Terms Of Survival Research Articles

Surgery and Anesthesia in Patients with Pulmonary Hypertension.

Pulmonary hypertension is characterized by right ventricular impairment and a reduced ability to compensate for hemodynamic insults. Consequently, surgery can be challenging but is increasingly considered in view of available specific therapies and improved longer term survival. Optimal management requires a multidisciplinary patient-centered approach involving surgeons, anesthetists, pulmonary hypertension clinicians, and intensivists. The optimal pathway involves risk:benefit assessment for the proposed operation, optimization of pulmonary hypertension and any comorbidities, the appropriate anesthetic approach for the specific procedure and patient, and careful monitoring and management in the postoperative period. Where patients are carefully selected and meticulously managed, good outcomes can be achieved.

QUANTIFYING THE NEED FOR A BEST SUPPORTIVE CARE CLINIC

Abstract AIMS Patients newly diagnosed with high-grade primary brain tumour and poor performance status discussed in the Multidisciplinary team (MDT) may not be felt to benefit from active treatment and their uptake in clinic is poor. We aimed to explore the volume of patients not being treated in our region, their survival rates, and the reasons for the limited requests for clinical review. METHOD Data was obtained from medical records of identified patients from April 2021 to April 2022. This included demographics, presentation, diagnosis date, clinic visits, and date of death. RESULTS 78 patients were referred for suspected high-grade primary brain tumours and selected for best supportive care by the MDT. Only 73 (64% male) were diagnosed radiologically with a high-grade primary tumour and the rest were excluded. Median age was 79 years (range 74 – 84). The commonest presenting symptoms were confusion (53%), falls (29%), and dysphasia (25%). Median survival time after diagnostic scan was 67 days (range 34 – 107). Survival rates at 1, 3, 6, and 12 months were 82%, 33%, 8%, and 1%, respectively. 28 patients (38%) were seen in clinic. 13 had been provided with the option to attend by letter. The median duration from referral to clinic was 9 days (range 7 – 14). CONCLUSIONS Only a third of non-treatable patients with newly diagnosed high-grade primary brain tumours are being seen in the clinic. Communication between the MDT and the patient offering this service is poor. Longer term survivors suggest an incorrect diagnosis who may benefit from further review.

Identifying bottlenecks in the life cycle of plants living on cliffs and rocky slopes: Lack of knowledge hinders conservation actions

Long term survival of plant populations relies on successful reproductive cycle to obtain generation turnover. Focusing on plant species of conservation concern, we brought together a group of plant conservationists from different countries to assess whether the already available information on plant reproductive biology and autecology is adequate for identifying which phases of single species life cycle might act as bottleneck.We compiled a list of 80 plant species of conservation concern living on European cliffs and rocky slopes, for which biological and autecological information was collected from scientific literature, technical reports, and expert knowledge.Results have shown that the available information on species reproductive biology and autecology is inadequate to identify bottlenecks in the life cycle of many species and to provide insights for the practical conservation of many more. Available knowledge is mainly referred to the flowering phase, less on seed production and much less on seedling establishment and on cloning. Meanwhile and noteworthy, flowering resulted to be the less critical phase for the fulfilment of the species life cycle.Overall, with this perspective article we aim to encourage a constructive debate among the scientific community members and policymakers to set up novel concerted strategies for the conservation of plant species of conservation concern. The challenge of the discussion is the implementation of the current approach with new biological and ecological information to be exclusively targeted at identifying the constraints that limit the generation turnover and furnishing specific indications for active management.

Survival Strategies in the Economic Recession at Firm Level: The Case of Large Scale Construction Companies in Sri Lanka

As a form of business, construction contracting is heavily sensitive to recessions in the economy. As in many other countries, the Sri Lankan construction industry has also suffered a high proportion of business failures due to the current economic recession. Hence, the aim of this research is to delineate the commercial strategies adopted by construction companies in Sri Lanka to endure short term survival in the recession. A comprehensive literature survey was carried out to reveal these strategies in different contexts. A questionnaire survey was subsequently administered among the large scale contractors to gauge their responses using the Mean Item Score (MIS) and the Relative Importance Index (RII). The study concludes that Cut non-essentials and dispense the indispensable, De-scaling/De-scoping, Minimizing wastage, Getting clear on basic costs and adjust the profit margin with a sense and Slowing down the progress are among the first five strategies found to have been prioritized at contracting firms. Along with 43 strategies, the study recommends that there is a need for firms to network and collaborate to share resources, in order to survive in business during the fierce conditions of the economy.

SPECT for risk stratification in patients with advanced liver disease

BackgroundPatients with advanced liver disease (ALD) have unique hemodynamics including high resting cardiac output and low systemic vascular resistance which may reduce the sensitivity of pharmacological myocardial perfusion imaging (MPI). MPI is frequently ordered for patients with ALD if liver transplantation is being considered. Because of the limited data on effectiveness of MPI in the ALD population, we conducted this cohort study focused on cardiac outcomes after pharmacological MPI. MethodsWe conducted a cohort study comparing normal versus abnormal MPI among 454 patients with ALD between 1/1/2011 and 06/01/2021 at a single tertiarycare academic medical center. Abnormal MPI was defined as summed stress score > 2 on LVEF < 40 %. The primary outcome was to compare the frequency of major adverse cardiovascular events (MACEs) among ALD patients with and without abnormal MPI. Secondary outcome included individual components of MACE analyzed by chi square. Kaplan-Meier survival curves and a logistic-regression model of associations with MACE were also performed. ResultsIn this cohort, 58 patients were observed to have an abnormal MPI. Baseline characteristics between the groups were similar, except prior coronary disease, which was more common among the abnormal MPI group (risk ratio 2.07, 95 % confidence interval 1.30–3.30, P = 0.003). MACE was more common in the group with abnormal MPI (n = 24, 41.4 % versus normal MPI n = 104, 26.3 %, P < .001). No difference in MACE was observed when stratified by liver disease type. In the logistic regression model, diabetes mellitus, stage 3 chronic kidney disease, and summed stress score >2 were retained as being associated with MACE. ConclusionsOur data suggest that MPI remains an effective test for identifying ALD patients at higher risk of mortality and cardiac events. Further study is needed to understand whether a strategy of routine MPI for liver transplant candidates effectively improves long term survival.

OS04.4.A LONG- AND SHORT-TERM SURVIVORS AMONG ADULT PATIENTS WITH DIFFUSE WHO GRADE 2-3 GLIOMA: CLINICAL FEATURES, MOLECULAR RECLASSIFICATION AND DNA METHYLATION PATTERNS

Abstract BACKGROUND Diffuse gliomas show considerable heterogeneity in terms of survival. The WHO classifications of 2016 and 2021 improved prognostic stratification due to the definition of biologically and clinically homogeneous tumor entities. However, further prognostic models considering clinical and molecular factors are needed to balance survival benefit with adverse treatment-related long-term effects in therapeutic decisions. MATERIALS AND METHODS Patients with diffuse gliomas of WHO grades 2 and 3 diagnosed in 2000 - 2019 have been included. Long term survivors (LTS) were defined as patients with an overall survival (OS) of &amp;gt;10 years after radiological diagnosis, whereas short-term survivors (STS) had an OS of &amp;lt;1 year. Histological diagnosis was performed by a board-certified neuropathologist. DNA methylation analysis of formalin-fixed, paraffin-embedded tumor tissue was conducted using the Illumina EPIC 850k platform. The Heidelberg Methylation Classifier was applied to obtain methylation-based diagnoses. RESULTS Of 697 patients with WHO grade 2 and 3 glioma, 182 (26.1%) were LTS, and 42 (6.0%) were STS. LTS were younger than STS (median age: 36 vs. 59.5; p&amp;lt;0.001) and had a higher Karnofsky Performance Score at diagnosis (median: 90% vs. 80%; p&amp;lt;0.001). LTS more frequently presented with epileptic seizures (p&amp;lt;0.001), while more STS had motoric (p&amp;lt;0.001), sensory (p=0.021), and visual deficits (p=0.027) as well as aphasia (p&amp;lt;0.001) and behavioral changes (p=0.009). Histological diagnoses (including pre-2016) showed astrocytic histology in 117 (70.9% LTS, 29.1% STS), oligodendroglial in 61 (93.4% LTS, 6.6% STS), oligo-astroglial in 43 (97.7% LTS, 2.3% STS) and not otherwise specified in 3 (all STS; p&amp;lt;0.001). Molecular reclassification of pre-2016 diagnoses (n = 143) yielded divergent entities in 46 (32.2%) cases. Overall, integrated molecular diagnoses included astrocytoma (isocitrate dehydrogenase [IDH]-mutant] in 65 patients (95.4% LTS and 4.6% STS), oligodendroglioma (IDH-mutant, 1p/19q-codeleted) in 64 patients (98.4% LTS and 1.6% STS), IDH-wildtype gliomas in 24 patients (100% STS), anaplastic pilocytic astrocytoma in 2 STS, diffuse midline glioma (H3K27-altered) in 1 STS, and dysembryoplastic neuroepithelial tumor in 1 LTS, while not otherwise specified diagnoses were found in 4 patients (75% LTS, 25% STS; p&amp;lt;0.001). Unsupervised clustering based on DNA methylation profiling revealed two major clusters consisting of IDH-wildtype STS (cluster A) and IDH-mutant patients (cluster B; 94.6% LTS, 5.4% STS). In cluster B, one subcluster (n = 8) contained 3/4 IDH-mt STS. Further analyses of these cases including validation with publicly available DNA methylation data are ongoing. CONCLUSION LTS and STS show distinct clinical and molecular features. Further profiling of cases with divergent survival could provide more refined prognostic stratification.

OS13.7.A ONSET SYMPTOMS PREDICT SURVIVAL IN GLIOBLASTOMA PATIENTS -REAL WORLD DATA FROM 1719 PATIENTS IN THE SWEDISH BRAIN TUMOUR REGISTRY 2018-2021

Abstract BACKGROUND Glioblastoma, the most common malignant brain tumour in adults, still has a poor long term survival. Non-invasive clinical prognostic markers are important to more accurately predict a patient’s survival. The aim of our register-based real-life study was to explore if onset symptoms have a prognostic value for survival. MATERIAL AND METHODS Data on onset symptoms and survival, as well as known prognostic factors, were retrieved for all glioblastoma patients registered in the Swedish Brain Tumour Registry between 2018 and 2021. The prognostic impact of different onset symptoms were calculated using the Cox proportional hazard model. RESULTS Data from 1719 adults with pathologically verified glioblastoma were analysed. The median survival was 347 days (330-364). The two-year survival was 21.9 %. The most common onset symptoms were focal neurological deficits, cognitive dysfunction, headache, epilepsy, and signs of raised intracranial pressure, with some patients having multiple symptoms. Patients with initial cognitive dysfunction had a significantly shorter survival compared to patients without cognitive dysfunction (p&amp;lt;0.001). Patients with onset seizures had significantly longer survival compared to patients with no onset seizures (p&amp;lt;0.001). The differences in survival remained after Cox regressions adjusting for known prognostic factors. When comparing tumors of the same size, there was still a difference in survival between patients having or not having cognitive dysfunction. CONCLUSION This large real-life study shows that initial cognitive impairment is a negative, and epileptic seizure at onset is a positive prognostic factor for survival in glioblastoma patients.

Understanding the force motion trade off of rigid and hinged floating platforms for marine renewables.

In this work, we compare the motion and structural response of a rigid and hinged floating structure subject to regular waves. We do this to understand better whether what is the best option for floating marine renewable installations. The hinged structure has two hinges and three pontoons, whilst the rigid structure is made by replacing the hinges with rigid steel bars. We instrument the pontoons with motion detection spheres and with strain gauges to measure vertical point loads. We find that the motion response of the platforms is similar between hinged and rigid at low and high frequencies. However, at intermediate frequency waves, single and triple sagging occur for rigid and hinged structures, respectively. We find significant load alleviation for the hinged structure in the range of frequencies where sagging behaviour occurs. These insights reveal that hinged design can contribute to long term survivability by reducing loads in the structure, whilst identification of motion patterns and natural frequencies are necessary to select operating modes for marine renewable generators mounted on the platforms.

PE020 - The impact of positive surgical margins on long term survival after robot assisted radical prostatectomy: 20 years’ report from the EAU Robotic Urology Section (ERUS) Scientific Working Group

PE020 - The impact of positive surgical margins on long term survival after robot assisted radical prostatectomy: 20 years’ report from the EAU Robotic Urology Section (ERUS) Scientific Working Group

Safety of cerebrospinal fluid drainage in descending and thoracoabdominal aortic replacement surgery.

Spinal cord injury (SCI) remains a significant morbidity of surgical repair of descending thoracic aortic aneurysms (DTAA) and thoracoabdominal aortic aneurysms (TAAA). We present our 17-year experience with cerebrospinal fluid drainage (CSFD) as a protective strategy during open surgical repair of descending and thoracoabdominal aortic disease. We conducted a retrospective chart review of 132 patients who underwent open surgical repair of DTAA and TAAA and dissections with concurrent use of CSFD for spinal cord protection. Information regarding survival, postoperative course, and complications related to CSFD use were extracted from electronic health records (EHR) and analyzed. Mean patient age was 65.4±13.0 years, and 82 (62.1%) were male. A CSFD was successfully inserted in all patients. The mean hospital length of stay after surgery was 12.2±11.2 days, and in-hospital mortality was 7.6%. Postoperative transient paresis was observed in 5 patients (3.8%), and permanent paraplegia was seen in 4 (3.0%). CSFD related complications were reported in 25 patients (19%). Complications included persistent cerebrospinal fluid (CSF) leakage, blood-tinged CSF (with subdural hematoma reported in 3 patients) and spinal cutaneous fistula in 9 (7%), 14 (11%), and 1 (1%), respectively. Long term survival was 50.9% at 15 years. CSFD is associated with minor complications, without major sequalae. It is a safe practice and likely contributes innocuously to decreased SCI in patients undergoing open repair of DTAA and TAAA.

Investigation of ectoparasites in budgerigar and canaries in Burdur city of Turkey

Ectoparasite infestations are of the most important and neglected diseases of birds. Ectoparasites cause sirious harmful effects such as; irritation, feathers and skin damage, restlessness, anemia, weight loss, transmission of other pathogens, reducing overall fitness and decreasing long term survival depending on the intensity of the infestation. The main objective of this study was to investigate the ectoparasites of budgerigars and canaries in Burdur city of Turkey. The material of the study was consisted of randomly selected 555 budgies in 192 cages and 121 canaries in 49 cages belongs to 12 different breeders in center district of Burdur city, Turkey. The feathers of head, neck, abdomen, legs, tail, beak, under the wings, around the cloaca and feet of all birds, in addition cages and cage equipments have been examined in terms of ectoparasites. As a result; no ectoparasite species were found on/between feathers and other body parts of overall 676 cage birds, however, a large number of Dermanyssus gallinae were found in cages and cage equipments. Dermanyssus gallinae have been detected in rates of 28.65% and 28.57% in budgerigar and canary cages, respectively. The present study is the first investigation study of ectoparasites of budgerigar and canaries in Turkey and rarely in the world. In addition, within this study D. gallinae infestation is being reported for the first time from budgerigar and canaries from Turkey.

844 Surgical Outcomes and Mortality for Patients Undergoing Total Pelvic Exenteration for Colorectal Cancer at One Year

Abstract Total pelvic exenteration (TPE) is undertaken at specialist centres for locally advanced rectal cancer. It carries significant morbidity and mortality. Research is often performed on small sample sizes resulting in limited data on surgical outcomes and mortality. A retrospective study conducted in St Thomas’ Hospital analysed colorectal cancer patients who underwent TPE’s from 2017-2021. Demographics and perioperative data including Clavien-Dindo (CD) score, 90 day and 1 year mortality was collected. Significant post-operative complications were considered for patients scoring &amp;gt;2 on CD scale. 124 patients were included in the study, mean age 63 (SD 10), (87% male; 13% female). TPE was undertaken for a primary rectal cancer in 77% and for recurrent disease in 23% of patients. Mean blood loss was 1688mls and median length of hospital stay was 18 days. Significant complications seen in 34% of patients. 69% patients had R0 resection, 25% R1 resection. Disease recurrence was significantly more prevalent in patients with R1 resections (p&amp;lt;0.0001). In total 42 patients experienced disease recurrence (60% metastatic, 40% local), mean disease free period was 405 days. 71% of relapsed patients had adjuvant therapy advised, with only 27% of advised patients going on to receive treatment. 1 year mortality shown to be 12% with 3 patients within 90 days of surgery. Patients experience a considerable risk of post-operative complications following TPE with over a third experiencing significant complications in the immediate post-operative period. Patients with R0 resections go on to have significantly less disease recurrence. Further research required into long term survival.

54 Is Nicotine Replacement Therapy (NRT) Offered and Prescribed to Current Smokers Admitted to Thoracic Surgery?

Abstract Background Cigarette smoking is a well-known habitual risk factor for lung cancer. Lung cancer resections make up the majority of BRI Thoracic Surgery admissions. Smoking has a negative impact on long term survival and disease progression of lung cancer patients increasing risk of recurrence and secondary tumours following surgery with curative intent. Method Retrospective analysis of all patients discharged from thoracic surgery during December 2021, February 2022 and March 2022. Interventions were implemented following thoracic surgery team meetings in January and February. Data was obtained from pre-operative assessments, inpatient clinical notes, discharge summaries and discharge medications. Interventions included team discussions and education, implementation of NRT prompts in EPR pathway and NRT prescribing stickers in drug charts. Results The majority of admissions were for lung cancer resections reaching 49% of admissions in February and March. In December, February and March: 70%, 55% and 50% of patients respectively had no documented discussion of smoking cessation/ NRT during admission and were not discharged with NRT. Conclusions 78% of patients who were offered NRT as an inpatient accepted and were discharged with appropriate NRT. The number of patients who had no documented discussion about smoking cessation, and subsequently no NRT prescribed on discharge improved over the months (70%, 55% and 50% respectively). 16% of patients had no smoking status documented at pre-op or during admission. There is room for improvement in NRT discussions on the ward, allowing prescription of NRT to promote smoking cessation on discharge.

462. MAJOR PATHOLOGIC RESPONSE IN ESOPHAGEAL ADENOCARCINOMA: SHOULD WE ADOPT A NEW PARADIGM IN DEFINING RESPONSE TO TREATMENTS?

Abstract Background Incidence of adenocarcinoma (ADC) of the esophagus is arising in Western countries and it is still burdened by a significant mortality. A complete primary tumor regression after neoadjuvant treatment is associated with improved long-term survival, however this favorable response is rarely achieved. The primary endpoint of this study was to determine whether the survival benefit associated with a complete tumor regression could be achieved also with a major, albeit subtotal, tumor response. Methods We evaluated all consecutive patients who underwent esophagectomy for cancer at 2 high-volume centers. Inclusion criteria were histologically confirmed ADC involving the thoracic esophagus or Siewert I and II cancers, treated by neoadjuvant chemotherapy (CT) or chemoradiotherapy (CRT) and surgery. Pathological tumor response was quantified using the Mandard score. Kaplan-Maier plots were used to estimate overall survival (OS) according to the TRG. Results Overall, 424 patients were recruited in the study period, 236 received CT and 188 CRT. The median follow-up time was 55 months. TRG 1 and 2 showed comparable OS curves both in the CT group (p = 0.76) and in the CRT group (p = 0.82) (Figure 1). TRG 1–2 were associated with a significantly improved OS compared to TRG 3–5 after CT (p = 0.004) and CRT (p = 0.0003). The trend was confirmed in the whole cohort, with TRG 1 and 2 patients showing comparable 5-years OS proportions (70% vs. 65%, p = 0.52) and a significantly improved survival compared to TRG 3–5 (p &amp;lt; 0.0001). Conclusion Tumor regression after neoadjuvant treatment is significantly associated with long term survival irrespective of the adopted regimen. The long-term survival was comparable between TRG 1 and TRG 2 patients after CT and CRT and in the overall population. This finding allowed us to define the criterion of major tumor response, which includes both TRG 1 and 2 patients, potentially creating a homogeneous and larger subgroup of subjects to be evaluated in future clinical trials.

255. EARLY COST-EFFECTIVENESS MODELLING STUDY COMPARING MINIMALLY INVASIVE TRANSCERVICAL ESOPHAGECTOMY (MICE) AND TRANSTHORACIC MINIMALLY INVASIVE ESOPHAGECTOMY (TMIE) IN OESOPHAGEAL CANCER PATIENTS

Abstract Introduction Minimally Invasive transCervical Esophagectomy (MICE) is a novel transcervical approach to esophagectomy with the possible advantage of decreased pulmonary complications. MICE is in an early stage of introduction in patients which are treated with the McKeown procedure in regular practice. The aim of this study was to provide insight in the potential cost-effectiveness of MICE and its sensitivity to different complications. Methods A decision tree modelled the postoperative outcomes of recurrent laryngeal nerve paresis, anastomotic leakage, pulmonary complications and 30-day mortality. Subsequently, we developed a Markov state transition model to calculate the effects of these input parameters on health outcomes (QALYs) and costs. The results were analysed with a sensitivity analysis and a scenario analysis of a clinical trial of a similar procedure. Results Preventing complications seemed to be effective in reducing hospital costs, but resulted in a limited improvement of health outcomes. Improving 30-day survival demonstrated to have a larger effect on health outcomes. A scenario analysis of data from a clinical trial studying similar procedures resulted in a cost reduction of €2974 and an increase of 0.016 QALYs per patient. Conclusion Reduced healthcare costs and improved health outcomes from reducing complications and 30-day mortality could offset the increased cost of MICE and lead to a cost-effective innovation. We advise close monitoring of short and long term survival outcomes in future studies.

Calcium Jacket of Left Ventricle: An Aristocracy of the Monster

Extensive myocardial dystrophic calcification is rare and indicates a poor prognosis with a risk of arrhythmia and recurrent heart failure. We present a long term survivor of extensive myocardial infarction presenting as myocardial calcification related unstable ventricular tachycardia needing an implantable cardioverter defibrillator.

Thyroid Disorders in Pediatric Long Term Survivors after Hematopoietic Stem Cell Transplantation

Background Thyroid dysfunction is one of the major long term endocrinopathies shown after hematopoietic stem cell transplantation (HSCT), it is usually described after total body irradiation, thyroid dysfunction after the use of chemotherapy only in conditioning regimen was evaluated in our study. Aim of the Study To assess the frequency of thyroid dysfunction after HSCT in children using chemotherapy only in conditioning and to relate the thyroid dysfunction after HSCT to the underlying disease and transplant related factors. Subjects and methods This cross sectional observational study was conducted over 12 months duration, from 1st of September 2020 to 1st of September 2021, at Pediatric Transplant Unit, Children,s hospital, Ain Shams University, on pediatric long term survivors who received HSCT in the duration between 2011 to 2019. They were investigated for thyroid dysfunction by measuring Thyroid-stimulating hormone (TSH), free thyroxine (Free T4) and free triiodothyronine (Free T3), Antithyroglobulin antibody (Anti-TG) and by thyroid US. Results The frequency of thyroid dysfunction among the long term survivors was 30% (6/20) including: subclinical hypothyroidism 50%, subclinical hyperthyroidism 16.7%, primary hyperthyroidism 16.7% and graves’ disease 16.7%. The most common thyroid disorder was subclinical hypothyroidism. No significant correlation was observed between the frequency of thyroid disorders and type of conditioning regimen used (p = 0.16), underlying disease (p = 0.5), age at transplantation(p = 0.35). Also, no significant correlation was observed between the thyroid disorders and graft versus host disease (GVHD) (p = 0.92) or Anti-TG (p = 0.26). Conclusion HSCT recipients had a high frequencyyof thyroid gland disorders, therefore, the thyroid status of each HSCT recipient should be screened before and after transplant. These findings also emphasize the need for long-term monitoring of thyroid function following HSCT.

Nationwide analysis of unplanned conversion during minimally invasive distal pancreatectomy for pancreatic adenocarcinoma

BackgroundUtilization of minimally-invasive distal pancreatectomy (MIDP) for pancreatic adenocarcinoma has increased. While unplanned conversion to an open procedure during MIDP is associated with inferior short-term outcomes, the long-term consequences of conversion have not been adequately examined. MethodsPatients with pancreatic adenocarcinoma undergoing MIDP were selected from the National Cancer Database (2010-2015) and subdivided based on the occurrence of unplanned conversion. Post-operative outcomes and overall survival (OS) were examined. Conversion was additionally compared to a matched group of planned open resections. ResultsAmong 592 patients undergoing attempted MIDP, unplanned conversion occurred in 23.1%. Despite increased 90-day mortality among patients experiencing conversion, there was no difference in median OS between groups (25.0 vs 27.8 months, p = 0.095). For patients undergoing conversion, post-operative outcomes and long-term survival were similar when compared to a propensity-matched group of patients undergoing planned open resection. On multivariable analysis, treatment at an academic facility (OR 0.63) and a robotic approach (OR 0.50) were both significantly associated with completed MIDP. ConclusionDespite inferior post-operative outcomes compared to successful MIDP, unplanned conversion did not result in significantly reduced long term survival. MIDP can be attempted selectively but treatment at experienced centers via a robotic approach should be considered.

ThTP4.1 Evaluation of Post-operative Outcomes in Laparoscopic &amp; Open Anterior Resections (AR) for Rectal Cancer: A 15 year cohort study

Abstract Aims AR offers sphincter preserving surgery for rectal cancers, &amp; has functionally comparable results to APER's or Hartmann’s resection. Use of mechanical stapling devices has allowed laparoscopic AR to become widely available. Aim of study is to evaluate post-operative outcomes in laparoscopic AR’s. Methods A cohort study collated post-operative outcomes in laparoscopic AR’s performed at a single-centre from January 2008 to February 2023. Open AR’s were recruited as controls. Results Conclusion Laparoscopic AR accounted for prolonged operative times &amp; shorter hospital stay. There were no differences in early post operative mortality &amp; complications. Laparoscopic AR had better long term survival, This could be explained by better case selection for laparoscopic AR (since laparoscopic resection were adopted as routine practise, as opposed to open AR became less employed in recent years).

MOY 3 Management of acute cholecystitis in Scotland: A population wide cohort study

Abstract Aims Acute cholecystitis (AC) is a common Emergency General Surgery presentation, and is managed either by a cholecystectomy or conservatively. Surgery during the acute inflammatory phase has been shown to be safe and superior, however, operative rates vary widely. Also, medium-long term survival rates with each approach are still not definitively established. This real-world population analysis aims to describe the current management and outcomes of patients with AC across Scotland. Methods This was a national cohort study using data obtained from Information Services Division, Scotland. All adult patients with the admission diagnostic code for AC were included. Patient level data were used to identify all patients admitted to Scottish hospitals between 1997-2019 and outcomes tracked for inpatients or after discharge through the unique patient identifier. This was mapped to mortality data to establish date and cause of death. Results 47558 patients diagnosed with AC, admitted in one of 46 hospitals were included. These patients accounted for 58824 episodes (27.2% of patients encountered &amp;gt;1 episode). The study population had a median age of 58 years (IQR=43-71), 64.4% were female, and most had no comorbidities. 28741(60.4%) patients had an operative intervention during the index admission. Patients who had an operation during their index admission had a lower risk of 90-day mortality compared to non-operative management (OR 0.62, 95% CI 0.55-0.70). Conclusions In this comprehensive analysis of AC in Scotland, 60% of patients had an index cholecystectomy. Patients undergoing surgery had a superior survival to those managed conservatively, further advocating for an operative approach in this cohort.