TP7.2.9 Natural orifice surgery in early rectal cancer; is it the way forward?

Aims

Transanal-endoscopic microsurgery (TEMS) for early rectal cancer is an attractive alternative to radical surgery. With proper patient selection, it is possible to achieve acceptable oncological outcomes with fewer complications. We aim to study the outcomes following TEMS for suspicious or proven rectal cancers performed in our unit.

Method

We performed a retrospective analysis of prospectively collected data between May-17 and Oct-20. The patients’ details, tumour specific data, short term outcomes, and recurrences were recorded.

Results

A total of 45 patients with early rectal cancer (M = 29, F = 15) were included in this study. With1 exclusion due to intraoperative rectal perforation, 44 were available for further analysis. Eleven had a diagnosis of cancer at the time of surgery, an additional 11 patients were confirmed on final histology, and 22 were benign. Final histology showed: T1=14, T2=4, T3=3 &Tx=1. The majority (68%) had clear resection margins (R1=3, R2=1, Rx = 3). Twelve patients went on to have further treatment. Seven had resectional surgery (AR = 5, APR=2) for unfavorable histology (2), residual disease (3), or recurrence (2). The other 5(23%) received chemotherapy+/-radiotherapy (unfit/patients’ choice) for unfavorable. Histology (3) or residual disease (2).

Conclusion

With judicious patient selection, it is possible to offer a less invasive option with acceptable oncological and patient related outcomes for suspicious and proven malignant rectal lesions. The majority of patients (84%) were able to avoid radical surgery or stoma, thereby reducing the associated morbidity. Whilst this is a single institution study, we believe with available expertise this could be widely replicated.

SP4.2.6 Colorectal cancer services during COVID-19; an experience of a tertiary centre

Aims

COVID19 has placed unprecedented constraints on healthcare services. Colorectal cancer (CRC) care was one of the many areas predicted to suffer due to these additional pressures. We believe that despite the challenges posed by COVID19, we have continued to deliver a standard of care for elective and emergency CRC resection that compares favorably with the national average.

Method

We conducted an analysis of the elective and emergency CRC resections carried out at a tertiary center over a 10-month period (Feb-Dec 2020). Data was collated from patient, operative, and theatre records and compared to the national average as defined by the 2020 National Bowel Cancer Audit (NBOCA).

Results

A total of 227 patients underwent surgery (189 elective and 38 emergencies), with a median age of 69. Of these, 153 were laparoscopic (67%), 57 open (27%), and 17 robotic (7%). The median length of stay was less than the national average; 5 days for elective surgery (NBOCA: 6) and 8 days for emergencies (NBOCA: 10). Within 30 days, overall unplanned readmissions rate was 6.5% (NBOCA: 11.6%) and return to theatre was 3.2% (NBOCA: 8.4%). Elective surgery had a 90-day mortality of 1% (NBOCA: 3%) compared to 7.8% for emergencies (NBOCA: 10.5%).

Conclusion

Despite the added constraints of the COVID19 pandemic, CRC resection in our unit remains safe with better outcomes than the national standard. We have demonstrated that with adequate precaution and a concerted team effort, delivery of safe care with reasonable outcome is achievable.

Hardiness as a mediator between perceived stress and happiness in nurses

The relevance of the study of happiness and stress in nurses has been emphasized. In this sense, the intelligent use of hardiness is enable nurses to cope better with stress and contribute to being happier. This study aimed to examine the relationship among hardiness, perceived stress, and happiness in nurses. Moreover, we examined the mediator role of hardiness on the relationship between perceived stress and happiness in nurses. Our study revealed that hardi-attitude nurses evaluate situations as less stressful which results in a higher happiness. This study showed hardiness as being a protective factor against perceived stress and a facilitating factor for happiness in nurses. The findings could be important in training future nurses so that hardiness can be imparted, thereby giving them the ability to control their stress. Nursing is a stressful occupation with high levels of stress within the health professions. Given that hardiness is an important construct to enable nurses to cope better with stress and contribute to being happier; therefore, it is necessary we advance our knowledge about the aetiology of happiness, especially the role of hardiness in decreasing stress levels and increasing happiness. The present study sought to investigate the role of hardiness as a mediator between perceived stress and happiness. The participants, comprising 252 nurses from six private hospitals in Tehran, completed the Personal Views Survey, the Perceived Stress Scale, and the Oxford Happiness Inventory. Structural Equation Modelling (SEM) was used to analyse the data and answer the research hypotheses. As expected, hardiness partially mediated between perceived stress and happiness among nurses, and nurses with low levels of perceived stress were more likely to report greater hardiness and happiness. In addition, nurses with high levels of hardiness were more likely to report happiness. This study showed hardiness as being a protective factor against perceived stress and a facilitating factor for happiness in nurses. The findings could be important in training future nurses so that hardiness can be imparted, thereby giving them the ability to control their stress.