ml) for up to 72 hours. Exosome transfer ... The primary outcome was hours until first bowel movement. ... with a median of 108.5 (range 7.6â313.9). CRP was ...
Poster Abstracts P = 0.02, MSH2 P < 0.001, Control P < 0.001). There was no association with increasing OCRS and earlier age of onset of disease in MLH1, MSH2 or sporadic groups (P > 0.05). Conclusion: This study confirms that SNPs previously reported to be associated with CRC are most prevalent in patients with sporadic colorectal cancer.. These SNPs have no current value in predicting age of onset of disease in any of the populations included in the study.
P041 Exosomal miRNA-200 induces mesenchymal-epithelial transition: an explanation for Paget’s seed and soil hypothesis? K. Emo, R. Bhome, L. House, E. Sayan & A. Mirnezami Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK Colorectal cancer (CRC) is the second leading cause of cancer mortality across Europe and metastases are the primary cause of death. Epithelial-mesenchymal transition (EMT) is a transdifferentiation programme which confers metastatic capability to cancer cells. Mesenchymal-epithelial transition (MET) is the reverse process, which allows circulating tumour cells (CTCs) to regain an epithelial phenotype and colonise the secondary site. The stimulus for MET in CRC remains unknown, however miRNAs (miR-200/205) have been implicated. We propose that transfer of exosomal miRNAs to CTCs induces MET. Lung exosomes were isolated from 16 HBE bronchial epithelial cells via serial centrifugation, and validated using electron microscopy and western blotting. These were co-cultured with metastatic CRC cells at varying concentrations (20–200 mg/ ml) for up to 72 hours. Exosome transfer was demonstrated using fluorescence microscopy. RNA was extracted from exosome and cell samples. MiR-200 levels were assessed by qPCR and E-cadherin mRNA by regular PCR. Lung exosomes were richer in miR-200a and miR-200b compared to exosomes from metastatic CRC cells (30-fold and 22-fold respectively; P < 0.05). Metastatic CRC cells co-cultured with 100 mg/ml lung exosomes for 24 h, had a significant increase in miRNA-200b levels (3.8-fold; P < 0.05), which was accompanied by a reduction in E-cadherin mRNA levels. MiR-200a levels were not increased. This proves the concept that exosomes from a known secondary site (lung) deliver miR-200 to circulating CRC cells, repressing E-cadherin mRNA and triggering MET. This work suggests that exosomes can deliver functionally relevant miRNAs to CTCs, orchestrating the colonisation of secondary sites.
P042 The effect of IV lidocaine on the resumption of gut function after colorectal surgery: a meta analysis C. Cooke, Ewan D. Kennedy, D. Speake, Hugh M. Paterson & Nicholas T. Ventham Department of Colorectal Surgery, Edinburgh, UK Background: Resumption of gut function is a critical determinant of patient recovery after colorectal surgery and is one of the key research topics identified through the Delphi process initiated through the ACPGBI. This study aims to evaluate whether Intravenous (IV) lidocaine accelerates resumption of bowel function after colorectal surgery compared to routine post-operative care. Methods: A meta-analysis of randomised control trials comparing IV lidocaine versus epidural or routine post-operative analgesia in patients undergoing colorectal surgery. The primary outcome was hours until first bowel movement. Secondary outcomes included further determinants of gut function, pain and recovery indices. Results: Four hundred and ninety patients from ten RCTs were included. IV lidocaine was associated with a shorter time until first bowel movement (8 studies, 353 patients, weighted mean difference = !9.14 hours, 95% confidence Interval !17.52 to !0.77, P = 0.03). In subgroup analyses, when IV lidocaine was compared to routine care, typically morphine patient-controlled analgesia (PCA), there was a reduced incidence of ileus, flatus resumed more promptly, and length of stay was reduced. However, when compared to epidural, these potential beneficial effects of IV lidocaine could not be demonstrated. Statistical heterogeneity was high. Conclusion: IV lidocaine significantly accelerates return of gut function compared to routine post-operative care after colorectal surgery Further studies comparing IV lidocaine to epidural administration within a contemporary ERAS protocol are warranted.
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P044 Is there a role for C-reactive protein in colorectal surgical patients with uncomplicated postoperative recovery? A. Patel, H. Aslam, P. Mitchell & T. Salem Hany Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK Aim: Use of C-reactive protein –CRP-in monitoring postoperative complications in elective colorectal patients is well established. The majority of patients follow an uncomplicated recovery. The aim of this study was to assess whether repeated measurements of CRP is useful in uncomplicated recovery. Methods: Retrospective chart review of all uncomplicated elective colorectal resectional surgery and all reversals over a 10 months period from September 2015 to June 2016. Patients ‘demographics, use of CRP, Length of stay -LOS- and readmissions were assessed. Results: Of a total of 112 patients, 78 had no postoperative complications (70%). Median age was 67 years (range 19–91) and 49 were males. CRP was performed in 58/78 (74%) patients between day 1–3 and in 64/78 (82%) patients after day 4 postoperatively. Highest CRP levels in this group occurred on day 3–4 postoperatively with a median of 108.5 (range 7.6–313.9). CRP was repeated 3 times on average per patient during admission. Median CRP at discharge was 56.6 (range 1.6–214.2). The Median LOS was 6 days (range 2–17). 68/78 (87%) showed a falling trend in CRP. CRP did not affect the overall management plan in this group of patients. 29/34 patients were documented as medically fit for discharge continued to have CRP levels checked. Only 4/78 patients were readmitted (5%) within 28 days of discharge. Three with wound infection and one with presacral collection treated conservatively. Conclusion: There was no evidence to support routine use of CRP in uncomplicated patients. Clinical progress and resource management should be the key in managing such patients.
P045 Cross-matching and intra-operative requirement of blood transfusion in colorectal surgery M. Oliveira-Cunha, H. Sisodia, K. M. Boyle & J. Yeung University Hospitals of Leicester NHS Trust, Leicester, UK Introduction: Current ACPGBI guidelines suggest that preparation for blood transfusion should occur prior to colorectal cancer resection; cross-matching may be suited to more extensive procedures such as rectal resections. The purpose of this study was to investigate the use of cross-matching in preparation for potential blood transfusion in patients undergoing surgery for colorectal malignancy, and subsequent need for blood transfusion in this population. Methods: A prospectively maintained database was examined. Patients who underwent colorectal cancer surgery between 01/04/14 and 31/03/16 were identified and their transfusion requirements noted. Results: 321 consecutive colorectal resections were carried out in the period studied. Median age was 70 years (range 21 to 94 years), male to female ratio was 1:1.16. The most common procedure identified for the cross-matched population was anterior resection (21.2%). Of the 226 cross-matched records and 95 non-crossmatched patients, no patient required blood transfusion, intra-operativelyor on the same day. In the study period, 452 units of blood were cross-matched but not used. The estimated cost of a Group & Save (G&S) sample is £40.60; conversion to a fully cross-matched sample is an extra £30. The cost of one unit of packed red cells is £112. Therefore, there is potential to save up to £254.60 per case. Conclusions: Blood transfusion is not commonplace for the patient undergoing colorectal surgery. Therefore we advocate having a pre-operative Group and save sample in the laboratory but do not feel that a full cross-match is required.
P046 Differences in post-operative bowel function and ileus between right and left sided radical colorectal resections B. Liu & K. Thane Glan Clwyd Hospital, Betsi Cadwaladr University Health Board, North Wales, UK Background: Enhanced Recovery (ERAS) recommend early commencement of post-operative diet. Is this equally feasible among different types of colorectal resections? There are speculations that post-operative ileus is more common among radical right-sided colonic resections than left-sided equivalents, but minimal research has addressed this.
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! 2017 The Authors Colorectal Disease © 2017 The Association of Coloproctology of Great Britain and Ireland. 19 (Suppl. 4), 14–64
