s / International Journal of Surgery 10 (2012) S1–S52 S24 ABSTRACTS 0269: GASTROINTESTINAL STROMAL TUMOUR OF THE RECTUM: A REVIEW OF SURGICAL TREATMENT, OUTCOMES AND THE ROLE OF IMATINIB M.J. Wilkinson, J.E.F. Fitzgerald, D.C. Strauss, A.J. Hayes, J.M. Thomas. The Royal Marsden Hospital NHS Foundation Trust, London, UK Aims: Gastrointestinal stromal tumours (GISTs) of the rectum are rare, accounting for only 0.1% of all rectal tumours. This study investigates the presentation, management and outcomes of rectal GISTs at a specialist unit. Methods: Retrospective cohort study analysing a prospectively maintained database at a tertiary referral centre from Jan 2001 Jan 2012. Results: A total of 14 patients (6 female, 8 male), presented with a primary rectal GIST. Commonest presenting symptoms were rectal bleeding (n1⁄46) and tenesmus (n1⁄46). Median tumour size at presentation: 8cm (range 2 12cm). 12 patients received neoadjuvant imatinib; median reduction in tumour size 2.8cm (range 0.5 5.6cm); p 1⁄4 0.001. Surgical resection was performed in 6 of the 14 patients (2 patients declined surgery and 6 are continuing imatinib to downsize). Complete macroscopic clearance was obtained in 100% of patients. On follow up, 12 patients are alive without metastases: median follow-up 31.3 months. There were 2 deaths from unrelated causes. The remaining 5 patients operated on are disease free (median DFS 1⁄4 36.2 months). Conclusions: Biopsy is essential in establishing the diagnosis. Neoadjuvant imatinib substantially downsizes rectal GISTS which may permit less invasive surgery. Favourable outcomes can be achieved for rectal GISTs in specialist centres. 0283: A PROPOSED STANDARD FOR PRE-OPERATIVE LAPAROSCOPIC COLORECTAL CANCER RESECTION ENDOSCOPIC TATTOOING. IDENTIFICATION OF MODIFIABLE PRACTICES AT AN ENHANCED RECOVERY CANCER CENTRE Ajay Sud, Arkeliana Tase, Elinor Baker, Santanu Bhattacharjee, Shiva Dindyal, Stefano Andreani. Whipps Cross University Hospital, London, UK Aims: The National Bowel Cancer Screening Program specifies a 100% target for tattooing of suspected malignant lesions. There remains no all-inclusive guideline for colorectal tattooing. We aim to identify factors contributing to suboptimal practice. Methods: The data collected incorporated retrospective analysis of all 144 colorectal surgery patients at Whipps Cross Hospital whom underwent oncological colorectal resections for tenmonths from January 2008 and six months from June 2010. Results: In 2008 and 2010, 39% and 52% respectively, of our patients received pre-operative tattooing. In 2008 and 2010, 30% and 50% respectively of lesions were only documented to be distally tattooed. The mean number of days between their pre-operative endoscopy to surgery in 2010 was 69 days. In 2008 consultant gastroenterologists tattooed 70% of suspect lesions, but by 2010 this reduced to 36%. Only 40%were underwent solely distal tattooing, and 22% of ulcerating lesions were tattooed. Conclusions: Surgeons are the direct recipients of suboptimal tattooing. They are best placed to lead the colonoscopy community to ensure efficacious tattooing practices, enabling optimal uncomplicated oncological resection. The standard for practice should be a recent distal ‘360-degree' tattoo with one vial per 30 degrees, to all suspicious lesions, irrespective to the endoscopic morphology. 0316: IROBOT INITIALIZING A ROBOTIC COLORECTAL SERVICE Faira Eldriana Rizal, Benjamin Stubbs, P. Mathur, Colin Elton, Daren Francis. Department of Coloproctology, Barnet and Chase Farm Hospital,