1. Mr D Light ST5 Mr S Subramonia Consultant Laparoscopic Colorectal Surgeon Consultant Laparoscopic Colorectal Surgeon Mr A Krishna Consultant Laparoscopic Colorectal Surgeon and Consultant Laparoscopic Colorectal Surgeon and Lead for Colorectal Cancer

2.  152,600 population  100 – 120 colectomies a year for cancer  3 colorectal surgeons  2 colorectal nurse practitioners

3.  Appointment of two laparoscopic colorectal surgeons 2012 ◦ May 2012 Mr Subramonia ◦ June 2012 Mr Krishna  Changes in surgical practice  Enhanced recovery  Changes in endoscopic investigation

4.  37 procedures  Mean age 73 years (49 to 93 years)  26 laparoscopic (70%)  2 conversions (bleeding IMA on colon side, 1 adhesions)  One defunctioning ileostomy for laparoscopic low anterior resection ◦ Reversed at 3 months  Median post op stay ◦ 6.5 days overall (IQR 5 – 10) ◦ 7 days laparoscopic (IQR 4.5 – 10)

5. SurgeryNumber SILS R hemicolectomy8 (2 for adenomas) Laparoscopic R hemicolectomy5 Open R hemicolectomy7 Laparoscopic left hemicolectomy1 Open left hemicolectomy1 Laparoscopic assisted anterior resection4 Open anterior resection2 Laparoscopic sigmoid colectomy3 (2 benign) Open low Hartman’s3 Laparoscopic APR2 Open APR1 Open total colectomy1

6.  Two 28-day deaths (post op MI day 2, anastomotic leak day 20)  One 38-day death due to respiratory complications in known lung ca)  2 major complications (anastomotic leak day 12 post open R hemi – ileostomy formed, rectal stump blow out post open low Hartmans with abdo wall dehiscence)  4 pneumonia  1ileus

7. OutcomePastRecent Laparoscopic procedures 4%70% Post op stay12 days6.5 days Serious complications 38%27%

8.  Previous standard for colonic investigation was flexible sigmoidoscopy and CT colonography  Now simple and evidence based  Standardised follow up of lesions  Cancer follow up is now standardised to national guidelines