Oral and Parenteral versus Parenteral Antibiotic Prophylaxis for Patients Undergoing Laparoscopic Colorectal Resection: An Intervention Review with Meta-Analysis

This study aims to systematically assess the efficacy of parenteral and oral antibiotic prophylaxis compared to parenteral-only prophylaxis for the prevention of surgical site infection (SSI) in patients undergoing laparoscopic surgery for colorectal cancer resection. Published and unpublished randomized clinical trials comparing the use of oral and parenteral prophylactic antibiotics versus parenteral-only antibiotics in patients undergoing laparoscopic colorectal surgery were collected searching electronic databases (MEDLINE, CENTRAL, EMBASE, SCIENCE CITATION INDEX EXPANDED) without limits of date, language, or any other search filter. The outcomes included SSIs and other infectious and noninfectious postoperative complications. Risk of bias was assessed using the Cochrane revised tool for assessing risk of bias in randomized trials (RoB 2). A total of six studies involving 2252 patients were finally included, with 1126 cases in the oral and parenteral group and 1126 cases in the parenteral-only group. Meta-analysis results showed a statistically significant reduction of SSIs (OR 0.54, 95% CI 0.40 to 0.72; p < 0.0001) and anastomotic leakage (OR 0.55, 95% CI 0.33 to 0.91; p = 0.02) in the group of patients receiving oral antibiotics in addition to intravenous (IV) antibiotics compared to IV alone. Our meta-analysis shows that a combination of oral antibiotics and intravenous antibiotics significantly lowers the incidence of SSI compared with intravenous antibiotics alone.

EP.TU.582Impact of enteral prophylactic antibiotic course on the trends of inflammatory markers following laparoscopic colorectal cancer surgery

Introduction The study aimed to assess the effect of oral prophylactic antibiotic (OAB) with mechanical bowel preparation (MBP) on the serial measurement of postoperative inflammatory markers and clinical outcomes of the patients undergoing laparoscopic colorectal cancer resection surgery. Methods A retrospective data collection was carried out from January 2019 to March 2020 for the patients undergoing laparoscopic colorectal cancer resection. Daily measurements of inflammatory markers were obtained upto 7 days following surgery. The measurements of inflammatory markers were compared between patients who received a 1 week course of OAB along with MBP to those who only received MBP. Results There were a total of 110 patients that were divided into 2 groups: patients who received OAB and MBP (n = 44, 40%) and those who had MBP only (n = 66, 60%). There was no significant difference between the patient characteristics and preoperative staging of the cancer between the 2 groups. The overall length of stay was significantly lower in the patients who received OAB (9.09 days [SD 7.94] vs. 6.63 days [SD 4.96], P 0.02). The patients with OAB and MAP had persistently and significantly low levels of white blood cell count, CRP, and neutrophil count throughout the postoperative period as compared to those who only had MBP. Conclusion The study demonstrated reduction in serial measurement of inflammatory markers throughout postoperative stay for the patients receiving preoperative OAB. The use of OAB helps in physiological recovery of the patient by reducing the inflammatory process postoperatively.

EP.FRI.476 Routine group and save sampling prior to elective laparoscopic colorectal cancer resection – Is it necessary?

Introduction Laparoscopic colorectal cancer resection (LCCS) has been shown to reduce blood loss when compared to open surgery. There are no national guidelines regarding need for pre-operative group and save(G&S) sampling in LCCS patients. Our study aims to assess the necessity of G&S samples through identifying rates of post-operative transfusion following LCCS. Methods Retrospective study of all patients who underwent LCCS between 1st January 2019 and 31st December 2019. Results Of 102 surgical procedures, 42 right hemicolectomy, 21 anterior resection, 19 sigmoid colectomy, 12 left hemicolectomy, and 8 APER. The median age was 67(range 56-86) years. All received two valid G&S samples. 13 cases were converted. The median pre-operative haemoglobin was 127g/L, and median post-operative haemoglobin was 114g/L. The median blood loss was &lt;100mls. Only 4(3.9%) patients required post-operative transfusion, 3 of whom were converted due to intra-operative bleeding. The fourth case had decreased haemoglobin post-operatively without need for return to theatre. A significant difference was evident in pre-operative haemoglobin level in patients who needed transfusion compared to those who did not (P = 0.031). A total of 9 units were transfused. Twenty-one pre-operative cross-matched units were not used. Conclusion Evidently, blood transfusion is most likely required in open conversion cases due to intra-operative blood loss, as well as in patients with low pre-operative haemoglobin. A patient specific approach to assessing requirement for pre-operative G&S in elective LCCS patients is required to improve cost-effectiveness, particularly taking into account those with normal pre-operative haemoglobin.

EP.FRI.945 Common Factors in Patients needing Emergency Colorectal Cancer Resections

Aim Colorectal cancer resection is a major part of general surgical emergency workload. We aimed to identify common characteristics amongst cohort of patients needing emergency resection for colorectal malignancies. Materials & Methods This is a single centre study focusing on patients operated urgently for colorectal cancer between 2017 and 2018. Patients’ information was obtained from a prospectively maintained local trust database. The variables were subjected to Mann-Whitney, Chi-Square analysis and cumulative survival function plots. Results 79 patients had emergency colorectal cancer resections. A mean age of 79 years and equal gender distribution were observed. The male cohort was associated with older age at surgery, younger age at death, longer length of stay (LoS) and higher proportion of open versus laparoscopic surgery (all p&lt; 0.05) We also observed longer LoS in patients who had open surgery, presence of stoma post-surgery and patients whose carcinoma was first identified and referred by a secondary care team. These latter patients were more likely to present with obstructive and pain symptoms. Histologically, they were found to have more advanced tumour and nodal staging (all p &lt; 0.05). Interestingly also, patients with T3 tumours are more likely to present with bleeding and those with T4 more likely with pain (p &lt; 0.05). Within the 18 deceased, we found longer post-surgery LoS, higher grade of tumour and nodal involvement (p &lt; 0.05). Conclusion A sub-cohort of patients at higher risk of significant morbidity and mortality can be identified from patient characteristics and targeted for improving their outcomes as well as further research.

EP.TU.601Improving extended venous thromboembolism prophylaxis prescription compliance at discharge for colorectal cancer resection patients

Aims Extended venous thromboembolism prophylaxis (exVTEp) is used to reduce venous thromboembolism (VTE) incidence following colorectal cancer (CRC) resection. Within our tertiary care centre patients undergoing CRC resection should receive an electronic VTE risk assessment (eVTE) within 24 hours and exVTEp at discharge, compliance targets set at 95%. Our aim was to improve absolute compliance rates of exVTEp prescription at discharge following CRC surgery. Methods Data were collected prospectively on CRC resection patients pre and post an educational intervention for doctors during surgical induction, with posters placed in key areas highlighting discharge exVTEp importance. Patients discharged between August-December 2019 served as pre-intervention and those between December 2019-March 2020 as post-intervention cohorts. Time periods reflected junior doctor rotating periods within the country’s healthcare system thus providing more comparable data sets. The service evaluation was registered within the Trust (19-562Q) Results Of 80 pre-intervention and 40 post-intervention eligible patients: 81.25% vs. 92.68% received exVTEp at discharge, 70.19% vs. 72.34% had a valid eVTE and 32.50% vs. 36.59% had exVTEp recorded in the post-operative note. Those missing exVTEp documentation in the post-operative plan were significantly less likely to receive exVTEp at discharge with an 80% decrease in exVTEp prescription compared to patients with exVTEp documented within the post-operative note (unadjusted-OR 0.2051, 95%CI 0.0431-0.9773; p = 0.0276). Conclusions Educational and visual interventions have shown improvement in exVTEp prescription at discharge. Despite suboptimal eVTE scores true service quality in delivering exVTEp is high. The relationship between exVTEp post-operative instruction and exVTEp prescription needs further investigation.

EP.TH.299Is peritoneal lavage with water the optimal washout as a preventative method for peritoneal disease following colorectal cancer resection? A systematic review

Aim To study available data on the advantages of peritoneal lavage with distilled water following colorectal cancer resection in improving overall patient outcomes Methods PubMed, Google Scholar, and Cochrane databases were searched until October 2020. References from relevant articles were reviewed to widen the search. Results Overall, 3 experimental studies were identified. Water was found to be superior to other peritoneal lavage solutions in inducing tumorigenic cell lysis in vitro. Mice who underwent peritoneal lavage with water survived longer and had a significantly reduced peritoneal tumour burden compared to mice who did not undergo lavage or those treated with saline lavage solution. Peritoneal secretions were found to contaminate water lavage and reduce its cell-lytic effect. Nonetheless, complete cell lysis was achieved, in vivo, by prolonging the time of cell exposure to contaminated lavage solution by 20 min. Conclusion Single peritoneal lavage with water is probably safe and may have a positive influence on patient outcomes. Further evidence is required to regard sequential peritoneal lavages with water as beneficial and safe in humans.

EP.TU.313Colorectal cancer follow up: Can CT Colonography replace Colonoscopy?

Aims Current guidelines recommend surveillance colonoscopy at one year following Colorectal Cancer Resection (CCR), yearly CT chest, abdomen and pelvis, CEA, and colonoscopy in 3 years. Previous studies showed no significant difference between CTC and colonoscopy detection rates of colorectal cancer or polyps &gt;6mm. A review of abnormalities detected on surveillance colonoscopies one year following CCR. If the incidence is low CT Colonography (CTC) would be an alternative to colonoscopy and, when performed simultaneously with surveillance CT chest would be cost-effective, and help in the selective use of colonoscopy. Methods A retrospective analysis of one-year surveillance colonoscopies following CCR in 2016 at a health board with three different sites. Normal colonoscopy criteria included: no polyps, no tumour, and no abnormality at the anastomosis. Subtotal colectomy, panproctocolectomies and incomplete colonoscopies were excluded. Results 111 surveillance colonoscopies were performed one-year post CCR. Age range 30-87 years (39 patients were above 75). Ninety scopes were normal (81.1%). Eight identified only hyperplastic polyps (7.2%); indirectly making over 88% of surveillance colonoscopies unremarkable. Detected abnormalities: nine low-grade adenomas (8.1%), one anastomotic recurrence (0.9%), and only three new cancers (2.7%). There were no complications related to the procedure. Each colonoscopy costs £996 at this health board, CTC is significantly cheaper. Conclusion New cancer or recurrence post-CCR detected at one-year colonoscopy is very low; therefore, CTC would be ideal alternative surveillance. Adding it to CT Chest would significantly reduce the number of hospital attendances per patient, which is more cost-effective and reduces risk.