EP.TU.2Standards in Operation notes

Aim

The authors performed an audit of compliance with RCS standards in a colorectal department.

Methods

Thirty random operation notes were selected from a conserved pool. Their compliance was recorded against RCS good surgical practise record keeping and also looked particularly at fistula surgery and there documentation.

Result

Compliance was found to be poor and recommendations were put in place and the following was re audited.

Conclusion

As some specialities are developing operation note standards specific to individual procedures, the findings are compared with previous similar published work.

Circumferential resection margin (CRM) positivity after MRI assessment and adjuvant treatment in 189 patients undergoing rectal cancer resection

PURPOSE

The management of rectal cancer relies on accurate MRI staging. Multi-modal treatments can downstage rectal cancer prior to surgery and may have an effect on MRI accuracy. We aim to correlate the findings of MRI staging of rectal cancer with histological analysis, the effect of neoadjuvant therapy on this and the implications of circumferential resection margin (CRM) positivity following neoadjuvant therapy.

METHODS

An analysis of histological data and radiological staging of all cases of rectal cancer in a single centre between 2006 and 2011 were conducted.

RESULTS

Two hundred forty-one patients had histologically proved rectal cancer during the study period. One hundred eighty-two patients underwent resection. Median age was 66.6 years, and male to female ratio was 13:5. R1 resection rate was 11.1%. MRI assessments of the circumferential resection margin in patients without neoadjuvant radiotherapy were 93.6 and 88.1% in patients who underwent neoadjuvant radiotherapy. Eighteen patients had predicted positive margins following chemoradiotherapy, of which 38.9% had an involved CRM on histological analysis.

CONCLUSIONS

MRI assessment of the circumferential resection margin in rectal cancer is associated with high accuracy. Neoadjuvant chemoradiotherapy has a detrimental effect on this accuracy, although accuracy remains high. In the presence of persistently predicted positive margins, complete resection remains achievable but may necessitate a more radical approach to resection.