SummaryResearchers worldwide with information about the Kirsten ras (Ki-ras) tumour genotype and outcome of patients with colorectal cancer were invited to provide that data in a schematized format for inclusion in a collaborative database called RASCAL (The Kirsten ras incolorectal-cancer collaborative group). Our results from 2721 such patients have been presented previously and for the first time in any common cancer, showed conclusively that different gene mutations have different impacts on outcome, even when the mutations occur at the same site on the genome. To explore the effect of Ki-ras mutations at different stages of colorectal cancer, more patients were recruited to the database, which was reanalysed when information on 4268 patients from 42 centres in 21 countries had been entered. After predetermined exclusion criteria were applied, data on 3439 patients were entered into a multivariate analysis. This found that of the 12 possible mutations on codons 12 and 13 of Kirsten ras, only one mutation on codon 12, glycine to valine, found in 8.6% of all patients, had a statistically significant impact on failure-free survival (P = 0.004, HR 1.3) and overall survival (P = 0.008, HR 1.29). This mutation appeared to have a greater impact on outcome in Dukes' C cancers (failure-free survival, P = 0.008, HR 1.5; overall survival P = 0.02, HR 1.45) than in Dukes' B tumours (failure-free survival, P = 0.46, HR 1.12; overall survival P = 0.36, HR 1.15). Ki-ras mutations may occur early in the development of pre-cancerous adenomas in the colon and rectum. However, this collaborative study suggests that not only is the presence of a codon 12 glycine to valine mutation important for cancer progression but also that it may predispose to more aggressive biological behaviour in patients with advanced colorectal cancer. © 2001 Cancer Research Campaign http://www.bjcancer.comIt is widely accepted that mutations in the Kirsten ras (Ki-ras) gene in patients with colorectal cancer develop early in the progression from adenoma to carcinoma. Our first collaborative study including 2721 patients, clarified that Ki-ras mutations are not only 692

Conversion rates for laparoscopic colectomy are dependent on a multitude of factors that require appropriate adjustment including the learning curve (operative experience) for individual surgeons. The laparoscopic model described can be used as the basis for performance monitoring between or within institutions.

An international working party was convened in Rome, Italy on 16-17 June, 2005, with the purpose of developing a consensus on the application of the circular stapling instrument to the treatment of certain rectal conditions, the so-called Stapled Transanal Rectal Resection (STARR). Since the procedure has been submitted to only limited objective analysis it was felt prudent to hold a meeting of interested individuals for the purpose of evaluating the current status and to make conclusions and recommendations concerning the applicability of this new approach.

The CUSUM method was a useful tool for objectively measuring performance during the learning phase of IPAA surgery. With adequate training, supervision, and monitoring, the learning curve in IPAA surgery may be reduced even further.

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These data define the metrics of performance for hand-assisted and straight laparoscopic colectomy on an augmented reality simulator. The improved scores with the hand-assisted approach suggest that with this simulator a hand-assisted model may be technically easier to perform, although it is associated with increased intraoperative errors.

Aims: Fast track postoperative protocols can yield a 4.3‐day (d) stay after intestinal surgery, compared to 7–10 d with traditional (TRAD) approaches. Patient satisfaction, quality of life and pain are poorly understood after abdominal surgery, and have not been compared after fast track and traditional care. Methods: Sixty‐four intestinal resection cases were randomly allocated to CREAD (controlled rehabilitation with early ambulation and diet) or TRAD. CREAD cases received: no NG tubes; ambulation and liquids on d 1; soft diet, oral analgesia on d 2. TRAD patients had: NG tubes; liquids, oral analgesia and diet after bowel function; ambulated on d 2. Postoperative endpoints at discharge, d 10 and d 30 used the Short Form‐36 quality of life form, Cleveland clinic global quality of life scale (CGQL) and the McGill pain score. Results: Length of stay including readmissions was 5.4 d in CREAD and 7.1 d in TRAD patients (P = 0.02). Changes in the mental component of the SF36 (reduced from 51 to 42, P < 0.01), and McGill score (increased from 3.9 to 7.6, P < 0.05) in CREAD patients at discharge, were resolved at d 10 and d 30, and are attributed to the shorter stay of CREAD patients. There were no differences in any other variable at any time. Conclusions: Patients using the CREAD had a shorter postoperative stay, without altered quality of life or pain scores on d 10 and d 30 after surgery, when compared to patients managed by the TRAD approach. It should be considered as a primary care pathway for patients undergoing intestinal resection.