Introduction The COVID-19 pandemic has led to changes in NHS surgical service provision, including reduced elective surgical and endoscopic activity, with only essential emergency surgery being undertaken. This, combined with the government-imposed lockdown, may have impacted on patient attendance, severity of surgical disease, and outcomes. The aim of this study was to investigate a possible ‘lockdown’ effect on the volume and severity of surgical admissions and their outcomes. Methods Two separate cohorts of adult emergency general surgery inpatient admissions 30 days immediately before (16 th February 2020 to 15 th March 2020), and after UK government advice (16 th March 2020 to 15 th April 2020). Data were collected relating to patient characteristics, severity of disease, clinical outcomes, and compared between these groups. Results Following lockdown, a significant reduction in median daily admissions from 7 to 3 per day (p<0.001) was observed. Post-lockdown patients were significantly older, frailer with higher inflammatory indices and rates of acute kidney injury, and also were significantly more likely to present with gastrointestinal cancer, obstruction, and perforation. Patients had significantly higher rates of Clavien-Dindo Grade ≥3 complications (p=0.001), all cause 30-day mortality (8.5% vs. 2.9%, p=0.028), but no significant difference was observed in operative 30-day mortality. Conclusion There appears to be a “lockdown” effect on general surgical admissions with a profound impact; fewer surgical admissions, more acutely unwell surgical patients, and an increase in all cause 30-day mortality. Patients should be advised to present promptly with gastrointestinal symptoms, and this should be reinforced for future lockdowns during the pandemic.

There continues to be large variation in margin policy and re-excision rates across units. Altering margin policies to follow either SSO-ASTRO or ABS guidelines would result in a modest reduction in the national re-excision rate. Most re-excisions are for involved margins rather than close margins.

INTRODUCTION There is increasing and conflicting research debating the oncological benefits of extralevator abdominoperineal excision (ELAPE) compared with standard abdominoperineal excision (SAPE). However, there is very little in the literature on the long-term effects on patients' wellbeing following the two procedures. The aim of this study was to determine the oncological outcomes and long-term quality of life (QoL) of patients at two hospitals having undergone ELAPE or SAPE. METHODS Consecutive patients with rectal cancer who underwent either ELAPE or SAPE between January 2009 and June 2015 at a single centre were analysed. Oncological outcomes were determined by histology and follow-up imaging. QoL data were obtained prospectively using the QLQ-C30 and QLQ-CR29 questionnaires. RESULTS A total of 48 patients (36 male, 12 female; 27 ELAPE, 21 SAPE) were reviewed. The mean age was 67.4 years and the median follow-up duration was 44 months (range: 6-79 months). Four patients (2 ELAPE, 2 SAPE) developed local recurrence. Rates of distant metastasis were similar (ELAPE: 11%, SAPE: 14%). There was no significant difference in mean global health status score (ELAPE: 77.3, SAPE: 65.3). Impotence was the most frequently reported problem (mean symptom scores of 89.7 and 78.8 for ELAPE and SAPE respectively). CONCLUSIONS This is the largest study with the longest follow-up period that compares QoL after ELAPE with that after SAPE. Although more radical in nature, ELAPE did not demonstrate any significant impact on QoL compared with SAPE. There was no significant difference in long-term oncological outcome between the groups. Impotence remains a significant problem for all patients and they should be well informed of this risk prior to surgery.

Background: Near-peer teaching initiatives has been shown to be a highly successful method of improving student learning. There has been little data on surgical teaching initiatives of this kind and little data to show if this improves student confidence in surgical topics. This study was designed to show whether a regional surgical teaching programme, delivered by junior doctors, improves confidence levels of students prior to their final examinations. Method: Final year medical students were invited from four hospitals in the Northern deanery of England to participate in a voluntary surgical teaching day. Junior doctors were then recruited to present on various surgical topics based on their own knowledge and experience of finals examinations and working on the wards. A pre and post-course questionnaire was designed, validated and distributed to the students to assess their confidence on a five-point Likert scale of 1-5 (1-most confidence, 5-least confidence) levels in each of the 11 chosen topics. Other variables were also measured relating to the topics including visual material, enthusiasm, content relevance and communication. Results: 53 students completed the questionnaire (n = 53). There were 31 females and 22 males with a mean age of 24.7. A mean level of confidence of 2.7 pre-course and 1.6 post-course showed an increase in confidence by 68.8%. All eleven topics covered showed improvement in confidence. General Surgical Principles showed the lowest improvement in confidence from 2.683 to 1.917 (p = <0.001) compared to endocrine which showed the maximum increased in confidence from 3.650 to 1.694 (p = <0.0001). Orthopedics showed an increased in confidence from 3.010 to 1.62 (p = <0.0001). Conclusion: Near-peer education designed by medical students and delivered by junior doctors is an effective way for improving confidence levels and test results prior to finals examination and is also valuable for junior doctors.

Background RCS Eng, the Royal College of Surgeons of England, has published much information with regard to the consenting process. A majority of patients seek health information through online resources as well as discussing with the care givers. Therefore, it is necessary that online material is both of high quality and reliable for patients. We aimed to evaluate the quality and standard of the online patient information on laparoscopic cholecystectomy to help in the consenting process. Methods A search was carried out as per the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Sources were assessed using five validated scoring tools: Flesch–Kincaid Reading Ease Score (readability), DISCERN and IPDAS scores (quality of content) and HONcode and the Information Standard Certification (standards of accreditation). Results The average readability of all websites was higher than recommended for patient literature. Less than half of the sources had received HONcode or Information Standard accreditation. On grading of quality and content, across validated scoring tools, no source achieved the minimum recommended level. Conclusion Online patient information related to laparoscopic cholecystectomy is of poor quality. We recommend a multidisciplinary approach to participate in publishing more readable online resources of a higher standard to help patients and clinicians in consent and shared decision making.