The Outcome of Surgery for Colorectal Cancer in Very Elderly Patients

s / International Journal of Surgery 8 (2010) 501–578 524 Results: Out of 86 that units met the inclusion criteria, 66 units were successfully contacted. The United Kingdomwas the leading contributor of articles with 40% (34/86) of the total articles included, followed jointly by Germany and Sweden with 12% (10/86) each. Forty-nine (74%) followed their own recommendations, leaving 17 (26%) who did not. The UK formed the largest proportion of this group with 10 (58%) units who didn't implement recommendations internally. Conclusion: Most surgical units who publish recommendations in the British Journal of Surgery implement changes within department. However, there is significant proportion that don't “practice what they preach”. We discuss possible reasons for this. THE OUTCOME OF SURGERY FOR COLORECTAL CANCER IN VERY ELDERLY PATIENTS M.J.M. Douglas , T. Sammour , A. Kahokehr , A.B. Connolly , A.G. Hill . 1 University of Auckland; University of Aberdeen Aims: Colorectal cancer (CRC) is predominantly a disease of the elderly, and surgery remains the definitive treatment. Few studies focus on very elderly patients and their post-operative return to function. This study aimed to evaluate this with particular emphasis on pre and post-operative residential status, mobility level and morbidity. Methods: Retrospective review of data from 86 patients aged 85 or older at a single centre who had undergone surgery for primary CRC between 1993 and 2009 was undertaken. Data included demographics, mode of presentation, operation, length of hospitalisation, complications (predefined criteria), and 30-day mortality rates. Pre-operative morbidity and predicted mortality were categorised according to ASA and CR-Possum scores. Functional status was assessed by recording changes in residential care level and mobility. Results: Morbidity and mortality were less than expected according to ASA and CR-Possum scores, with median predicted mortality risk according to CR-Possum being 15.9%. Actual thirty-day mortality was 8% and seemingly was affected by mode of presentation (elective or emergency) rather than age. More than half of patients experienced no change in residential status (57%) or mobility(56%). Conclusions: Age alone should not be a barrier to CRC surgery, as outcomes seem favourable in selected very elderly patients. OUTCOME FOLLOWING WHIPPLE\'S PANCREATODUODENECTOMY IN THE ELDERLY: THE CAMBRIDGE EXPERIENCE R. Sivaprakasam, R. Lahiri, S. Mohamed, S. Liau, E.J. Huguet, N.V. Jamieson, R.K. Praseedom, A. Jah. Department of Hepatopancreaticobiliary Surgery, Addenbrookes Hospital Background: Whipple's procedure is a recognised surgical treatment for pancreatic malignancies. The safety and feasibility of whipple's procedure in elderly still remains a debate and evidence in the literature is limited. Aim: To assess the safety of whipple's procedure in elderly, we reviewed our experience and analysed the operative morbidity and medium term outcome. Methods: The study was performed in the last five years and all the patients above the age of 75 years were included in this study. The data was collected prospectively and the data collected were; demographics, co-morbidities, pancreatic leak, hospital stay and survival at 30 days, 1 and 3 years. Results: A total of 58 patients with amedian age of 77 years were included in this study . The mean tumour size was 22.93mm and 24.1% had R1 resection. The mean hospital stay was 23.3 days and incidence of pancreatic leak of 16.2%. Survival at 30 days, one and three years were 100%, 80% and 65%. Conclusion: Our experience demonstrates that thewhipple's procedure is feasible and safe in elderly. Therefore age alone should not be a deterrent in offering whipple's procedure as a treatment option in the management of pancreatic tumours. ANALYSIS OF THE ASSOCIATION BETWEEN HEREDITARY NEUROPATHY WITH LIABILITY TO PRESSURE PALSIES (HNPP) AND BILATERAL CUBITAL AND CARPAL TUNNEL SYNDROMES REQUIRING DECOMPRESSION A. Barnard, D. Armstrong, M. Arundell, F.D. Burke. Pulvertaft Hand Centre, Royal Derby Hospital, Derby, UK Compression syndromes of the median nerve at the wrist and ulnar nerve at the elbow are common, but it is unusual to have bilateral compressions of both nerves. Hereditary Neuropathy with liability to Pressure Palsies (HNPP) is an autosomal dominant sensorimotor mononeuropathy of the peripheral nervous system. It makes a patient more susceptible to demyelinating nerve injury from pressure, stretch or repetitive use. In 1992 the genetic basis of Charcot Marie Tooth was found to be due to duplication on Chromosome 17p11.2-12. This contains an important codon sequence for the production of myelin – peripheral myelin protein-22 gene (PMP22). A year later HNPP was found to be due to a deletion on the same gene and has been a focus of recent research as the reported prevalence of 1 in 2500 is thought to be largely underestimated. Patients presenting over the last 10 years to the Pulvertaft Hand Centre with nerve conduction study evidence of bilateral carpal and cubital tunnel syndromes were identified. 45 patients consented to genetic testing. No patients were found to have the PMP-22 deletion. Conclusion: There does not appear to be any evidence of an association between HNPP and bilateral carpal and cubital tunnel syndrome. DELIBERATE SELF-HARM IN THE GENERAL SURGICAL PRACTICE Ashraf Hassouna, Gabor Libertiny. Northampton General Hospital Aims: To review outcome of surgically treated adult deliberate self-harm patients. Methods: Patients admitted between 1995 and 2008with the diagnosis of self-harm were identified. Data were collected retrospectively. Results: 39 patients were identified with 78 admissions. 26 admissions were secondary to ingested foreign bodies (F.B) including razor blades, magnets, batteries, pens, coins and toothbrushes. 49 admissions were due to self-mutilation and two admissions for foreign bodies in the rectum. 13 episodes (50%) with F.B ingestion were treated conservatively, 8 (30%) were treated with endoscopic removal of F.B and 5 (20%) episodes required laparotomy. There was one hospital death as a result of aortoduodenal fistula from a biro impacted in the third part of the duodenum. One patient developed gastro-cutaneous fistula as a result of swallowed coins. Self –mutilation varied from minor laceration, insertion of F.B into skin to stab wounds. Total of 49 episodes of self-mutilation were recorded involving 22 patients. 12 episodes (25%) were treated conservatively.