Surgical PracticeVolume 20, Issue S2 p. 21-44 PosterFree Access Poster First published: 14 September 2016 https://doi.org/10.1111/1744-1633.12208Citations: 2AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat P7: Mir-542-3p suppresses colorectal cancer progression through targeting survivin C Ye, Z Shen, K Jiang, Y Ye and S Wang Department of Gastroenterological Surgery, People's Hospital, Peking University, Beijing 100044, People's Republic of China Aim: miR-542-3p has been reported to be a tumor suppressor in several tumor types, while its role in colorectal cancer (CRC) has not been fully understood. Methods: Real-time PCR was used to detect the expression of miR-542-3p in tissues and plasma of CRC patients. The impact of miR-542-3p on the aggressive phenotypes of CRC cells were evaluated by in vitro and in vivo functional assays. Luciferase activity assay was conducted to confirm the direct binding of miR-542-3p and Survivin. Results: miR-542-3p was decreased in CRC cell lines that derived from metastatic sites. Among the 65 CRC patients enrolled in this study, 63.08% (41/65) had a decreased miR-542-3p expression in cancerous tissues. miR-542-3p expression was associated with lymphovascular invasion (p = 0.008), distant metastasis (p = 0.006), tumor stage (p = 0.034) and patients’ survival (p = 0.027). A decreased expression of miR-542-3p in plasma was detected in stage IV patients. in vitro and in vivo experiments showed that miR-542-3p could inhibit the aggressive phenotypes of CRC cells. Finally, Survivin was identified as a direct target of miR-542-3p in CRC. Conclusion: miR-542-3p expression is decreased and associated with prognosis in CRC patients. It inhibits the aggressive phenotypes of CRC cell lines. Survivin is a direct target of miR-542-3p in CRC. P8: The impact of indocyanine-green fluorescence imaging on left-sided colonic resection – a prospective study CC Foo, RYK Chang, NF Shum, JHW Man, KK Ng, J Yip and WL Law Queen Mary Hospital 102 Pok Fu Lam Road, Hong Kong Aim: Perfusion is one of the most important factors in colonic anastomotic healing. The near-infrared light (NIR) technology and intravenous fluorescent dye with indocyanine-green (ICG) allows intra-operative assessment of colonic microvascular perfusion. This study aims to assess the impact of using NIR+ICG in left-sided colonic resections. Methods: A prospective study was carried out for patients who had colonic or rectal resections that involve ligation of the inferior mesenteric artery. Results: 30 patients were recruited. The mean age was 64.5 years. 66.7% were male. They had either cancer of the descending colon (3.3%), sigmoid colon (26.7%) or rectum (70.0%). Total mesorectal excision was performed in 63.3% of the cases. For the site of transection, there was a change in decision in 53.3% of the cases, in which 50.0% had a more proximal transection and 3.3% had a more distal transection. When there was a change of transection site, the mean distance between the intended and eventual transection site was 3.90 ± 3.34 cm (range 1-12 cm). In 10.0% of the cases, there was a change in the decision on whether to mobilize the splenic flexure of the colon or not. Defunctioning stoma was performed in 70.0% of the cases. There was no clinical anastomotic leakage observed. Conclusion: The use of NIR+ICG to assess bowel perfusion in left-sided colonic resection has a major impact on intraoperative decision. There is a role for further studies to evaluate whether it has a positive impact on reducing anastomotic leakage rate. P9: Identifying a safe range of stimulation current for intraoperative neuromonitoring of the recurrent laryngeal nerve: results from a canine model T Li, G Zhou, XD Yang, KW Jiang and S Wang Department of Gastrointestinal Surgery, Surgical Oncology Laboratory, Peking University People's Hospital, Peking University, Beijing 100044, China Aim: To develop an experimental canine model to determine whether supramaximal stimulation during intraoperative neuromonitoring (IONM) of the recurrent laryngeal nerve (RLN) could induce nerve damage, and investigate the safe range of stimulation current intensity. Methods: Total thyroidectomies were performed on twenty dogs, and their RLNs were stimulated with a current of 5–20 mA (stepwise in 5 mA increments) for one minute. The evoked electromyography (EMG) of vocal muscles before and after supramaximal stimulation were recorded and compared. Acute microstructural morphological changes in the RLNs were observed immediately postoperatively under an electron microscope. Results: The average stimulating threshold for RLNs stimulated with 15 mA and 20 mA showed no significant changes compared to the unstimulated RLNs (15 mA group: 0.320 ± 0.123 mA vs. 0.315 ± 0.097 mA, p = 0.847; 20 mA group: 0.305 ± 0.101 mA vs. 0.300 ± 0.103 mA, p = 0.758). Similar outcomes were shown in average evoked EMG amplitude (15 mA group: 1,025.500 ± 267.962 μV vs. 1,020.600 ± 273.336 μV, p = 0.834; 20 mA group: 1,162.300 ± 274.763 μV vs. 1,199.500 ± 257.701 μV, p = 0.148). However, obvious acute microstructural morphological changes were observed in the nerves that were stimulated with 20 mA. Conclusion: A stimulation intensity less than 15 mA was safe for IONM of the RLN. P10: Impact of an evaluation system- SOMIP (surgical outcomes and monitoring & improvement program), in a regional hospital KKF Wong, SK Leung and CW Man Department of surgery, Tuen Mun Hospital, Hong Kong Background: SOMIP was started in Hospital Authority (HA) in 2008 in order to monitor and improve the surgical outcomes of public hospitals. Aim: Evaluate the impact of this audit system in the surgical services outcome in Tuen Mun Hospital (TMH). Method: 7 years (7/2008- 6/2015) annual reports were reviewed. Area for improvement were discussed among hospital staffs with corresponding improvement programs are started as follows: (A) Intra-departmental events: Specialists participation in all major/ ultra-major operations Specialists’ night round to review all new patients Monthly audit meeting Communication skills in wards, e.g. CRM, SBAR, MEWS Other HA hospitals visiting Monthly nursing safety round (B) Inter-departmental events: Monthly Surgical Quality & Safety Circle meeting Liaisons system with ICU Sepsis bundle protocol (C) Hospital events: Additional emergency operation sessions Additional surgical HDU beds Post-operative pneumonia prevention program Results: From 7/2008 to 6/2015, 12636 operations (major/ ultramajor) were performed. From 7/2014 to 6/2015, 868 elective and 627 emergency major/ ultra-major operations (OT) were performed in TMH. Elective OT mortality rate (2014’-2015’) was 1.2% (highest in 2009’-2010’: 2.4%) while emergency OT mortality rate (2014’-2015’) was 4.9% (highest in 2009’-2010’: 13.5%) There is a decrease in both elective and emergency OT mortality rate throughout the years. Emergency operation morbidity rate dropped from 36.8% (2009’-2010’) to 28.9% (2014’-2015’), but elective operation morbidity rate remains static (~15%). Conclusion: Deficits were identified in this audit program. With specific improvement programs, better surgical services can be achieved. P11: A retrospective review with long term follow-up of ultrasound screening detected non-palpable breast cancer: a population-based study from single-center in china (2001–2014). R Yao, B Pan and Q Sun Department of Breast Surgery, Peking Union Medical College Hospital No.1 Shuaifuyuan Wangfujing, Dongcheng district, Beijing, China Background: Milestone studies showed that ultrasound (US) was an effective primary screening test for breast cancer, and it has been officially designated to be the initial imaging test for breast cancer screening in China, due to its improved sensitivity in Chinese women who usually have denser breasts and develop breast cancer earlier than Caucasian counterparts. However, there is little data about the tumor biology and long-term survival of the US-detected non-palpable breast cancer (NPBC) in Chinese population. Methods: From January 2001 to December 2014, 572 asymptomatic women with positive (BI-RADS 4 and 5) initial screening US underwent biopsies and were diagnosed in Peking Union Medical College Hospital. The clinicopathological features, treatment choice, 10-year disease-free survival (DFS) and overall survival (OS) were reviewed. Prognostic factors of US-NPBC were identified. Results: The 572 US-NPBC comprised 8.22% of contemporary 6,958 breast cancer. The mean age at diagnosis was 51.33 (range 25–88) years. The majority of the patients presented with more invasive breast cancers, high rates of lymph node positivity, and more multifocal cancers. The mean follow-up time was 40.04 (range 1–163) months. The 5-year DFS were 91.8%, while 5-year OS were 98.1%. Multivariate analysis revealed that pT, pN and p53 was identified as DFS-predicctors for US-NPBC, while OS-predictors were pN and immunophenotype. Conclusion: This retrospective analysis with long term follow-up confirms that US-NPBC in Chinese women showed good cancer behavior and favorable prognosis. pT, pN and p53 appeared to be the most significant predictors of DFS, while pN and immunophenotype were the OS-predictors. P12: Patient-centered multi-disciplinary team (MDT) approach for morbid obesity patients in New Territories West Cluster (NTWC), Hong Kong MHC Lo, KKF Wong, WH Hui, HL Yiu, SK Leung, KKY Cheng, MY Ng, PY Wu, KY Ho, YY Ho, V Hung, MF Chow, VCH Cheung, WM Kwan, KC Chan, P Choi, J Koo, S Shing, A Kwan, AAUW Yang and E Wong 1Department of Surgery, Tuen Mun Hospital, 23 Tsing Chung Koon Road, Tuen Mun, New Territories 2Medicine and Geriatrics, Tuen Mun Hospital, 23 Tsing Chung Koon Road, Tuen Mun, New Territories 3A&IC, Tuen Mun Hospital, 23 Tsing Chung Koon Road, Tuen Mun, New Territories 4Dietetic, Tuen Mun Hospital, 23 Tsing Chung Koon Road, Tuen Mun, New Territories 5Physiotherapy, Tuen Mun Hospital, 23 Tsing Chung Koon Road, Tuen Mun, New Territories Aim: Morbid obesity is a major health problem due to its associated co-morbidities and complications. Multi-discplinary team (MDT) approach was initiated in NTWC to provide comprehensive care for morbidly obese patients. Methods: Patients with morbid obesity were first assessed by endocrinologists. Potential surgical candidates (aged 30–50, BMI 30–40, ambulatory, no complex co-morbidities) were reviewed in a multi-disciplinary meeting involving surgeons, specialty nurses, anesthesiologists, intensivists, dietitians and physiotherapists. Structured peri-operative dietetic assessment and physiotherapy were provided. Anesthesiologists will offer pre-operative assessment and assist in positioning of bougie for gastric tube sizing. Bariatric surgery was performed by single team of surgeons specializing in upper gastrointestinal surgery. Initial postoperative intensive care was provided by intensivists. Results of surgery performed during 1/2012 to 12/2015 were reviewed. Results: From 1/2012 to 3/2016, 19 patients (13 females, 6 males) with mean age and BMI of 39.6 (23–52) and 41.8 (33.2-53.8) received bariatric surgery (laparoscopic sleeve gastrectomy +/− cholecystectomy) in NTWC. Mortality and morbidity rates were 0% and 5.3% (1/19) respectively. One patient was complicated with small bowel injury, which was repaired and recovered uneventfully. Upon follow-up at > = 1 year, 77% (10/13) of patients achieved >50% excessive weight loss (total weight loss x 100/ initial excess weight). 87.5% (4/16) of patients showed improving metabolic diseases control, in terms of dosage reduction of anti-hypertensives and oral hypoglycemic agents, and decreasing HbA1c level. Overall results were comparable to international standards. Conclusion: Multi-disciplinary approach is crucial in treating morbidly obese patients. Multi-specialty participation is important to achieve satisfactory results. P13: A national report from China Liver Transplant Registry: steroid avoidance after liver transplantation for hepatocellular carcinoma Q Wei, X Xu, L Zhuang, L Zhou, H Xie, J Wu, M Zhang, Y Shen, W Wang and S Zheng Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou 310003, China Aims: We aimed to evaluate the efficacy and safety of steroid-free immunosuppression after LT for hepatocellular carcinoma (HCC). Methods: We analyzed HCC recipients without steroids after LT (SF group, n = 368) from January 2000 to December 2011, based on the China Liver Transplant Registry (CLTR) database. These recipients were matched 1:2 with control patients using steroids (S group, n = 736) for the same period after LT for HCC, according to propensity scores. Results: Compared with the S group, the SF group showed higher 1-year, 3-year and 5-year overall and tumor-free survival rates (P < 0 .05). The patients fulfilling the Milan criteria in in the SF group presented higher 1-year, 3-year and 5-year overall and tumor-free survival rates than those in the S group (P < 0.05). The recipients who experienced more tumor recurrence were younger, with HBV-DNA >1000 copies/ml and beyond Milan criteria (P = 0.028, P < 0.001 and P < 0.001). Multivariate analysis indicate that age, pretransplant HBV DNA level and Milan criteria were identified as the major risk factors associated with tumor recurrence in steroid avoidance recipients after LT. The incidences of new-onset diabetes mellitus (21.20% vs. 33.29%, P < 0.001), new-onset hypertension (10.05% vs. 18.61%, P < 0.001) and hyperlipidemia (4.08% vs. 7.20%, P = 0.042) were significantly lower in the SF group. Conclusions: Steroid-free immunosuppression could be safe and feasible for HBV-related HCC patients in LT and could increase patient survival and tumor-free survival and reduce post-transplant complications, such as diabetes, hypertension, and hyperlipidemia. Age, HBV DNA level and Milan criteria maybe risk factors associated with tumor recurrence in steroid avoidance recipients after LT. Patients fulfilling Milan criteria can benefit the most from steroid-free immunosuppression. Key words: steroid, liver transplantation, hepatocellular carcinoma, propensity score P14: Outcome of closure of ileostomy after elective low anterior resection of rectal cancer: A single-centred case series CK Tang, YW Wong and CM Poon Background: The construction of a defunctioning loop ileostomy is a common procedure in elective low anterior resection, in an attempt to avoid the consequences of anastomotic leak following the operation. However, its subsequent closure is commonly associated with complications such as post-operative ileus. The aim of this study is to investigate the incidence of post-operative ileus and complications following closure of ileostomy after elective low anterior resection of rectal cancers. Method: Electronic records (from Jan 2010 to Dec 2014) of patients having closure of ileostomy after low anterior resetion of rectal cancer in Tuen Mun Hospital and Pok Oi Hospital, Hong Kong were extracted from database and analyzed. Primary outcome was post-operative ileus. Secondary outcomes were post-operative complication, length of stay and re-admission. T-tests were carried out to investigate the risk factors for post-operative complications. Results: A total of 151 patients was included. Post-operative ileus occurred in 23 cases (15.2%). Post-operative complications occurred in 25 cases (16.6%). The mean post-operative length of stay was 4.19 days. 27 cases (17.9%) readmitted within 30 days after operation. This study failed to identify any risk factor for development of post-operative ileus or complication. Conclusion: Closure of ileostomy after elective low anterior resection for rectal cancer is associated with high rate of post-operative ileus and complications. P15: Retrospective review of predictive factors of underestimated invasiveness in patients with ductal carcinoma in situ of the breast on percutaneous core biopsy RKW Hung, SH Law, CK Kong and SL Leung Background and objective: Improved diagnostic breast imaging has increased the diagnosis rate of ductal carcinoma in situ (DCIS) which now accounts for almost 30% of newly diagnosed breast cancers.1 However, up to 44% of cases will be upstaged to invasive carcinoma after surgical excision due to the highly targeted nature of core needle biopsy.2–4 This will subject the patient for another operation for the staging of the axilla. The aim of this study is to review and identify possible predictive factors of upstaging ductal carcinoma in situ to invasive carcinoma after surgical excision to avoid additional risk of general anaesthesia. Material and methods: We retrospectively analyzed 89 patients diagnosed to have ductal carcinoma in-situ of the breast from 2010 to 2015. The association between post-operative upstaging to invasive carcinoma and clinical, radiological and pathological variances were reviewed Result: Tumor grading, DCIS subtypes and clinically palpable lesion were found to be associated with post-operative upstaging of the disease by using univariate analysis. While age, mammographic or ultrasonic size of the tumor showed no statistical significance. However, when the factors are compared with multivariate analysis, tumor grading is the only statistically significant factor to predict the presence of invasive component of ductal carcinoma in situ of the breast. Conclusion: Tumor grading is the most important factor to predict the presence of invasive component in patients diagnosed to have ductal carcinoma in situ of the breast preoperatively by core needle biopsy Reference 11. Allegra CJ, Aberle DR, Ganschow P et al. National Institutes of Health State-of-the-Science Conference statement: diagnosis and management of ductal carcinoma in situ September 22e24, 2009. J Natl Cancer Inst 2010; 102: 161e9. 22. Lee JW, Han W, Ko E et al. Sonographic lesion size of ductal carcinoma in situ as a preoperative predictor for the presence of an invasive focus. J Surg Oncol 2008; 98 (1): 15e20. 33. Ko E, Han W, Lee J et al. Scoring system for predicting malignancy in patients diagnosed with atypical ductal hyperplasia at ultrasoundguided core needle biopsy. Breast Cancer Res Treat 2008; 112 (1): 189e95. 44. Renshaw AA. Predicting invasion in the excision specimen from breast core needle biopsy specimens with only ductal carcinoma in situ. Arch Pathol Lab Med 2002; 126 (1): 39e41. P16: Analysis of factors influencing surgical choices of breast cancer patients in Mainland J Wang, Z Yin, R Chen, L Zhang and X Zha Department of breast surgery, the first affiliated hospital with Nanjing medical university Aim: For operable breast cancer, breast surgeries include mastectomy and lumpectomy (followed by radiotherapy), while axillary options are sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND). In real world, patients’ choices are influenced by tumor characteristics, as well as social and psychological factors. Methods: From April 2015 to June 2016, 138 operable invasive breast cancer patients received one-to-one interviews before surgery. Interviews focused on their considerations behind their surgical choices. Results: In regards to breast surgeries, 64.5% chose mastectomy while 29.0% chose lumpectomy, and 6.5% chose mastectomy + reconstruction. 14 patients who could choose lumpectomy finally chose mastectomy, reasons including fear of recurrence, radiotherapy, etc.. 6 patients who could choose mastectomy + reconstruction but chose mastectomy only for fear of breast implant, family members’ opinion, and for fear of another surgery. For axillary surgeries, 32.6% finally chose ALND and 67.4% chose SLNB. All 15 choosing ALND rather than SLNB were due to the concern of increased recurrent risk. Among 93 patients choosing SLNB, 88 stressed the fear of complications of ALND (e.g. lymphedema, dysfunction and sensation disturbance), 5 believing SLNB could keep their lymph nodes as for better immunity. Conclusion: Patients’ choice of surgical procedures may be different from surgeon's. In addition to tumor characteristics, many social and psychological factors exert an influence . However, surgeons still have the responsibility to guide patients in making properer and safer decisions. P17: Outcomes of hepatectomy following down-staging trans-arterial chemoembolization for advanced hepatocellular carcinoma HT Lok, CCN Chong, SYS Cheung, J Wong and PBS Lai Department of Surgery, Prince of Wales Hospital, The Chinese University of HongKong, Shatin, Hong Kong Aim: To evaluate the outcomes of hepatectomy following down-staging trans-arterial chemoemoblization (TACE) for advanced hepatocellular carcinoma (HCC) which was considered unresectable at presentation. Methods: Retrospective analysis was conducted on consecutive patients undergoing hepatectomy following trans-arterial chemoembolization for hepatocellular carcinoma in 2004–2016 Results: Forty eight patients (41 males) with median age of 56 (range 34 – 78) underwent hepatectomy following TACE. 27 patients had single tumor whereas as 21 patients had multifocal tumors, among which 8 patients had bi-lobed involvement. Unresectability was due to large centrally located tumor (n = 14), multi-focality (n = 6) and borderline liver function (n = 3). Median number of trans-arterial session received before hepatectomy was 2 (range 1 – 5). Trans-arterial therapy was cisplatin based (n = 42), doxorubicin based (n = 5) and lipiodol-ethanol mixture (n = 1). 32 patients had portal vein embolization. Resection margin was involved in one patient. Two patients suffered complication requiring re-operation and one 30-day mortality was recorded. With a median follow up duration of 33.1 months, median overall survival was 107.2 months whereas median recurrence-free survival was 52.7 months. Large central tumor (hazard ratio: 2.748, 95% confidence interval: 1.002 – 7.534) and multifocal disease (hazard ratio: 4.150, 95% confidence interval: 1.199 – 14.366) were found to be associated with worse overall survival in multivariate cox regression analysis. Drop in serum alphafetal protein and degree of tumor shrinkage after TACE, numbers of TACE sessions before hepatectomy were not associated with overall survival. Conclusion: TACE is effective in down-staging advanced hepatocellular carcinoma to render the tumor amendable to curative surgery with good long-term survival in selected patients. P18: Improved pain control by high volume pre-peritoneal local anaesthesia in elective colorectal cancer surgery SC Tam, YW Wong, SY Leung, CYJ Lam and LC Chong Department of Surgery, Tseung Kwan O Hospital, 2 Po Ning Lane, Hang Hau, Tseung Kwan O, New Territories, Hong Kong Aim: Pain after colorectal operations hinders recovery and mobilization, leading to complications and prolonged hospital stay. Pre-peritoneal continuous analgesics infusion provides effective pain control, but may lead to catheter-related complications. We aim to review the feasibility and efficacy of intra-operative pre-peritoneal high volume diluted local anaesthetics injection as an alternative. Methods: A retrospective review of patients underwent elective colorectal cancer surgery in our unit from October 2014 to November 2015. Patients receiving conventional LA to skin or high volume pre-peritoneal LA were compared in terms of pain score, analgesics requirement, mobility, and the length of hospital stay. Time to return of bowel function and resumption of diet, and post-operative complications were also compared. Results: 59 patients were included. 52.5% received conventional LA, while 47.5% received high volume pre-peritoneal LA. There is no significant difference in age, gender, operation type and laparoscopic rate between the two groups. High volume pre-peritoneal LA was associated with lower median pain score on Day 1 (1.5vs 3, P < 0.05), earlier wean off PCA (Day 1.5 vs 2.5, P < 0.05), earlier return of flatus (Day 2.5 vs 3, P < 0.05), earlier tolerance to fluid diet (Day 2 vs day 4, P < 0.05) and soft diet (Day 3 vs 5, P < 0.05). There is no significant difference in wound complication and collection rate between the groups. Conclusion: High volume pre-peritoneal local anaesthesia in elective colorectal cancer surgery is shown to have better early pain control leading to early weaning of PCA. It is a safe alternative. P19: Short-term results of extralevator abdominoperineal excision for low rectal cancer : A single centre experience CK Tang, YW Wong and CM Poon Objective: to evaluate the short-term results of extralevator abdominoperineal excision (ELAPE). Background: ELAPE was introduced in 2007, with an aim to reduce intra-operative bowel perforation rate and circumferential margin positivity (CRM+). Current evidence had shown conflicting results regarding its benefit over conventional APE. Method: Data on all ELAPEs performed from Feb 2010 to Dec 2014 were extracted from electronic records in Tuen Mun Hospital, Hong Kong. The data was evaluated for patient's demographics, tumour characteristics, pathological characteristics and clinical outcomes. Results: A total of 28 patients were included. The mean operative time was 288.7 minutes. The mean hospital stay was 11.2 days. ELAPE was associated with an intra-operative perforation rate of 0 (n = 0). The rate of CRM+ was 10.7% (n = 3) and the rate of perineal wound complication was 32.1% (n = 9). No patient developed isolated local recurrence (mean follow-up length 31.6 months). Conclusion: The short-term results of ELAPE of low rectal cancer showed that ELAPE was safe. It demonstrated a low rate of intra-operative perforation and local recurrence. P20: Transaortic approach for transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis; first case series in Hong Kong SCY Chow, RHL Wong, GSH Cheung, APW Lee, E Wu, IYP Wan, S Wan and MJ Underwood Division of Cardiothoracic Surgery, Department of Surgery Division of Cardiology, Department of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital , 30–32 Ngan Shing Street, Shatin, New Territories Hong Kong Aim: Transcatheter aortic valve implantation (TAVI) has established itself as the primary treatment for patients with severe degenerative aortic stenosis who are at high or prohibitive risk for surgery. Transaortic TAVI provides an alternative access for patients with severe ilio-femoral disease and is well described in the western population. Studies in Asian population is lacking. We report the first case series of transaortic TAVI in Hong Kong. Method: From 2015 to 2016, we enrolled 5 patients who underwent transaortic TAVI in our center. All patients had symptomatic severe degenerative aortic stenosis, and were considered by a multidisciplinary HEART team to be of prohibitive risk for surgical aortic valve replacement as well as unsuitable for transfemoral TAVI . Results: The mean age was 78.4 +/− 3.9 years and 3 patients were male. Four patients had parasternal incision and one patients had mini-sternotomy performed under general anesthesia with Evolut R self expandable Corevalve implanted. Transaortic TAVI with Evolut R Corevalve was successfully performed in all patients. There was no mortality within 30 days of procedure and 1 cardiovascular related mortality at 5 months post operation. Peak to peak gradient immediately post implantation was 0.4 +/− 0.8 mmHg. No patient had residual para-valvular regurgitation of more than mild in severity. One patient developed post-operative bleeding from pleural tapping site requiring re-sternotomy for hemostasis. Conclusion: In our early experience with transaortic TAVI, procedural success was achieved in all patients without mortality at 30 days post procedure. P21: Sphincter preservation in low rectal cancers: incidence and risk factors for failure JCK Mak, CC Foo, R Wei and WL Law Division of Colorectal Surgery, Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong Aim: Advances in surgical techniques and changes in the treatment of rectal cancer have led to a decline in abdominal perineal resection rates, with an increase in sphincter preservation operations. The aim of this study is to evaluate the cumulative incidence and risk factors associated with permanent stoma in patients undergoing sphincter-preserving resection of distal rectal cancer. Method: From 2000 to 2014, patients who underwent sphincter preserving low anterior resection for distal rectal cancer (within 5 cm from the anal verge) were included. Data was retrieved from a prospectively collected database. The occurrence of a permanent stoma over time and its risk factors were investigated by using a Cox proportional hazards regression model. Results: One hundred and ninety four patients were included over the study period, with 46 patients ending up with a permanent stoma. The mean follow up period was 51 months (range (2.3-190). The cumulative permanent stoma incidence was 23.7 percent. Anastomotic related complications, disease progression and the patient's wish were the main reasons for a permanent stoma. Multivariate analysis showed that the independent risk factors for permanent stoma were local r