Lymph node harvest in colorectal resections: an audit at a south-east England colorectal surgery unit comparing performance in 2005 and 2008 with analysis of the influence of key operative factors

s / International Journal of Surgery 10 (2012) S1–S52 S22 ABSTRACTS Background: In concordance with the national guidelines, the St. Mark's Hospital colonoscopic tattooing protocol stated that suspicious lesions should be tattooed, with the exception of those in the caecum and within 20 cm of the anal verge. Three tattoos should be placed (120 apart, close to the lesion) and distal to lesions proximal to the splenic flexure (SpFlx). Left sided lesions should have tattoos placed proximal to the lesion. Aims: To audit compliance with the tattooing protocol in patients undergoing surgery for colorectal neoplasia. Methods: We reviewed endoscopy reports for the location of tattoos relative to the lesion and number of tattoos placed in all patients who had surgery over 12 months. Results: 114 reports were available and full compliance with the protocol was observed in 71 cases (62%). 19 cases (17%) were partially compliant and 24 cases (21%) were non-compliant. Incomplete documentation (22 cases) and inability to place tattoos proximal to obstructing lesions (19 cases) were the major causes of reduced compliance. Conclusions: Educational intervention is necessary to address poor documentation. However, changes to our protocol are also required. The new protocol recommends that all tattoos should be placed distal to the lesion, regardless of the anatomical position. 0051: DOES RIGID SIGMOIDOSCOPY HAVE A PLACE IN THE MODERN OUTPATIENT COLORECTAL CLINIC? Mouhamed E. El Sayad, Abidon Bamidele, Kawan Shalli, Emad Aly. Aberdeen Royal Infirmary, Aberdeen, UK Background:Although flexible sigmoidoscopy is now used in most outpatient colorectal clinics, rigid sigmoidoscopy is still used in many other (OP) colorectal clinics. The aim of our study is to assess the efficacy of rigid sigmoidoscopy. Methods: Retrospective review of 103 patients that attended OP Colorectal clinic who had undergone rigid sigmoidoscopy for colorectal symptoms. Findings as well as requirement of further investigation were recorded. Results:103 patients. Presenting symptoms were; change in bowel habit 47 (45.6%), PR bleeding 33 (32%), rectal mass 8 (7.8%), Abdominal pain 4 (3.9%), faecal incontinence 1 (0.9%), tenesmus 1 (0.9%), anaemia 1 (0.9%) and follow up patients 8 (7.8%). Finding were; normal mucosa 62 (60.1%), inflamed mucosa 5 (4.9%), rectal polyp 2 (1.9%) and uninformative 34 (33.1%). Of the 103 patients, 68 (66%) required further investigations. 35 (34%) did not required further investigation. Amongst those who had a normal finding, on further investigation 16 (25%) had different pathologies. 3 (42%) out of 7 patients whom had abnormal finding on rigid sigmoidoscopy, no abnormality was detected on further investigation. Conclusions:Our study showed that rigid sigmoidoscopy was rarely useful in the OP clinic set up. Further investigations were almost always needed to complete the assessment of the patient. 0097: LYMPH NODE HARVEST IN COLORECTAL RESECTIONS: AN AUDIT AT A SOUTH-EAST ENGLAND COLORECTAL SURGERY UNIT COMPARING PERFORMANCE IN 2005 AND 2008 WITH ANALYSIS OF THE INFLUENCE OF KEY OPERATIVE FACTORS Khabab Osman, Catherine Pringle, Humphrey Scott. Ashford & St Peter's NHS Trust, Chertsey, Surrey, UK Lymph node examination is vital in the staging of colorectal cancer and ultimately influencing decisions on post-operative management. The ‘Association of Coloproctology of Great Britain and Ireland’ as well as the ‘National Institute of Clinical Excellence’ recommend that at least 12 lymph nodes are examined per resection. Aim: This study assesses the performance of a large colorectal surgery unit in England against the above targets between 2005 and 2008 with an analysis of the influence of operator and patient variables. Method: A hospital database search was used to identify all patients who underwent colorectal cancer resections in the months of October in 2005 (n1⁄451) and 2008 (n1⁄469). Information was extracted manually from notes and computed. Results: A significant improvement was shown in lymph node clearance from 8.2 to 11.0 between 2005 and 2008 respectively (p1⁄40.0019). No statistically significant difference between elective/emergency or open/ laparoscopic resections was shown. The strongest improvement was found in open resections between 2005 & 2008 cohorts. Conclusion: The results of the study provide further cause to explore and discuss the reasons behind the apparent improvement in lymph node harvest and to determine the relative importance of surgical technique, histopathological techniques and other possible influential factors. 0115: COLORECTAL RESECTIONS: EVALUATING SHORT TERM POSTOPERATIVE OUTCOMES IN LAPAROSCOPIC VERSUS OPEN SURGERY Ee Von Woon, Prem Ruben Jayaram, Pete Chong. Universtiy of Glasgow,