewed. Results: Median follow-up time was 40 months (range, 6–68). Fifty-two patients (69%) had a history of previous surgery for fistulas. Primary healing was observed in 52 patients (69%). No patient reported postoperative incontinence. All recurrences were reported within 12 months. Patients’ satisfaction and compliance were very high. Conclusion: Long-term follow-up after ‘FiLaC’ showed maintenance of favorable outcome seen in previous reports. Main indications included high, trans-sphincteric fistulas or inter-sphincteric fistulas in patients with a potential for faecal incontinence. The presence of secondary tracts or undrained abscess at pre-operative radiologic or ultrasonographic assessment may be a contraindication for this procedure. Drainage of abscess and placement of draining seton is necessary in these cases prior to ‘FiLaC’. The procedure can be repeated and has low morbidity. The anatomy of anal canal is preserved.

P419 Doppler-guided haemorrhoidal laser procedure (‘HeLP’) without or with muco-pexy (‘HeLPexx’) in the treatment of haemorrhoidal disease P. Giamundo Department of General Surgery, Bra, ASL CN2 - Region Piemont, Italy Aim: ‘HeLP’ is a doppler-guided haemorrhoidal dearterialization performed by means of a 980 nm diode laser and a 1000 micron conic fibre. It is minimally-invasive and no anesthesia is required. In case of symptomatic mucosal prolapse, the addition of muco-pexy (‘HeLPexx’) may be beneficial in the long-term Method: ‘HeLP’ causes shrinkage of terminal branches of superior haemorroidal artery 2.5 cm above dentate line. In ‘HeLPexx’ 3 to 6 running sutures are added to fix the prolapsing mucosa. 205 patients with 2nd–3rd degree haemorrhoids were treated with ‘HeLP” and 115 patients with 3rd degree haemorrhoids were treated with HeLPexx Results: Resolution of symptoms was reported in 82% of cases after HeLP at median follow-up of 40 (range, 6–72) months and 92% of cases after HeLPexx at median follow-up of 30 (range, 6–48) months. HeLP was well tolerated, was performed without anesthesia and morbidity was 7%(intra-operative bleeding). Morbidity after HeLPexx included: urinary retention (8), sub-mucosal hematoma (4), and transient haemorrhoidal thrombosis (4). No long term severe complications were reported. Conclusion: HeLP is minimally-invasive procedure which can be performed without anaesthesia and is indicated in symptomatic haemorrhoids with moderate prolapse. HeLPexx is indicated in case of associated significant prolapse. It is moderately painful, but offers satisfactory results without long-term complications.

be a simple, safe, not expensive, minimally invasive and potentially effective procedure in the treatment of anal fistula.

P421 Implementation of a new high-volume circular stapler in stapled anopexy for haemorrhoidal disease B. A. Grotenhuis, J. Nonner, E. J. R. De Graaf & P. J. Doornebosch IJsselland Hospital, Capelle a/d IJssel, The Netherlands Aim: Stapled anopexy is a safe technique for the treatment of haemorrhoids with short-term benefits, but carries a higher recurrence risk, which might be due to limited volume of resected tissue. In this study we investigated the introduction of a high-volume circular stapling device; in particular whether an increased amount of resected tissue could affect patients’ short-term postoperative outcome. Method: Between November 2011 and March 2015 stapled anopexy was performed for haemorrhoids and/or anal prolapse in 143 patients (N = 25 conventional PPH3©-stapler versus N = 118 high-volume CHEX©-stapler). In this retrospective dataset, operation details and short-term postoperative outcome were compared. Results: With the high-volume stapler a significantly higher amount of tissue was resected: 9.8 g (range 6.2–11.4) versus 6.4 g (range 4.9–8.8) with the conventional stapler, P < 0.01. There was no difference in frequency of intra-operative use of Bupivacain injection or haemostatic sutures at the stapling-line. There was no difference in postoperative short-term outcome including readmission and complication rates. Conclusion: A high-volume stapling device for stapled anopexy was introduced safely with a higher amount of resected tissue, without worsening clinical short-term outcome. Whether higher stapling volumes lead to improved long-term outcome with less re-interventions should be further investigated.

P422 Treatment of functional anorectal pain with botulinum toxin injection in the pelvic floor I. Han-Geurts, D. van Reijn & C. Deen-Molenaar Proctos Clinics, Bilthoven, The Netherlands Aim: Functional anorectal pain including levator ani syndrome is characterised by hypercontractility of the pelvic floor muscle of unknown origin. This hypercontractility can result not only in pain but also in obstructive defecation. Treatment is difficult and currently consists of pelvic floor physical therapy and pain medication with variable results. The result of adjuvant treatment with botulinum toxin injections in the pelvic floor muscle is evaluated. Method: Data of patients with functional anorectal pain treated with botulinum toxin injections in the pelvic floor between 2009 and 2014, were analysed. Results: Seventy patients complaining of functional anorectal pain were included. In 32 patients also an anal fissure was demonstrated. Patients had a history of pain for a mean duration of 5.2 years. Fourteen patients received injections with botulinum toxin on two occasions, three patients on three. The injections were given in 65% of the patients in the levator muscle and in 35% in the internal sphincter. Symptomatic improvement was demonstrated in 65% with a median follow up of 12 months. No adverse events were demonstrated. Conclusion: Injections with botulinum toxin in the pelvic floor for functional anorectal pain may be an effective therapy with good short- and middle term results.

P420 Acellular dermal matrix plug (Pressfit) in the treatment of primary trans-sphincteric anal fistula: a prospective study G. Giarratano1, E. Toscana1, E. Giustozzi1, S. Mohamed2, P. Sileri2 & C. Toscana1 1 CdC Villa Tiberia, Rome, Italy, 2Policlinico Universitario Tor Vergata, Rome, Italy

P423 Permanent end colostomy trephine diameter and area over time K. Ho1, T. Economou2, E. White1, N. Smart3 & I. Daniels3 1 University of Exeter Medical School, Exeter, UK, 2College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, UK, 3HeSRU, Royal Devon and Exeter Hospital, Exeter, UK

Aim: We report data of a prospective study designed to evaluate feasibility, early and long-term outcomes of Acellular Dermal Matrix (ADM) plug (Pressfit) in the treatment of primary trans-sphincteric anal fistula. Method: Between January 2014 and September 2015, 15 patients with primary trans-sphincteric anal fistula were assessed by endoanal ultrasound, and treated using ADM-plug. A seton was placed for a minimum period of two months before the intervention in all patients. A plug was surgically positioned using a press-fit technique. The Wexner Incontinence score was evaluated before and after surgery. Results: Median follow-up was 18 months (range 8–28) and median healing time was 75 days (range 60–115). There were no major complications. Three recurrences were observed (20%). The post-operative pain, evaluated with a VAS score, ranged between 0–3 in 13 patients (86%) and 4–7 in two patients (14%). No impairment of continence was observed and there was no difference in Wexner Incontinence score before and after surgery. Conclusion: The surgical treatment of anal fistula remains challenging and a sphincter-saving procedure is desirable. Our results suggested that ADM-plug could

Aim: To evaluate colostomy trephine axial and sagittal diameters and the area of the trephine over time. Method: Retrospective review of all end colostomies following abdominoperineal excision (APE) between 01/01/2006 and 31/12/2014. Age, sex, trephine position relative to rectus abdominis muscle (RAM), and serial axial and sagittal trephine diameters on follow up computed tomography (CT) imaging were collected retrospectively. Trephine area was approximated as: Area = p(A/2)(B/2), A = sagittal and B = axial diameters. Results: Hundred and three APEs were performed, of which 91 (88.3%) colostomies were created through the RAM and 12 (11.7%) lateral to RAM. Mean age was 65.5 years. There were 44 females (42.7%) and 59 males (57.3%). The difference between axial trephine diameter in males compared to females was 0.17 mm/month [95%CI: 0.30, 0.03], (P = 0.008). Sagittal trephine diameter increased by 0.22 mm/month [95% CI: 0.12, 0.32] for both genders. The difference between trephine area in males compared to females was 6.78 mm2/month [95%

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Poster Abstracts CI: 12.56, 0.93], (P = 0.009). Colostomy trephine location and age were not statistically significant factors. Conclusion: Female gender is an important factor in affecting the rate of axial trephine diameter and trephine area increase. Colostomy trephine location and patient age are not significant contributors.

P424 A one-year follow-up study of patients undergoing modified laparoscopic ventral rectopexy at a tertiary referral centre J. Hodgkinson, Y. Maeda, K. Tan, A. Leo, C. Vaizey & J. Warusavitarne St Mark’s Hospital, London, UK Aim: We describe outcomes of our modified laparoscopic ventral rectopexy (LVR) technique tailored to rectal prolapse with concurrent rectocele, enterocele and/or intussusception. Method: Posterior suture rectopexy was combined with anterior reinforcing biological mesh in the rectovaginal septum. All patients who had undergone modified LVR with longer than one-year follow-up were identified and followed up for recurrence of prolapse, change in symptoms and satisfaction. Data were collected by structured telephone interview. Results: Sixteen patients were identified; eleven were available for follow-up at one year. Four were not contactable. One patient had died more than 30 days postoperatively. There were three primary and five recurrent repairs of full thickness rectal prolapse and three performed for intussusception/rectocele. The primary symptom was obstructive defaecation in ten cases and incontinence in one. No post-operative recurrences of prolapse were identified. Eight patients reported an improvement in symptoms post-operatively. One superficial wound infection was seen and no mesh-related complications were identified. Conclusion: Good initial results are demonstrated for repair of primary and recurrent prolapse. Further data is required to fully evaluate outcomes however this early data suggests this technique can be used safely in the treatment of rectal prolapse with obstructive defaecation particularly where prolapse is recurrent.

P425 Improving documentation of chaperones in intimate examinations: perfecting the proforma Y. Hussain & S. Lockwood BTHFT, West Yorkshire, UK Aim: Intimate examinations are often distressing for patients1. GMC cases with allegations of inappropriate examination or a chaperone not being present have risen over 60% in the past 5 years2. Following recommendations in the Ayling report3 and the GMCs ‘Intimate examinations and chaperones’4 our NHS Trust created a surgical admission proforma allowing for full documentation of rectal examinations. This audit aim to determine current use and documentation of chaperones in the Surgical Assessment Unit (SAU). Method: A prospective audit analysing case notes of 40 consecutive adult patients presenting to SAU. Multiple variables collected from a standardised clerking proforma. Results: 37.5% (n = 15) of patients were male and 62.5% (n = 25) female. Median (range) age was 54 (16–91) years. 67.5% (n = 27) of had a chaperone present. Of these, 40.7% (n = 11) had name and grade recorded and 37.0% (n = 10) were countersigned. Commonest indication for examination was abdominal pain 35% (n = 14). Incidence of chaperone use by gender of assessor to patient was; F:F(78.6%), F:M (50.0%), M:F(63.7%), M:M(71.4%). Conclusion: Correct documentation of chaperone use falls short of complete compliance with the GMC guidelines in our hospital. However, the authors suggest that a structured area in the clerking proforma aids correct documentation, which is in the interest of all parties involved in intimate examinations.

P426 Bacteriology of perianal abscesses can predict the complexity of consequent anal fistulae A. Ijeomah & G. Kaur Scunthorpe General Hospital, Scunthorpe, UK This abstract has been previously published.

P427 Quality of life and outcomes following video assisted anal fistula treatment H. Joshi, S. Rout, M. Scott, A. Samad, M. Chadwick & R. Rajaganeshan St Helens and Knowsley NHS Trust, Liverpool, UK Aim: Video assisted anal fistula treatment (VAAFT) is a novel technique. We performed a prospective longitudinal study with the aim of evaluating outcomes and how quality of life was affected with this treatment. Method: Patients undergoing VAAFT were entered into a prospective database. A longitudinal study design was employed. Data were collected in structured, one-onone interviews at one week and one, two and three months after surgery. The QoL scale employed the World Health Organization Quality of Life-BREF (WHOQOLBREF) questionnaire. Results: A total of 40 patients underwent a VAAFT procedure from October 2014 to September 2015 of which 57.5% were trans-sphincteric. On mean follow up of 8.5 months 87.5% had resolution of symptoms. Patients (n = 20) completed quality of life questionnaires. Over the study period, average scores for all QoL improved significantly from 435 (SD 6) points at one week to 477 (SD 48) points at 3 months after surgery (F = 83, P < 001). Conclusion: VAAFT allows for assessment of the fistula tract and ablation under vision. It has high healing rates, even in patients that have had multiple previous interventions. The procedure has a very low morbidity and patients are very satisfied with the post-operative recovery.

P428 The role of endoanal ultrasound (EAU) in detecting occult anal sphincter injuries in primiparous women after vaginal delivery: a systematic review H. Kaiyasah, L. Alozaibi, A. AlAni, W. Hazim, A. AlMazrouei & F. Badri Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates Aim: Obstetric anal sphincter injuries (OASIs) occur frequently at the time of first vaginal childbirth which can lead to incontinence. Many remain undiagnosed and are frequently classified as occult when identified on endoanal ultrasound (EAU). This review was conducted to assess the effectiveness of EAU in early detection of OASIs. Method: Four databases (Cochrane, PubMed, Medline & Google scholars) were searched for studies looking into the role of EAU in detecting clinically occult OASIs in the first 72 hours of postpartum period. Minimum sample size included was above 100. The period of publication was between 2000 and 2015. Results: Four studies were found describing ultrasound-diagnosed occult sphincter injury based on the inclusion criteria. Two were prospective studies and two were randomised controlled trials. The largest sample size was 752 primiparous women, among those 5.6% had an occult sphincter tear. Severe incontinence was reported 3 months after childbirth by 3.3% of women in the intervention group (repair done after EAU detection) compared with 8.7% in the control group (no EAU done) P = 0.002). Conclusion: The use of EAU has proven to be helpful in detecting occult OASIs in the initial postpartum period in primiparous women. This in turn may aid in preventing major faecal incontinence.

P429 994 cases of Ferguson Haemorrhoidectomy: 10-years’ experience of a single surgeon A. S. Karaca Ankara Numune Education and Research Hospital, Ankara, Turkey Aim: To evaluate the outcomes of haemorrhoidectomy surgeries performed by the Ferguson Haemorrhoidectomy method in patients with prolapsed internal haemorrhoids. Method: A total of 994 patients who had underwent Ferguson Haemorrhoidectomy were included in this study. Patients’ medical files were reviewed and data including their complaints, concomitant anorectal diseases, operation findings, postoperative early- and late-term complications were recorded. Results: Of all cases, 70% were men and mean age was 47 (18–79) years. Symptom duration varied between 1 month to 5 years and the most common symptoms, in order of frequency, were palpable lumps, bleeding and pain. Piles had the usual (3.7.11 o’clock) localization in 74% of the cases. A majority of the patients (68%) had grade 4 haemorrhoids, and 23% had anal fistula as a concomitant anorectal disease. Of these patients, 50 (4.3%) had severe pain, 17 (1.7%) had bleeding and 38 (3.9%) had urinary retention. Nine patients developed complications in the longterm; two had anal stenosis, six had anal fistula, and one patient had anal fistulaabscess. Conclusion: Ferguson Haemorrhoidectomy (FH) is still the most commonly used procedure for haemorrhoid surgery. Our findings support that FH is an effective and safe procedure, and thus provides a preferable option.

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Poster Abstracts P430 Coexistence of rectocele and anal incontinence and long term results of simultaneous surgical repair € ßelik & E. Ozc € ßimen € Ozc F. Karakayali, T. Tezcaner, E. Haberal, U. Department of General Surgery, Faculty of Medicine, Baskent University, _Istanbul, Turkey Aim: In this study, we evaluated the coexisting prevalence of faecal incontinence and rectocele and also the long-term results of the perineal repair techniques used for the management of these patients. Method: A total of 567 female patients presenting to our clinic with outlet obstruction symptoms were evaluated prospectively. Coexisting pathologies of rectocele and faecal incontinence were determined in 61 patients (mean age 60). Mesh repair with a perineal approach were performed in 52 patients, followed by an overlapping sphincteroplasty in 17 and levatoroplasty in 35 patients. All patients were evaluated with anal manometry pressure measurement, Wexner Incontinance Score, Adjusted Obstructive Defecation Score (ODS), Cleveland Clinic Constipation Score (CCCS) and Adjusted Pelvic Floor Disorder Questionnaire (PFDI-20) in the pre- and postoperative periods. Results: The mean follow-up time was 22 months. The post-operative decrease of the CCCS, Wexner and ODS scores were statistically significant. Although they were not statistically significant, the mean resting and squeezing pressures were found to be increased in the anal manometry assessment. PFDI-20 also revealed a significant better quality of life in the post-operative follow-up. Conclusion: In such patients, adding a levatoroplasty or sphincteroplasty procedure to the mesh repair of rectocele may provide increased success rates and better patient satisfaction.

P431 Risk factors affecting wound complications and recurrence after excision of sacrococcygeal pilonidal disease M. R. Keramati, A. Keshvari, S. Jamali & M. K. Nouritaromlou Tehran University of Medical Sciences, Tehran, Iran Aim: Excision with Healing by Secondary Intention (EHSI) is one of the most popular and widely used surgical procedures for Sacrococcygeal Pilonidal Disease (SPD). This study describes risk factors leading to the development of various postoperative complications and recurrence after this procedure. Method: In this prospective analytic cohort study, 177 patients with SPD who underwent EHSI procedure were included. Clinical presentation, past medical/surgical history, pilonidal disease characteristics, and excised ellipse characteristics were measured as possible risk factors. Post-operative complications and recurrence were recorded as outcomes. Results: A total of 177 (129 males, 48 females) patients underwent EHSI with a mean age of 25.58  7.9 years. Twenty patients (11.3%) had a history of previous surgery for their SPD (including EHSI or flap procedures). Discharge was the most common presenting symptom detected in 132 (74.5%) patients. Mean length, width, and weight of the excised ellipses were 5.64  8.04 cm, 2.94  8 cm, and 29.56  36.01 g, respectively. Analysis detected significant relations (P < 0.05) between the type of previous SPD treatment and recurrence (n = 16) and postoperative complications including delayed wound healing (n = 47) and bleeding (n = 3). Conclusion: Patients with a history of previous pilonidal surgery are prone to the development of future recurrence or delayed wound healing after the EHSI procedure.

P432 Delayed wound healing after excision of sacrococcygeal pilonidal disease: is it curettage a solution? A. Keshvari, M. R. Keramati, M. Kazem & N. Taromlou Tehran University of Medical Sciences, Tehran, Iran Aim: Excision and healing by secondary intention (EHSI) is one of the common Method for the treatment of sacrococcygeal pilonidal disease. In 30% of patients, the wound does not heal completely in expected time of eight weeks. In this study we present our experience with curettage as a treatment of delayed healing. Method: In this study, all patients who underwent curettage due to delayed wound healing after EHSI procedure between 2008 and 2015 were selected. Delayed wound healing was defined as lack of complete wound closure and epithelialization after 90 days from the operation. Results: Curettage was performed for 18 patients. The mean age was 22.11 years and BMI was 25.48. Mean time between first operation and curettage was 169 days. In three patients, the curettage was repeated twice. The patients were followed up for a mean of 58 months. Complete wound healing was detected in 77.8% of patients in mean time of 76 days after curettage. Four patients did not heal and were considered as non-healing wound or recurrent disease. Conclusion: Curettage could be an accepted treatment for patients with delayed wound healing after EHSI, before considering them as recurrent disease.

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P433 Conversion of a suprasphincteric into intersphincteric fistula track: results of a single centre prospective trial I. Kostarev, A. Titov & M. Andrey State Scientific Centre of Coloproctology, Moscow, Russia Aim: This study evaluates the efficacy of method of treatment of complex suprasphincteric anal fistulae by conversion of suprasphincteric into intersphincteric fistula track (CFT). Method: Twenty-four patients with suprasphincteric fistula were included (15 males, nine females). 20 patients underwent CFT with excision of peripheral part of fistula, suturing of fistula opening through the wound and drainage of intersphincteric space (IS) by latex seton. Four patients underwent CFT with mobilization of peripheral part of fistula to the rectal wall and full transposition of fistula track into IS. Results: Mean follow-up was 19 months (range, 6–36). Complete healing of wound and formation of a new intersphincteric fistula observed in 12 (50%) patients. Success rate was 50% (10/20) after CFT with drainage of IS by latex seton and 50% (2/4) after CFT with transposition of fistula track into IS. Newly formed intersphincteric fistula excised after wound healing. Recurrence developed in one patient 13 months after surgery. No patients reported any incontinence postoperatively. Conclusion: Conversion of a suprasphincteric into intersphincteric fistula track could be a method of choice for treatment of patients with complex anal fistulae when other sphincter-sparing methods were noneffective or in cases when only cutting seton may be used.

P434 Acute and chronic anal fissure-mutual treatment-higher satisfaction I. Kostic, B. Maric, A. Milojkovic & A. Aleksic General Hospital, Cacak, Serbia, Serbia Aim: The most significant problems associated with anal fissure are pain and discharge. Our goal was to show that mutual treatment with hot bath, stool softeners and oinment with topical anaesthetics (OTA) are the best treatment combination to improve pain in acute and chronic fissures. Method: This is retrospective study from 2010 to 2015. Two groups were compared. Group A were 40 patients with acute fissure treated with hot baths twice a day, tool softeners and OTA. Group B were 40 patients with chronic fissure who received the same treatment. Patients included in this trial had fissures which significantly affected their quality of life. We graded their satisfaction and quality of life at 7 days, 2 weeks and 1 month following treatment. Results: In group A 87.5% patients were fully satisfied after 2 weeks with the acute fissure having almost no influence on their quality of life. In group B 82.5% of patients were partially or fully satisfied after 1 month; 75% having no or minimal influence on quality of life. Conclusion: For patients with acute fissure this treatment can provide full satisfaction, with no influence on quality of life within 2 weeks. For patients with chronic fissure the treatment can provide satisfaction in most of cases. After 4 weeks there was no influence on the quality of life of a majority of patients with chronic fissures.

P435 The role of Metronidazole in managing post haemorrhoidectomy pain; a systematic review N. J. Lyons, J. Baptiste, S. Pathak, P. Charters, I. R. Daniels & N. J. Smart Exeter Surgical Health Service Research Unit (HeSRU), Royal Devon and Exeter Hospital, Exeter, UK Aim: There is conflicting data on the effectiveness of Metronidazole in reducing pain following open haemorrhoidectomy. The aim of this study is to systemically review randomised controlled trials (RCTs) addressing this questions and conduct a meta-analysis. Method: A systematic review was undertaken in accordance with the PRISMA protocol. Of 122 articles initially identified, 7 were taken forwards to full review following application of the inclusion/exclusion criteria. The primary outcome was post-operative pain on days 1, 2 and 7 with secondary outcomes including pain on first defecation post procedure as measured using a Visual Analogue Scale (VAS). Results: Meta-analysis of post-operative pain which demonstrated significant (P < 0.001) reductions in pain on day 1 (1.11, 95% confidence interval 1.56 to 0.66), day 2 (1.75, 95%CI 1.96 to 1.54) and day 7 (1.74, 95% CI 1.87 to 1.61). Meta-analysis of pain on first defecation was likewise strongly significant (P < 0.001) in favour of Metronidazole with a mean of 1.12 (95% CI 1.43 to 0.81). Conclusion: Whilst the analgesic mechanism of Metronidazole remains unclear, this meta-analysis of RCT evidence appears to demonstrate that Metronidazole provide significant pain relief post open haemorrhoidectomy compared to placebo. As such our recommendation is that Metronidazole should be routinely offered to patient undergoing these procedures.

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Poster Abstracts P436 Long-term outcome of laparoscopic rectopexy K. N. Tan, Y. Maeda, J. T. Jenkins & R. H. Kennedy St Mark’s Hospital, Harrow, Middlesex, UK Aim: To review the long-term outcome of laparoscopic rectopexy for rectal prolapse: Method: A structured telephone interview was conducted to assess recurrence of rectal prolapse and functional outcome. Results: Eighty-six patients (80 females, median age 66 (range 21–96) were operated between 2006 and 2014. Forty-one patients (48%) had at least one previous prolapse surgery. Seventy-four patients (86%) had a suture rectopexy, 9 (10.5%) had mesh only rectopexy, and 3 (3.5%) had a combined ventral mesh and suture rectopexy. Thirty-six patients (42%) were available for telephone interview at a median of 73 (range 27–121) months. The recurrence of prolapse occurred in 12 patients (33%) at a median of 11 (range 0–60) months, of whom eight patients had suture rectopexy and eight patients had previous prolapse surgery (P < 0.05). New onset faecal incontinence and constipation was seen in 6 (17%) and 2 (6%) patients respectively. Pre-operative expectations were met in 23 (64%) patients with a median satisfaction score of 4 (not met: 1, very satisfied: 5). Colostomy was required in four patients (3: intractable incontinence, 1: evacuation difficulties). Conclusion: Laparoscopic suture rectopexy offers a reasonable long-term outcome as a primary repair of rectal prolapse. Satisfaction was high.

P437 Local application of Nifedipine versus calibrated lateral internal sphincterotomy for treatment of chronic anal fissure S. Mahmoud, M. A. Elkheir & M. A. Elshafy Mansoura Faculty of Medicine, Mansoura, Dakahlia, Egypt Aim: To compare local application of Nifedipine with tailored closed lateral internal sphincterotomy for treatment of chronic anal fissure. Method: Fifty-six patients with chronic anal fissure were included in the study. Pre-treatment manometry was done to exclude low anal pressure patients. They were divided into two groups. The first group (28 patients) were subjected to local application of 0.5% Nifedipine ointment every 8 hours daily for 3 weeks. The second group (28 patients) were managed with closed lateral internal sphincterotomy. Visual analogue scale and healing time were recorded. The patients were followed up for 6 months with manometry, clinical response and quality of life were evaluated. Results: Both techniques showed significant reduction in resting and squeeze pressures. Pain score was better on the seventh postoperative day in the Nifedipine group but the reverse was true on the first day. The surgery group had better healing and clinical improvement. Incontinence was observed in the surgery group but not in the Nifedipine group. Conclusion: Local application of Nifedipine is a good alternative to surgery for treatment of chronic anal fissure where continence is in jeopardy.

P438 Satisfaction of patients who underwent proctologic surgery in an ambulatory surgical centre W. Malta, T. Correia & A. Povo Centro Hospitalar do Porto EPE, Porto, Portugal Aim: Despite recent developments in proctologic surgeries, there is still some resistance to performing them on an outpatient basis. The purpose of this study was to evaluate the satisfaction of patients who underwent proctologic surgery in an ambulatory surgical centre. Method: Medical records of patients who underwent surgery of haemorrhoids, anal fissures and perianal fistulas from March 2011 to July 2014 were reviewed. Demographic data, type of procedure and complications were collected. Additionally, the Cleveland Clinic Incontinence Score, the Faecal Incontinence Quality of Life Instrument (FIQLI) and a global satisfaction inquiry were applied telephonically. Results: A total of 534 patients underwent proctologic surgery of whom 56.5% were male and the mean age was 48.5 years. The mean global satisfaction with the ambulatory care was 9.6/10 and most patients considered the absence of hospitalization an advantage. In the FIQLI, 88% of patients considered their general health good/very good; no one had concern about accidental bowel leakage nor felt sad in relation to its proctologic health. Conclusion: The proctology surgery can be safely performed in an outpatient basis, with low morbidity rate, good pain control and without significant post-operative complications. Furthermore, besides the reduction of hospital costs achieved, it has good acceptance by the patients who showed very good satisfaction.

P439 Short-term results of national multicentre prospective study of stapled hemorroidopexy I. Melbarde-Gorkusa1, K. Snipe2, A. Martinsons1, I. Brunenieks3, A. Kusmane4, S. Skrjabins5, D. Soldatenkova6 & A. Ahmetovs7 1 Pauls Stradins Clinical University Hospital, Riga, Latvia, 2Riga 1st Hospital, Riga, Latvia, 3Hospital Aizkraukle, Aizkraukle, Latvia, 4Adazu Hospital, Adazi, Latvia, 5 Jelgava City Hospital, Jelgava, Latvia, 6RAKUS, Riga, Latvia, 7LJMC, Riga, Latvia Aim: The aim is to evaluate the results of stapled hemorroidopexy (SH). Method: From January to April 2016, 72 consecutive patients with symptomatic II-IV degree haemorrhoids underwent SH. The area of resected mucosa (cm2) was measured. The pre-operative and post-operative symptoms and time to return to work were assessed prospectively. Follow-up was at 2 and 6 weeks. Further 6month follow-up is planned. Results: The mean age was 46 years (range 24–77). The mean BMI was 26.7 (range 16.4–39.4). The mean area of the resected mucosa was 24.37 cm2 (range 11.65–39.51 cm2). Simultaneous surgical intervention, such as fissure or external haemorrhoid piles resection, was performed in 68% of patients. The main indication for surgery was bleeding during defecation; 94.4% of patients experienced this preoperatively (severe in 40%). Mild postoperative bleeding during defecation was observed in 40.3% of patients at 2 weeks and 11.4% at 6 weeks follow-up. The mean pain score on a 0–10 scale diminished from 2.9 (range 0–10) at 2 weeks follow up to 1.5 (range 0–4) at 6 weeks follow up. The mean time to return to work was 13 days. Conclusion: SH is safe and well tolerated surgical method. SH reduce symptoms of disease. In our study prolonged sick leave after surgery compare to literature data was observed.

P440 Ligasure haemorrhoidectomy: how we do it G. Milito1, G. Lisi2, P. Sileri1, E. Aronadio1 & M. Grande1 1 University Hospital of Tor Vergata, Rome, Italy, 2University Hospital of Borgo Roma, Verona, Italy Aim: Haemorrhoidectomy is considered the gold standard for grade 3–4 haemorrhoids. Milligan-Morgan’s and Ferguson’s procedures are the most used techniques. The aim of this article is to present our Ligasure Haemorrhoidectomy focus on technical aspects showing our results with a large number of patients and a long-term follow-up. Method: Between June 2001 and June 2014 at our department patients were selected to undergo LigaSure haemorrhoidectomy for grade III and IV haemorrhoids. Patients of both genders aged 19–80 years with ASA grade I-III were included. Operative time, postoperative pain, day of discharge, early and late complications were recorded. Time to return to work was also assessed. Results: Thousand patients were successfully treated with LigaSure. Mean followup was 5 years and 30 patients were lost from the follow-up after the first postoperative month. All patients returned to work activities 8.2 days after surgery. Amongst early postoperative complications, 21 patients experienced urinary retention and three patients had a minor bleeding. As late complications, anal fissure was detected 35 patients and three anal fistulas and four abscess were also observed. At the end of the five year follow-up 27 recurrences were detected. No soiling or incontinence was observed. Conclusion: This large clinical study has confirmed the benefits of the LigaSure system in performing haemorrhoidectomy. In our opinion, as confirmed in the literature, this technique may be the best option in IV degree haemorrhoids.

P441 LigaSure versus conventional diathermy haemorrhoidectomy: A retrospective monocentric study G. Milito1, G. Lisi2, P. P. Sileri1, E. Aronadio1 & M. Grande1 1 University Hospital of Tor Vergata, Rome, Italy, 2University of Borgo Roma, Verona, Italy Aim: The aim of this retrospective study was to compare LigaSureTM and conventional diathermy haemorrhoidectomy. Method: Between June 2001 and June 2014 at the University Hospital of Tor Vergata, Rome, one thousand patients with grade III or IV haemorrhoids underwent LigaSureTM and Diathermy (Milligan–Morgan) haemorrhoidectomy as a day-case procedure. Operating time, postoperative pain score, hospital stay, postoperative complications, wound healing time and time to return to normal activities were assessed. The mean follow-up was five years. Thirty patients were lost to follow-up. Results: The mean operating time for LigaSureTM haemorrhoidectomy was significantly shorter than that for diathermy (P < 0.011). Patients treated with LigaSureTM had significantly less postoperative pain when measured on a visual analogue scale (P = 0.001), shorter wound healing time (defined as time to absence of swelling; P < 0.012) and less time off work (P < 0.01) than patients who had diathermy. Neither postoperative complications nor mean hospital stay (day-case surgery) were significantly different.

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Poster Abstracts Conclusion: LigasureTM haemorrhoidectomy demonstrates simplicity and reproducibility. The cost of the device is justified by a low complication rate, fast wound healing, a quick return to work, a reduced postoperative pain and lower recurrence rate too. Our results suggest it may be the treatment of choice in grade III or IV haemorrhoids.

P442 Comparison of postoperative pain and quality of life in patients stapled haemorrhoid prexy and Ferguson haemorrhoidectomy in central Tehran Hospital in 2014–2015 M. Mohseni Tehran Azad University, Tehran, Iran Introduction: Haemorrhoid disease is the most common cause of lower gastrointestinal bleeding, is associated with pain and commonly affects patients’ quality of life. Method: The present study was a cross sectional-study of patients with haemorrhoids referred over one year. Stapled haemorrhopexy and haemorrhoidectomy candidates were included. The sample size in each group was 40. A significance level was set at 0.05. Results: In this study, most participants were male (55%). Quality of life at 6 months after surgery in those who underwent stapled hemorrhopexy was better than those who underwent haemorrhoidectomy. The mean pain score at 24 hours and 6 months after surgery was significantly lower following stapled hemorrhopexy than haemorrhoidectomy. Conclusion: The results of this study suggest that stapled haemorrhoidopexy is a safe and effective alternative for the treatment of haemorrhoids. It is associated with reduced postoperative pain and faster return to normal activities.

P443 Invaginative method for the treatment of rectovaginal fistulae A. Mudrov, A. Titov & I. Kostarev State Scientific Centre of Coloproctology, Moscow, Russia Aim: To determine and evaluate the efficacy of invaginative method of treatment of rectovaginal fistulae. Method: We considered a consecutive group of women (n = 19) with high rectovaginal fistulas. Mean age was 33.7 (range 22–54). Three patients had a Crohn0 s fistula. All patients were underwented fistula surgery by invaginative method, which consists of invagination of the fistula tract into the rectal lumen. All patients had been treated without diverting stoma. Mean follow-up was 17.1 months (range 5– 21). Results: Successful results were been registered in 15 patients. Four patients (21.1%) had recurrence presenting between 2 and 4 weeks postoperatively. Two of them suffered from Crohn’s disease. Conclusion: The invaginative method is safe and effective technique for treatment of high rectovaginal fistulae. This method can be performed without diverting colostomy.

P444 Fistulotomy and primary sphincter reconstruction for management of transsphincteric fistulas: single centre experience M. Ninkovic1, S. Czipin1, M. Huth1, S. Kuscher1, E. Gasser1, B. Henninger2, 1 € D. Ofner-Velano & I. Kronberger1 1 Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria, 2Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria Aim: Aim of this study is to evaluate outcome of fistulotomy and primary sphincter reconstruction for transsphincteric fistulas. Method: We retrospectively assessed all patients with transsphincteric fistulas treated with fistulotomy and primary sphincter reconstruction between June 2014 and March 2016. Postoperative follow-up included physical examination, evaluation of incontinence score, transanal endosonography and MRI. Results: In total, 25 patients (median 49 years, range 25–76) had a median preoperative duration of complaints of 16.5 (1–128) months. All patients had previous proctologic surgeries (abscesses or fistulas), including 12 (48%) patients with recurrent fistulas. After a median follow-up of 10 (1–21) months, transsphincteric fistula recurrence occurred in 2 (8%) patients, 2 (8%) had a perineal, extrasphincteric fistula at the lateral wound edge. Two patients (8%) showed new onset of urge incontinence (St. Mark’s score = 4). Six (24%) patients had a superficial wound infection. In asymptomatic patients, fistulas were not observed in transanal endosonography or MRI. Conclusion: Fistulotomy and primary sphincter reconstruction is a promising therapeutic option for transsphincteric fistula with low recurrence and complication and faecal incontinence rate. For detection of recurrent fistula or muscle defect, no difference is seen between transanal endosonography and MRI.

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P445 Results of sphincteroplasty in faecal incontinence due to anal sphincter lesion A. Oliveira, A. Manso, M. Rosete, M. Koch, J. Leite & F. Castro-Sousa Coimbra Medical School and University Hospital, Coimbra, Portugal Aim: In cases of faecal incontinence due to anal sphincter lesion, overlapping sphincteroplasty has shown deterioration of results on long-term evaluation. The aim of this study was to assess short- and long-term results and its impact on quality of life following sphincteroplasty. Method: Patients submitted to sphincteroplasty for anal sphincter lesion confirmed with endoanal ultrasonography between 2005 and 2014. Wexner score was applied pre and postoperatively. Failure was considered when no improvement on Wexner score was observed. Results: Thirty six patients were included (six males) with median age of 47  14 years. Obstetric injury had occurred in 25 cases, iatrogenic injury in eight cases and three cases were post-trauma. The median follow-up was 46 months (range 10–120). There were five cases of wound infection. There were six cases of treatment failure (16.7%), 5 of them treated with neurostimulation and 1 with dynamic graciloplasty. Clinical improvement was registered in 30 cases as the median Wexner score decreased from 16 (8–20) to 8 (2–18) (P < 0.05). There was no correlation between outcome and etiology, age or gender. Conclusion: These results suggest that sphincteroplasty should remain the first option in the treatment of sphincter lesion with incontinence.

P446 Banding haemorrhoids using the O’Regan Disposable Bander D. Paikos1, I. Moschos2 & D. Chatzopoulos2 1 G. H. G. Genimatas Hospital, Thessaloniki, Greece, 2Euromedica Kyanous Stauros Clinic, Thessaloniki, Greece Aim: Haemorrhoids are the most common anorectal disorder in the Western World and are a major cause of active, relapsing or chronic rectal bleeding. Many treatment options have been proposed and tried for early-stage haemorrhoids. There is general agreement that rubber banding ligation (RBL) is safe and effective. To evaluate the effectiveness and complications associated with RBL performed in outpatients for symptomatic haemorrhoids using the O’Regan Disposable Bander device. Method: Hundred and eighty consecutive patients underwent haemorrhoid banding with the O’Regan Disposable Bander. Results: The mean time required for one session was 6.2 min; the longest was 10 min. No major complications were noted. Minor early and late bleeding was reported in 10% and 6.7% respectively, but none was severe. Pain occurred in 6.7% but was not severe. In all cases, clinical and endoscopic (range and form scores) improvement was observed and patients of all ages, including the elderly, were found to be tolerant to the procedure. Conclusion: RBL performed in outpatients for symptomatic haemorrhoids using the O’Regan Disposable Bander device is associated with a good response and low complication rate. We recommend the technique as a safe and reliable treatment option.

P447 Pit Picking is a safe and successful therapeutic option in non-acute Pilonidal Sinus Disease F. Pakravan, C. Helmes, K. Wolf & I. Alldinger Center of Coloproctology, Dusseldorf, Germany Aim: Pilonidal Sinus Disease is a disease most commonly affecting hirsute men. Excision and lay open of the infected sinus being customary in earlier years, a minimal invasive approach has evolved in recent years. Both excision and reconstruction following the techniques of Karydakis, Limberg or Dufourmentel, and Pit Picking have shown good results. We present our results after Pit Picking. Method: A minimum follow up of 6 months was available for 93 patients (mean age 28.3 years) with an ambulant operation under general anaesthesia. Results: In 78 patients (83.9%) the disease was cured by the operation. The wounds healed after 38 days (24–78). In eight patients the disease was cured after a second Pit Picking operation. A total of seven patients were re-operated with a different technique. No major complications occurred. Conclusion: This is a retrospective study carried out in a practice specialised in coloproctology. Only patients who presented spontaneously in our practice were included in the study. This might create a selection bias. Pit Picking is a safe operation for Pilonidal Sinus Disease. Due to the low failure rate and the absence of major complications it should be considered as first choice in chronic and in acute Pilonidal Sinus Disease.

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Poster Abstracts P448 Treatment of haemorrhoids and obstructed defecation syndrome with TST STARR Plus. Results after 3 years F. Pakravan, K. Wolff, C. Helmes & I. Alldinger CPZ-Coloproktologisches Zentrum, Duesseldorf, Germany Aim: The aim of the study was to assess safety, efficacy and feasibility of transanal stapled procedure performed by TST STARR Plus in the treatment of haemorrhoids and obstructed defecation syndrome (ODS). Method: Patients with haemorrhoids (III-IV degree) and ODS with rectocele and/ or rectal intussusception were included. Preoperatively, after 30 days and 6 months ODS Score and CCIS were documented. Size of specimen, operative time, hospital stay and peri- and postoperative complications were reported. Results: From September 2013 to April 2016 60 patients were enrolled. Their median age was 50 (range 25–79 years) and 28 patients were female. Median operative time was 21 min (15–40), median resected size 6 9 4 cm, hospital stay 4 days (3–10). Median ODS Score decreased from 8 (2–17) preoperatively to 3 (0–11) after 30 days and 4 (0–11) after 6 months. Median CCIS was 0 (0–15) preoperatively, 0 (0–16) after 30 days and 0 (0–10) after 6 months. No intraoperative complications occurred. Postoperative bleeding occurred in one case and a hematoma in the staple line in another patient. Both complications were treated conservatively. Two patients reported aggravation of pre-existing faecal incontinence. Conclusion: TST STARR plus is safe and effective in this group of patients over a 3 years period. Faecal incontinence should be evaluated preoperatively.

P449 Recurrent rectovaginal fistulas: outcomes of various surgical procedures J.-H. Park1, S.-B. Ryoo1, Y.-H. Kwon1, D. W. Lee1, I. Song1, M. J. Kim1, J. W. Park1,2, S.-Y. Jeong1,2 & K. J. Park1 1 Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea, 2Colorectal Cancer Center, Seoul National University Cancer Hospital, Seoul, Republic of Korea Aim: We aimed to assess outcomes of various surgical procedures for recurrent rectovaginal fistula (RVF) and analyse the prognostic factors for successful closure. Method: From our study cohort of 92 prospectively enrolled patients who underwent operations for RVF, 24 patients (median age, 39 years) experienced recurrent RVF and were retrospectively reviewed. Results: The causes of RVF were rectum resection (n = 11), birth trauma (n = 6), Crohn’s disease (n = 3), radiation therapy (n = 2), and other (n = 2). A total of 47 operations were performed. The median number of operations was 3 (range, 2–6). The surgical procedures were 17 rectal advancement flaps (RAF), 10 diverting stomas, 7 gracilis muscle transpositions (GMT), 3 Martius flaps (MF), 3 adipose stem cell injections (ASCI), 3 bowel resections, 3 perineoplasties, and a seton procedure. Protective diverting stomy was performed in 15 operations (31.9%). The median follow-up period was 37.0 months. Complete closure occured in 14 patients (58.3%). The success rates of surgical procedures were significantly different (ASCI, 66.7%, GMT, 42.9%, MF, 33.3%, RAF, 23.5%, P = 0.045). The cause of RVF was also a significant factor (birth trauma, 83.3%, Crohn’s, 25.0%, radiation therapy, 25.0%, rectum resection, 19.2%, P = 0.025). Conclusion: Our results indicate that despite various surgical procedures, the success rate is only about 50% for closure of recurrent RVF.

P450 The limited surgical correspondence of intersphincterical infiltration viewed by 3D endoanal ultrasound (EAUS) in relapsed into scars complex fistula S. Podpriatov1,2, O. Umanets3, S. Podpryatov1,2, G. Marynsky2, S. Gichka4, V. Tkachenko2, I. Bielousov1,4, O. Sydorenko1, V. Shchepetov1 & K. Boiko1,4 1 Clinical research centre of bonding/welding surgery and new surgical technologies, Kyiv, Ukraine, 2E.O. Paton Electric Welding Institute of the National Academy of Sciences, Kyiv, Ukraine, 3National military medical centre, Kyiv, Ukraine, 4Kyiv municipal hospital clinic #1, Kyiv, Ukraine Aim: To recognise the properly corresponding endoanal ultrasound (EAUS) fistula branch viewing to clinical finding in relapse complex cases. Method: We compared the perioperative EAUS data with surgery results in relapsed high complex anal or anoperineal fistula cases. During 2005–2015, 3 women and 3 men have had a massive posttraumatic/surgical scars and/or rectocele underwent fistula surgery. We searched a main fistula loop from its branching point through perineal incision. After EAUS, probe and coloring data adjustment the main loop were incised, or closed by sealing (welding) FAISC method. The residual loops left untouched, skin wounds left open. Anal fissure scars and piles were incised if presented. Results: Fistula’s side loop was found in 3 of 6 infiltrated branches, and in one case fistula loop was found in non-infiltrated point. Any postoperative abscess or relapse observed this years. Infiltration became hyperechoic structure during 6 month.

Conclusion: Complete EAUS viewing the intersphincterical branch of relapsed in scars fistula by its infiltration corresponds with clinical finding about 50%. False main fistula loop in 1 of 6 cases were recognised. The hyperechoic postoperative changes prove the fistula infiltration arising. The recovery rate in case of non-recognised infiltrated branches probably depends of used surgery method also

P451 STARR surgery in ODS: a comparative analysis between published studies and the case series of 500 patients operated at India’s largest proctology clinic A. Porwal, P. Gandhi & D. Kulkarni Healing Hands Clinic, Pune, India Previously published in World Journal of Colorectal Surgery: Vol. 6: Iss. 1, Article 3, 2016.

P452 Rehabitation and improvement in quality of life by means of biofeedback pelvic floor exercise therapy in patients with pelvic floor dyssynergia A. Porwal, N. Patel, S. Wangnoo & A. Koul Healing Hands Clinic, Pune, India Background: Biofeedback Pelvic Floor Exercise Therapy (BFT) has been introduced as an alternative treatment to Pelvic floor dyssynergia (PFD). Method: A total of 35 consecutive patients diagnosed as pelvic floor dyssynergia (resting pressure >65 mmhg) were enrolled in the study and trained for pelvic floor muscle exercise. Patient performed exercise 20 mins per day for 12 weeks. Data have been collected using Longo’s obstructed defecation syndrome (ODS) score, Quality of Life (PAC-QOL) score and Bristol stool score and performed anal manomentry at every 4 weeks. Results: Study result demonstrated a statistically significant improvement in the mean resting pressure, maximum squeezing pressure and average of 10 secs hold (from 69.83  6.40 to 39.87  5.51, 98.67  17.23 to 128.67  26.92, 78.70  15.41 to 109.00  22.23, P = 0.005 at week 12). The mean total ODS decreased significantly (P < 0.0005) from baseline to 22.92  4.03 to 11.46  6.76 at week 12. Also, individuals ODS score items were significantly improved at week 8 and week 12. Bristol stool score significantly improved from 2.12  1.14 to 4.04  0.96 at 12 week (P < 0.0005). Significant improvements were recorded in total score of PAC-QOL at week 12. Conclusion: Biofeedback therapy provides improvement in bowel symptoms, anorectal function and reduces use of aperients in constipated subjects with pelvic floor dyssynergic.

P453 Trans Rectal Opening lay of Primary opening in Inter Sphincteric plane (TROPIS) procedure: a simple new sphincter sparing single stage procedure to treat Supralevator fistula-in-ano P. Garg1,2, P. Singh3, A. Porwal4, M. K. Garg5 & S. Singh6 1 Garg Fistula Research Institute, Panchkula, India, 2Indus Superspeciality Hospital, Mohali, India, 3University of North Texas Health Sciences Center, Fortworth, Texas, USA, 4Healing Hands Clinic, Pune, India, 5BPS Medical College, Khanpur Kalan, India, 6Punjab Civil Medical Services, Mohali, India Aim: Supralevator fistula-in-ano are extremely difficult to treat and there is no satisfactory treatment available. MRI was done and assessed in all patients with supralevator fistula to assess the location of supralevator extension. The laying open of Primary opening and Supralevator extension through transrectal route (TROPIS) in intersphincteric plane opened the intersphincteric space and helped in healing of Supralevator extension. The external sphincter was not cut at all. The infralevator portion(intersphincteric or transsphincteric) was laid open in intersphincteric and curetted in transsphincteric fistula. Method: MRI was performed in all cases and TROPIS was carried out. Vaizey’s incontinence scores were measured pre-operatively and 3 months post-operatively. Results: A total of 37 patients of Supralevator fistula were included over a 4 year period. The supralevator extension was in Intersphincteric plane in all 37 patients. The infralevator portion was either intersphincteric (n = 10) or transsphincteric (n = 27). TROPIS was done in 12 patients. Two patients tested positive for Tuberculosis and were started on Anti-Tubercular Therapy. A majority (10/12, 83.3%) patients were cured, with a median follow-up of 9 months and no change in incontinence scores. Conclusion: TROPIS is a simple new effective sphincter sparing single stage procedure to treat Supralevator fistula-in-ano with minimal impact of incontinence. The supralevator extension was in Intersphincteric plane in all patients.

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Poster Abstracts P454 Single institution experience of THD treatment for chronic haemorrhoids V. Pyrogovskyy1, B. Sorokin2, S. Zadorozhniy1, S. Plemyanik1, A. Taranenko1, S. Zlobenets1, U. Grecana2, A. Noyes1 & P. Murga1 1 Department of Proctology, Kyiv Regional Hospital, Kyiv, Ukraine, 2National Medical Academy for Postgraduate Education, Kyiv, Ukraine Aim: To study the THD technique and assess for complications and recurrence. Method: Between November 2007 to March 2016, 844 THD procedures were performed. Mean age 37.6 years, 471 (55.8%) male, 373 (44.2%) female. Contraindications included acute haemorrhoids and inflammatory bowel disease. Results: In the early postoperative period, only 62 patients (7.4%) required narcotic analgesics, mainly after anopexy. Postoperative complications: 1 (0.1%) submucosal anal abscess; 5 (0.6%) profuse bleeding for 4–5 days and 45 (5.3%) thrombosis, which were treated conservatively. The postoperative hospital stay was 1 day and when excision of anal fissure was also included with THD 2–3 days. Recurrence was seen in 34 (4%) cases. In 7 (20.6%) cases latex ligation was performed, 6 (17.6%) underwent a classical haemorrhoidectomy and 21 (61.8%) had a single haemorrhoid excised under local anaesthesia. Conclusion: THD is a minimally invasive technique which can be combined with simultaneous excision of anal fissures.

P455 Gracilis muscle transposition for the treatment of recurrent rectovaginal and pouch-vaginal fistulae: outcomes and long-term success rate M. Rottoli1, L. Gentilini1, R. Cipriani2, L. Boschi1, C. Gelati2 & G. Poggioli1 1 Department of General and Colorectal Surgery, S. Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy, 2Department of Plastic Surgery, S. Orsola-Malpighi Hospital, Bologna, Italy Aim: To assess the short and long-term outcomes of gracilis muscle transposition (GMT) for the treatment of recurrent rectovaginal and pouch-vaginal fistulae. Method: Retrospective analysis of a prospectively maintained database. The surgical technique included mobilisation of the gracilis muscle through minimally invasive incisions on the thigh and the transposition of the muscle into the rectovaginal space. Short-term outcomes and long-term success rate were recorded. Results: From 2005, 21 patients (age 45 years, 25–66) with a pouch-vaginal (7, 33.3%) or rectovaginal fistula due to Crohn’s disease (8, 38.1%), vaginal delivery (3, 14.3%), idiopathic causes (2, 9.5%) and previous rectal surgery (1, 4.8%) were included. The median duration of disease was 3.9 years (0.1–16). No major complications were recorded. The hospital stay was 6 days (4–11). After a median followup of 64 (4–132) months, the success rate was 70.8%. The median time to recurrence was 3.5 months (1–12). Although not statistically significant, the preoperative use of steroids (33.3% vs 6.7%, P 0.11) was higher in the recurrence group. Conclusion: GMT is associated with a low morbidity, shorter hospital stay and a satisfactory long-term success rate. It should therefore be considered as a standard of treatment for recurrent rectovaginal fistulae.

P456 Management and outcomes in patients with acute lower gastrointestinal tract bleeding V. Sulyma, O. Ryabchynska & A. Rufanova Dnipropetrovsk Medical Academy, Dnipropetrovsk, Ukraine Aim: Emergency care for patients with gastrointestinal bleeding (GI) remains a topical issue despite significant progress in the development of endoscopic haemostasis and angiographic techniques. Bleeding from the lower GI tract accounts for approximately 20% of all gastrointestinal bleeding. Overall mortality from such bleeding is quite small (3–4%), but mortality in elderly and frail patients with concomitant pathology may reach 10–25%. Method: In 2015 we identified 149 patients with suspected lower intestinal bleeding. We used the following diagnostic algorithm: clinical evaluation for acute gastrointestinal symptoms, quantify the amount of blood loss and extent of bleeding, patient severity score, localisation of the bleed and therapeutic measures. Conservative therapy included blood transfusion, haemostatic measures and symptomatic management. According to our guidelines patients also had endoscopic haemostasis if indicated. If the above measures failed patients were considered for surgery. Results: 13 (8.7%) with colonic bleeding underwent surgery. Mortality was 2.6%. Conclusion: Patients with lower GI bleed should be promptly managed using a diagnostic and therapeutic algorithm. Indications for surgery are failure of conservative management/endoscopic haemostasis and rebleeding.

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P457 “Painless” management of haemorrhoids H. Koh, J. Sayers, E. Tam, H. Swainson & P. Hainsworth Freeman Hospital, Newcastle-upon-Tyne, UK Aim: Pain is a major concern for patients, often being the deciding factor for patients to opt for either stapled haemorrhoidopexy (SH) or haemorrhoid artery ligation operation with recto-anal repair (HALO-RAR) over conventional haemorrhoidectomy (CH). We hereby present the post-operative pain experience for our patients who underwent any of these three procedures. Method: A prospective database of patients undergoing HALO-RAR was collected. Patients were asked to complete a post-operative pain diary. The data was compared with a prior randomised-controlled-trial comparing CH and SH in 2000– 2010. Statistical analysis was performed using Kruskal-Wallis test (SPSS v.20). Results: Fifty-five patients underwent HALO-RAR, 19 patients had CH and 19 patients had SH. 40 HALO-RAR patients, 18 SH patients and 17 CH patients returned their pain diary. Our results showed that pain is significantly higher among CH patients throughout the post-operative period. Despite this however, the majority of CH cases (78.9%) were performed as day cases, compared to 73.7% SH and 81.8% HALORAR cases. SH and HALO-RAR procedures although having lower pain scores are certainly not “pain-free” and patients need to be informed of this when consenting for their operations. Conclusion: All three haemorrhoid operations are painful. Meticulous pain management will facilitate day case procedure and discharge planning.

P458 Predictive factors for conversion from pure-NOTES to hybridNOTES for TaTME M. Sousa1, C. Veiga1, H. Rios1, A. Goulart1, F. Nogueira1, M. Rodrigues1, C. M. Sanz2 & P. Le~ao1,3 1 Braga Hospital, Braga, Portugal, 2La Mancha Center Hospital, Alcazar de San Juan, Spain, 3Surgical Sciences Research Domain, Life and HealthSciences Research Institute (ICVS), School of HealthSciences, University of Minho, Braga, Portugal Aim: To predict clinical, pathological and anthropometric factors to in conversion from a pure-NOTES to a hybrid-NOTES, as well as evaluating surgical outcomes and quality of life following these techniques. Method: A prospective study with 13 patients undergoing TaTME resection from 2014 to 2016. Seven patients underwent hybrid-NOTES resection and the others (n = 6) to pure-NOTES resection. The factors evaluated were clinical (age, gender, BMI, tumour location); anthropometric (promontory-subsacrum angle, promontorypubis, coccyx-pubis, intertuberous, anteroposterior/transverse mesorectum size, sigmoid deviation to the right, visceral fat), surgical (access, surgical time) and pathological (harvest/positive nodes, TME quality, tumour size, margins). The functional results were evaluated through three scales: Wexner, LARS and FIQoL. Results: There was a higher trend for conversion in men, older patients, high BMI, larger tumours and also those with a higher cross-sectional mesorectal size (P = 0.025). Pure-NOTES approach was highest among women and when the ischial intertuberosity distances were greater than 112 mm (P = 0.023). All patients had some degree of faecal incontinence, however, a substantial recovery was achieved within 6 months. Conclusion: Despite the small number of patients, this procedure seems feasible and can be undertaken whilst maintaining faecal continence and following oncological principles. A pure-NOTES TaTME can be an alternative for selected patients.

P459 Anal pilonidal sinus disease: primary origin and/or complicated with a perianal fistula? S. Soylu, S. Y€ uceyar, S. Ert€ urk & M. Paksoy Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey Aim: Pilonidal sinus, a chronic inflammatory cystic lesion, can also present as a primary anal/perianal condition. When pilonidal sinus disease mimics a perianal fistula it can pose a diagnostic challenge delaying treatment. We aimed to investigate whether anal pilonidal sinus cases were primary or complicated with a perianal fistula. Method: Anal pilonidal sinuses are rare. We present nine anal pilonidal sinus cases admitted to our clinic between 2002 and 2016. Preoperatively, patients were evaluated with physical examination, MRI, fistulography and rectoscopy. Results: Eight of them were males and one patient was female. Five of them were primary pilonidal sinus whilst the rest were complicated with perianal fistula. None of them had comorbidities. For three cases, excision of sinus was undertaken and a loose seton was inserted for the perianal fistula. Four patients were treated with marsupialisation. One patient was treated with excision and primary repair. One patient was treated with curretage and fistulotomy. At one year follow up no complications were seen.

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Poster Abstracts Conclusion: Pilonidal sinus disease can present primarily in the anal region. In cases of recurrent complex perianal fistulae, it is important not to overlook pilonidal sinus disease to ensure treatment and cure.

P460 Single surgeon experience with transanal hamorrhoidal dearterialisation for III-IV grade haemorrhoids G. Stanojevic, M. Nestorovic & B. Brankovic Clinic for General Surgery, Clinical Ceneter, Nis, Serbia Aim: To present a single surgeon’s experience, outcomes and patient satisfaction with THD and to demonstrate the value of haemorrhoidal artery ligation combined with concomitant procedures Method: Between March 2013 and September 2015, 65 patients (34 men and 31 women, mean age 46 years) were operated for III and IV grade haemorrhoids using THD and concomitant procedures where indicated. Most of the patients were operated under spinal, epidural or local anaesthesia (86.1%). Patients were seen postoperatively at week 3, at 3 and 6 months. Results: All patients were discharged within 24 hours, with no major complications. Two patients were readmitted for bleeding and postoperative pain. The first had 6 mucopexies and the second, had concomitant excision of piles. Two patients were lost to follow-up. At 6 weeks 46 (73.1%) patients were free of symptoms, in the rest symptoms improved. Three months postoperatively 92% of patients were highly satisfied, while 6.3% were moderately satisfied, in one case bleeding reoccurred and procedure failed. Six months after surgery 56 patients (88.8%) were highly satisfied although prolapse reoccurred in 4, 7.9% were moderately satisfied, while in two procedure failed. Conclusion: THD is safe and effective alternative compared to other interventional procedures with the advantage of less pain and also allowing for combined interventions.

P461 Impact of proctological procedures on sexual habits: a preliminary report A. Sturiale1, B. Fabiani1, I. Giani1, C. Menconi1, J. Martellucci1,2 & G. Naldini1 1 Proctological and Perineal Surgical Unit AOUP “Cisanello”, Pisa, Italy, 2General, Emergency and Mini-invasive Surgery, Careggi University Hospital, Florence, Italy Aim: The aim of the study was to analyse the effect on sexual habits in both genders in patients undergoing a proctological procedure. Method: From January 2016 an anonymous questionnaire was submitted to all patients referred to our centre with at least three months follow-up. The only exclusion criterion was incomplete healing. 195 patients were needed to have a sufficiently representative sample. Results: During the first four months 67 patients answered the questionnaire. The diseases were distributed as follows: 18 fistulae, 27 haemorrhoids, 15 fissures and 7 rectal prolapses. Of eleven patients who undertook anal sex before surgery only two did so after surgery without describing any problems. 85% of patients were afraid to return to their previous sexual habits because of fear of pain even if they were completely asymptomatic. Conclusion: Anal sex is commonly described in both genders. Proctological procedures may have an impact on this hedonistic practice but there are only a few previous reports about problems after this type of surgery. Nowadays a surgeon has a duty to inform the patient about the possible consequences of proctological surgery and its impact on sexual relationships.

P462 Combination of two surgical procedures for high transphincteric anal fistula treatment P. Talento, G. Ferreri & S. Maggiore Pelvic Floor Center, Surgical Department, Franchini Hospital, Montecchio Emilia, Italy Aim: The aim of the study was to assess safety, efficacy and feasibility of a bioabsorbable fistula plug in combination with rectal advancement flap (RAF) in the treatment of complex anal fistulas. Method: Between January 2014 to March 2016, 21 transphincteric fistulas were treated with a porcine dermal plug –Pressfit and RAF procedure in our institution. All patients previously underwent placement of a silicon seton for a minimum period of two months. Data was collected on patient demographics, fistula aetiology and position, previous anal surgery, complications. Patients were observed at 7, 21 days and 1, 3 and 6 months. STATA software (StataCorp, College Station, TX, USA) was used for simple descriptive statistics. Results: The overall success rate was 90.5% (n = 19). Recurrence rate was 19.0% (n = 4). The healing rate from the first surgery was 80.9% (n = 17) and 9.5% (n = 2) of the patients needed to repeat the treatment in order to have complete

closure of the tract. Anterior fistula position was associated with a higher recurrence rate. No postoperative complications were recorded. Conclusion: The use of a porcine dermal plug - Pressfit in combination with RAF is a safe procedure with good results in selected fistulas.

P463 Haemorrhoid laser procedure (HELP) for treatment of grade II and III symptomatic haemorrhoids: long-term results from a single institution prospective study A. M. Tamburini1, M. Lemma1, P. D. Nardi1 & R. Rosati1,2 1 Gastrointestinal Surgery IRCCS San Raffaele Hospital, Milan, Italy, 2Vita-Salute San Raffaele University, Milan, Italy Aim: To evaluate the long-term outcome of HeLP for symptomatic grade II and III haemorrhoids. Method: From November 2012 to November 2015, 69 patients with grade II or III haemorrhoids were enrolled. Endpoints were reduction of bleeding, postoperative complications, symptom relapse, reduction of pain and prolapse, resolution of symptoms and degree of patient’s perception of improvement. Follow-up was scheduled at 1, 4 weeks and 3, 12, 24 months. Rate and degree of symptoms were assessed with a 4 point VAS. The rate of subjective symptomatic improvement was evaluated with (PCGI –I) Scale. Results: Mean follow-up was 22, 57 months (+11, 4). Mean bleeding and baseline pain scores were 2, 31 and 0.45. Postoperative complications were seen in 15%. No major complications occurred. Mean bleeding and pain scores at 3, 12, and 24 months were significantly reduced. At 12 month follow-up 86.3% of patients reported improvement with the PCGI-I scale. After 24 months we observed a complete resolution of bleeding in 96.7%, resolution of pain in all patients, resolution of the mucosal prolapse in 78.2. % and symptoms relapse in 5% Conclusion: HeLP has shown to be effective in improving symptoms in grade II and III haemorrhoids with a relatively low postoperative complications and relapse rate.

P464 Expression of vascular endothelial growth factor (VEGF) and its correlation with clinical symptoms and endoscopic changes in patients with chronic radiation proctitis R. Trzcinski1, M. Brys2, M. Moszynska-Zielinska3, J. Chalubinska-Fendler3, L. Dziki1, M. Mik1 & A. Dziki1 1 Medical University of Lodz, Lodz, Poland, 2University of Lodz, Lodz, Poland, 3 Copernicus Memorial Hospital, Lodz, Poland Aim: Chronic radiation proctitis (ChRP) is a complication following radiotherapy for pelvic malignancies. The aim was to assess VEGF expression as a key proangiogenic factor in patients with ChRP. Method: The study group consisted of 50 patients (prostate, cervical and uterine cancers) and the control group comprised 20 patients. The EORTC/RTOG scoring system was used for grading of ChRP intensity. Endoscopic Gilinsky’s classification was used for evaluation of rectal mucosa changes. VEGF expression was analysed by ELISA method. Results: Most patients in the study group presented with 1st degree symptom intensity. Endoscopic assessment showed that most patients presented with Io degree rectal mucosal damage (62%). The predominant endoscopic finding was telangiectasia (86%).VEGF expression was significantly higher in the study group (P < 0.0001). Assessment of VEGF correlated between the control group and three degrees of endoscopic changes in the study group showing statistically significant differences for all three degrees (P < 0.0001, P = 0.0251 and P = 0.0005, respectively). Based on RTOG/EORTC scoring system, VEGF expression was significantly higher in the study group. Conclusion:-There is a significant increase of VEGF expression correlating with clinical and endoscopic symptoms. VEGF may serve as a marker for the clinical course of ChRP.

P465 Are Ki-67 and REG family genes expressions together with pathomorphological examinations worth doing in patients with chronic radiation proctitis? R. Trzcinski1, M. Brys2, A. Kulig3, L. Dziki1, M. Mik1 & A. Dziki1 1 Medical University of Lodz, Lodz, Poland, 2University of Lodz, Lodz, Poland, 3 Institute of Polish Mother’s Memorial Hospital, Lodz, Poland Aim: Rectal mucosa injuries following radiotherapy (chronic radiation proctitis, ChRP) for pelvic malignancies may intensify proliferation and regeneration in the rectal mucosa. The aim of the study was to perform pathomorphogical assessment of the rectal mucosa and to assess the effect of radiotherapy on rectal mucosa in terms of potential proliferative epithelial changes.

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Poster Abstracts Method: The study group consisted of 50 patients (prostate, cervical and uterine cancers) and the control group comprised 20 patients. Ki-67 antigen and the regenerating family genes expressions (REG1A, REG1B, and REG4) were evaluated in all patients. Results: Morphologic evaluation and expression level of Ki-67 did not reveal significant differences in both groups. REG family genes expressions in the study group and in the controls showed significant differences for REG1B and REG4 (P = 0.003 and P < 0, 0001, respectively). REG4 expression was the most significant for all three degrees of endoscopic changes according to Gilinsky’s classification when compared with the control group (P < 0, 0001, P = 0, 0002 and P = 0, 0003, respectively). Conclusion: There is lack of mucosal histopathological features that might be pathognomonic for ChRP. Unusual REG4 overexpression illustrates its considerable proliferative activity, thus this antigen may play an important role in the pathogenesis of ChRP. Ki-67 expression is not a helpful proliferative marker in the course of ChRP.

P466 Headache as an indicator of adequate treatment of anal fissure with glyceryl trinitrate rectal ointment leads to higher response rates D. Tsiftsis, G. Rallis, D. Katsaounis, C. Chouliaras & P. Ioannides Outpatient Clinic of Benign Rectal Disease, 1st Department of surgery, Nikea General Hospital, Pireus, Greece Aim: Glyceryl trinitrate rectal ointment is an established treatment for anal fissure. Reported fissure healing rates range from 50% - 80%. The main difficulty when applying rectal ointment treatment seems to be the correct and adequate application of the ointment. All Glycerine Nitrate studies report headache as a common side effect in 50% - 80% of treated patients. The aim of this study was to determine if headache can be used as a clinical marker of adequate treatment dosage. Method: We prospectively studied 45 adult patients presenting with anal fissure. We subscribed Glycerine Nitrate rectal ointment 4 mg/g every 12 hours. Patients were instructed to apply such quantity as to achieve a mild headache. Results: All patients were re-evaluated at days 7 and 14 by which time 100% reported a mild headache that was easily relieved. After 8 weeks of treatment 42/45 (93.3%) patients were completely asymptomatic. All patients were under regular follow up ranging from 3 to 16 months. None have complained of symptom recurrence. Conclusion: Mild headache as an adverse effect of Glycerine Nitrate rectal ointment treatment for anal fissure seems to be an indicator of correct and adequate individualized dosing leading to extremely high healing rates.

P467 Analysis of patients with anorectal complaints presenting to the emergency department requiring surgical consults D. Tsiftsis, G. Rallis, E. Kefalou, K. Tsekouras & P. Ioannides Outpatient Clinic of Benign Rectal Disease, 1st Department of surgery, Nikea General Hospital, Pireus, Greece Aim: The aim of this survey was to record the percentage of patients with true anorectal emergencies from all surgical consultations which presented to the Emergency Department (ED). Method: This was a retrospective study from records kept in the ED, the department of surgery and the outpatient clinic. We sampled a 3-month period from 10/ 2014 to 12/2014. Results: During this period a total of 1418 ED visits required surgical consultations. 49 related to anorectal symptoms (proctalgia, bleeding and anal discharge). 4/49 (8%) patients were diagnosed with perianal abscess and were treated surgically. The rest were directed to the outpatient clinic. A total of 22/49 patients presented to the outpatient clinic. 3/22 patients from this outpatient group underwent elective surgery, whilst the rest remained asymptomatic with non-surgical management. Almost 3% of the total number of ED surgical consults are related to anorectal symptoms. Perianal abscesses comprise 10% of these conditions and represent the only true emergency. A further 13% might need elective surgery. Conclusion: Proper outpatient screening of patient with anorectal complaints may significantly decrease the burden of surgical ED consultations.

P468 Massive bleeding due to true anorectal varices S. Uribe, R. Herrera, F. Celedon & E. Gleser Hospital de la Fuerza Aerea de Chile, Santiago, RM., Chile Aim: We present a clinical case of a patient with true anorectal varices and describe the surgical management using a stapled rectal mucosectomy.

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Method: A male with Child-C chronic liver disease, was admitted because of PR bleeding. The anal canal was explored, showing dilated varicose veins. Due to massive PR bleeding he was taken to the OR and a large haemorrhage secondary to rupture of one of the enlarged veins was noted. A running suture of Vycryl3-0 was placed with minimal success. Thereafter a purse string suture was applied with prolene2-0 at 4 cm from the dentate line and an Ethicon Proximate PPH Haemorrhoidal stapler was fired, achieving haemostasis. Two days later a re-bleed occurred which was less severe. The patient was again taken to the OR and a further PPH procedure was undertaken. No further bleeding occurred and the patient was discharged 2 weeks later. Results: In this patient with active ARV bleeding, the use of 2 PPH firings at different times was successful in stopping the bleeding. Conclusion: Bleeding ARV is an emergency and a life-threating condition that is difficult to manage. A PPH stapled mucosectomy can be used as a surgical option in this setting.

P469 Radiofrequency ablation of haemorrhoids: first results of a new technique C. Vivaldi & H. Schaefer Enddarmpraxis, K€oln, Germany Aim: To evaluate radiofrequency ablation (RFA) as a new treatment for third degree haemorrhoids. Method: From March 2015 to March 2016 20 patients with a maximum of two piles were treated by RFA (so called Rafaelo method, F-Care Systems, Belgium). Follow up was performed after one week, four weeks and after 6 months. Patients were asked for their use of painkillers as well as their daily activity, disability and complications. We used proctological symptom scores which included the following criteria’s: pain, bleeding, itching and weeping for patient survey. Results: After one week post-interventional painkillers were taken by four patients (20%). Two patients mentioned restrictions in daily life. None needed time off from work. In two cases a secondary bleed occurred. In one of these cases a reoperation was undertaken but no intra operative bleeding was found. After four weeks there was a considerable improvement of all symptoms in 19 out of 20 cases. Conclusion: RFA therapy of third degree haemorrhoids seems to be a quick procedure, reduced pain and complications with good short term outcomes.

P470 Impact of neoadjuvant chemoradiotherapy for rectal/anal carcinoma after intersphincteric resection (ISR) X. Wang1, Z. Gan1, Y. Gong2, C. Yang3 & L. Li1 1 Anal-colorectal Surgery, Chengdu, China, 2Wuhou district fifth people’s hospital, Chengdu, China, 3Chengdu frist people’s Hospital, Chengdu, China Aim: To assess the impact and effectiveness of neoadjuvant chemoradiotherapy in patients with rectal/anal carcinoma after inter-sphincteric resection (ISR). Method: The notes of 115 patients who underwent ISR in January 2012-October 2012 were reviewed. The patients were divided into two groups: Group A received long-term neoadjuvant chemo-radiotherapy, and Group B did not. Results: The perineal infection rate was 7.5% in Group A and 0% in Group B (P = 0.0470). During the first three years after surgery, the anal function in both groups was significantly better in the second and third year compared to the first year (P = 0.0341, 0.0118). Group A was worse than Group B in 1, 2, and 3 years (P = 0.0212, 0.0140,0.0411). The local recurrence rate was 1.9% in Group A and 3.2% in Group B (P = 0.213). The mortality was 3.8% and 3.2% in Group A and B respectively (P = 0.332). Conclusion: Neoadjuvant chemotherapy combined with ISR did not delay patient recovery and obtained similar survival rate and local recurrence rate. Nevertheless, neoadjuvant chemotherapy can increase perineal infection and it may have a significant impact on postoperative anal function.

P471 Long term results of anal fistula repair with FiLaC A. Wilhelm1, A. Fiebig2 & M. Krawczyk3 1 Center of Colorectal and Pelvic Floor Diseases, Cologne, Germany, 2Competence Network of Chronic Venous Diseases, Kiel, Germany, 3Institute of Medical Informatics and Statistics Christian-Albrechts-University, Kiel, Germany Aim: To present the first long term study with 5 year data for the FiLaC procedure. Method: A prospective study with 117 patients. Median follow up was 25.4 months. 13 patients had Crohn’s disease. 97% of patients were operated 2.4  1.7 times before definitive fistula repair. Results: Primary success rate was 64.1% and secondary success rate 88.0%. There was a significantly higher success for intersphincteric fistulas. There was no

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Poster Abstracts significant influence of the flap technique, age, sex and number of previous operations on the success rate. There was no major FI and only minor morbidity (0.8%). Conclusion: This study shows very promising long term results in sphincter preserving anal fistula repair using the FiLaCTM laser. No permanent major faecal incontinence was observed. There were no restrictions on the use of the laser due to the type of fistula, individual patient criteria or prior treatment.

P472 Feasibility of near infrared microvascularisation assessment of mucosal advancement flap A. Zawodnik, M. Elketbi, N. A. Naimi, J. Robert-Yap, B. Roche & F. Ris Geneva University Hospitals, Geneva, Switzerland Aim: Fistula cure is challenging with a high rate of recurrence (up to 20% in our hands). The aim of this study was to test the feasibility of using near infrared technology to assess the vascularisation of an advanced mucosal flap during a surgical procedure. Method: Prospective feasibility study between October 2014 and September 2015. An injection of ICG was conducted before the construction of an advanced mucosal flap and repeated at the end of the surgical intervention. Patients’ characteristics, fistula recurrence rate and peri-operative data were collected. Results: Nine patients were included in our study out of 50 operated during the same period. Two patients out of 9 presented with a recurrence (22%). There was no statistically significant difference in patient characteristics, duration of surgery, perioperative and post-operative complications in the recurrent group (RG) and the healed group (HG). Mean time for the signal to appear after the flap had been constructed was 29.8 seconds. Quality of signal did not seem to be predictive for recurrence.

Conclusion: The near infrared test can be performed in fistula cases, with no complications and adding minimal additional time to surgery. A prospective trial is needed to define the usefulness of this tool in this setting.

P473 Endorectal advancement flap: outcomes of primary repair for high anterior transphincteric and low rectovaginal fistulas D. Zitta, V. Baklashova & A. Fainstein Department of colorectal surgery, City Hospital No.2, Perm, Russia Aim: The aim of this study was to compare the effectiveness of different flap types in patients with anal fistulas and estimate the role of bowel preparation in complex fistula surgery. Method: A retrospective review of 45 patients who underwent endorectal advancement flap in our department for high anterior transphincteric and low rectovaginal fistulas during the period 1st May 2012 to 1st May 2015 was undertaken. 27 patients had full bowel preparation with PEG and the rest had enemas. Patients were followed up for 3 months. The main outcome was recurrence rate. Results: A mucosal flap was used in 14 cases and mucosal with internal sphincter in 31. There were 31 women and 14 men. The mean age was 38  22 years. 41 patients had cryptoglandular fistulas, 4 fistulas were caused by obstetric trauma. 36 patients had high anterior transphincteric fistulas, 9 had low rectovaginal fistulas. Overall recurrence rate was 40%. Mucosal flap was associated with a higher risk of recurrence 71%, whereas in mucosal-muscular flap group it was 25%. Recurrence rate in patients prepared by PEG was 26% whereas in patients prepared by enemas it was 61%. Conclusion: The type of flap and quality of bowel preparation are the most important factors influencing outcomes in patients with complex anal fistulas.

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