Self Expanding Metal Stent Placement by Colorectal Surgeons in the Management of Obstructing Colorectal Cancers

992 Methods: All patients undergoing surgery for breast cancer between 1 January 2011 and 31 March 2011 were included. Exclusion criteria were severe or uncontrolled co-morbidities, diabetic patients requiring sliding scale, patients on warfarin, sickle cell disease and those having immediate breast reconstruction. Results: Some 92 patients were treated in the three month period out of which 20 were excluded having reconstructive or other breast surgery. Nine were unsuitable for surgery under the 23-hour model according to the agreed clinical criteria. Of the 63 eligible breast cancer patients, 52 patients were treated successfully under the 23 hour model (83% - target >70%). There were no 30-day re-admissions for this cohort. Mean length of stay for all breast cancer surgery has reduced from 5 days to 2 days. Conclusions: It is possible to safely discharge over 80% of patients undergoing non-reconstructive breast surgery within ‘23-hrs’. Good communication links, strong project management and active user involvement have helped in implementing this project. P35. Self Expanding Metal Stent Placement by Colorectal Surgeons in the Management of Obstructing Colorectal Cancers Andrew Moriarity, J. Larkin, F. Cooke, P. McCormick, B. Mehigan St James’s Hospital, James’s St, Dublin 8, Ireland Introduction: Colorectal cancer presents acutely with obstruction in approximately 30% of cases. Emergency surgery is associated with significantly higher rates of complications and stoma formation. Placement of a self-expanding metal stent may obviate emergency surgery, potentially effectively palliating incurable cancers and acting as a bridge to surgery in patients with operable tumours. Methods: A database was prospectively compiled from 2006 to present of all patients having stent placement for an obstructing colorectal tumour. Stents were placed under endoscopic and fluoroscopic guidance by a consultant colorectal surgeon. Results: 35 patients (22M, 13F; mean age 69, range 34-91) had stents placed. 31/35 (89%) patients had left-sided disease (splenic flexure and distal). 4 (11%) had more proximal tumours - 2 transverse, 1 hepatic flexure and 1 right colon. The indication was palliative for 28 patients (80%). Stenting as a bridge to surgery was performed for the other 7 patients (20%). Successful decompression was achieved in all 35 patients (100%). Of the 7 patients who proceeded to resection, 5 are currently alive and disease-free (4, 14, 18, 22 and 44 months postoperatively); two have since died (3 and 14 months post surgery - both T3 N1 M0). However, 3 patients with palliative stenting subsequently required defunctioning stoma formation (2, 3, and 10 months post stent insertion) due to local tumour progression. Conclusions: When performed by experienced colorectal surgeons, stent insertion is safe and effective either for palliation or as a bridge to resection in the treatment of obstructing colorectal cancer. P36. Electrochemotherapy - a novel effective approach to naso-ocular basal cell carcinoma treatment Slawomir Salwaa, M. Bourkea, M. O’Shaughnessyb, S. O’Sullivanb, J. Kellyb, G. O’Sullivana a Cork Cancer Research Centre, Mercy University Hospital, Cork, Ireland b Plastic Surgery Department, Cork University Hospital Introduction: Electrochemotherapy is a novel therapeutic modality, which combines low-dose chemotherapy with the application of electric pulses that transiently and reversibly create pores in cancer cell membranes. This results in a substantially increased intracellular concentration of the chemotherapeutic agent. Treatment of naso-ocular basal cell carcinoma frequently involves complex curative surgical procedures, which may not be feasible in a proportion of patients due to deteriorating health or medical co-morbidities. Electrochemotherapy has the potential to ablate cutaneous cancers, even those recurring after surgery or radiotherapy. We

ABSTRACTS present a series of patients with surgically problematic lesions who underwent electrochemotherapy of their BCCs. Methods: Electrochemotherapy was carried out on 5 patients with biopsy proven basal cell carcinomas located in the naso-ocular region. These patients required complex surgical procedures but were unsuitable for anaesthesia or time consuming management. Lesions varied from 0.5x0.5 to 3x3cm in size. Both primary and recurrent lesions were treated. Treatment was performed using the IGEA Cliniporator with four pairs of linear needle electrodes. Bleomycin was the chemotherapeutic used in each case. Results: All lesions demonstrated complete response after 4-10 months follow up. One patient required a second treatment. Each case healed with minimal scarring. None of the patients reported side effects in relation to Bleomycin, electric current delivery or the healing process. Conclusions: Electrochemotherapy is an effective alternative to surgical excision in the treatment of Basal Cell Carcinoma. It is particularly useful when patients are medically unfit for time consuming reconstruction and prolonged convalescence is undesirable. P37. Selective group and save assay in patients having non reconstructive mastectomy for breast cancer is safe and cost effective. Fiammetta Ugolini, R. Rathinaezhil, C. Zammit Brighton and Sussex University Hospitals NHS Trust, Park Centre for Breast Care, 177 Preston Road, Brighton, East Sussex, BN1 6AG Introduction: Around 40% of patients diagnosed with Breast cancer undergo mastectomy which still considered being a major surgical procedure. Patients having this procedure have group and save routinely which costs £20/test. Meticulous haemostasis when raising the flaps has made this procedure less bloody and has helped to develop 23 hour care pathway for these patients. Aim: To correlate whether measuring blood loss per operatively relative to the weight of the mastectomy specimen has any impact in helping selectively perform group and save. Methods: Prospective study over 12 months between June 2010 and May 2011. All patients who had non reconstructive mastectomy during this period including bilateral procedures were included. The first 10 patients had post operative haemoglobin measured but as this did not drop significantly compared to preoperative value this was not performed for the rest of the patients. Results: In this series 85 patients underwent simple mastectomy. 7 patients had a bilateral procedure. Age range varied from 25 to 95 years and the mean age was 60 years. The average blood loss per procedure was 160 ml and range varied from 25 to 600 ml. The average weight of the mastectomy specimen was 613 grams and the range being 105 to 1888 grams. There was very little correlation between weight of the breast and blood loss. We did have 4 haematomas in this group and three needed evacuation and one settled on conservative measures. None of them required blood transfusion. Conclusion: Breast weight has very little bearing to the blood loss. Patients with post operative haematoma rarely require blood transfusion. Group and save analysis including cross matching takes 60-90 minutes turn around time and rarely is blood required urgently in mastectomy patients. Selective analysis can save money without compromising excellent patient care. P38. Evaluation of discharge/results clinic by CNS in breast care Makam Kishore, A. Tracey, R. Nangalia George Eliot Hospital NHS Trust, College Street, Nuneaton CV10 7DJ Introduction: Increasingly the breast clinics are getting busier and adding pressure on the system. Patients who are likely to have benign histology result are being mixed along with the patients of cancer histology. The increasing waiting time in the clinics will unnecessarily increase the anxiety and stress levels in patients. The time taken to travel to hospital