Background Radical surgery via total mesorectal excision might not be the optimal first-line treatment for early-stage rectal cancer. An organ-preserving strategy with selective total mesorectal excision could reduce the adverse effects of treatment without substantially compromising oncological outcomes. We investigated the feasibility of recruiting patients to a randomised trial comparing an organ-preserving strategy with total mesorectal excision.Methods TREC was a randomised, open-label feasibility study done at 21 tertiary referral centres in the UK. Eligible participants were aged 18 years or older with rectal adenocarcinoma, staged T2 or lower, with a maximum diameter of 30 mm or less; patients with lymph node involvement or metastases were excluded. Patients were randomly allocated (1:1) by use of a computer-based randomisation service to undergo organ preservation with short-course radiotherapy followed by transanal endoscopic microsurgery after 8-10 weeks, or total mesorectal excision. Where the transanal endoscopic microsurgery specimen showed histopathological features associated with an increased risk of local recurrence, patients were considered for planned early conversion to total mesorectal excision. A non-randomised prospective registry captured patients for whom randomisation was considered inappropriate, because of a strong clinical indication for one treatment group. The primary endpoint was cumulative randomisation at 12, 18, and 24 months. Secondary outcomes evaluated safety, efficacy, and health-related quality of life assessed with the European Organisation for Research and Treatment of Cancer (EORTC) QLQ C30 and CR29 in the intention-to-treat population. This trial is registered with the ISRCTN Registry, ISRCTN14422743.

These results indicate that changes in the bioavailability of VEGF-A sourced from ATII cells, namely the ratio of VEGF-Aa to VEGF-Ab, are critical in development of pulmonary fibrosis and may be a paradigm for the regulation of tissue repair.

A12 Thorax 2012;67(Suppl 2):A1-A204 Introduction Cardiopulmonary Exercise testing (CPET) has become an important tool for perioperative assessment as it may identify patients at risk of postoperative cardiopulmonary complications. Older (1) recommended that an Anaerobic Threshold (AT)<11 or >11ml/min/kg can be used to stratify post-operative treatment in colorectal patients (ITU, HDU or ward). The BTS guidelines (2) recommend that a Peak VO2 (PVO2)<15 or >15ml/ min/kg can be used as a risk assessment in thoracic surgical patients. However, CPET can be difficulty to carry out. This study was undertaken to determine whether selected lung function values correlated with CPET outcome, so that they could be used as an alternative to AT and PVO2. Method 500 pre-operative colorectal (388) and oesophageal (112) patients attending the Lung Function Department were analysed. Spirometry and Gas Transfer were performed to assess lung function. CPET was performed on a cycle ergometer to calculate PVO2 and AT. Results The area under the curve (AUC) of a Receiver Operating Curve (ROC) analysis was carried out on the 500 patients. This compared percent predicted FEV1, FVC, TLco and Kco values to PVO2 and AT. Abstract S21 Table 1 AUC FEV1 (% Predicted) FVC (% Predicted) TLco (% Predicted) Kco (% Predicted) PVO2 AT PVO2 0.560 0.557 0.721 0.625 1.00 0.894 AT 0.547 0.568 0.643 0.555 0.877 1.000 Discussion Our findings indicated that analysis of lung function variables cannot reliably predict PVO2 or AT outcome. However, of the variables recorded, TLco was the best marker for predicting a PVO2>15ml/min/kg (0.721). When the cutoff for TLco was set at 80% predicted it had a sensitivity and 1-specificity of 62% and 24% respectively. Interestingly, there was a significant correlation between AT and PVO2 (0.894), suggesting that AT can be used as a predictor of PVO2. If the cutoff for AT was set at 11ml/min/kg; the sensitivity was 91.7% and the 1-specificity 37.7%. However if the cutoff was adjusted to 12ml/min/kg; the sensitivity was 77.3% and the 1-specificity was 13.7%. Conclusion These results suggest that in pre-operative assessment of patients undergoing thoracic surgery, an AT>12ml/min/kg could be used as an alternative measure if the patient was unable to achieve a PVO2>15ml/min/kg. Reference 1. Older(1999). Cardiopulmonary exercise testing as a screening test for perioperative management of major surgery in the elderly. Chest; 116; 355-62. 2. BTS Guidelines on the selection of patients with lung cancer for surgery (2001). Thorax 56:89-108.

Compared with CD117, DOG1 (using the K9 antibody) is a more specific marker, whereas PKC theta (using the clone 27 antibody) is a considerably less specific immunohistochemical marker for GIST.

Although the inflammatory pathology of Crohn's disease is manifestly its most important attribute, the connective tissue changes are important in the genesis of the more chronic features of the disease, and yet these have received little attention from clinicians, pathologists, and scientists. Fat-wrapping appears to be pathognomonic of Crohn's disease, and is an important marker of disease for surgeons. There is evidence of a complex interplay between the effector inflammatory cells of Crohn's disease and adipocytes, hyperplasia of which results in fat-wrapping. Pathologically, this is exhibited in the close relationship between the transmural inflammation that is so characteristic of Crohn's disease and fat-wrapping. Fibrosis and muscularization are also important components of the chronic changes of intestinal Crohn's disease. Neuronal and vascular changes make up the remaining connective tissue changes: these constitute a distinctive feature, and are even specific for Crohn's disease. For pathologists, the combination of these connective changes will allow a diagnosis of chronic 'burnt-out' Crohn's disease, even in the absence of its highly characteristic inflammatory features. The connective tissue changes of Crohn's disease form an important part of its long-term pathology. They deserve more attention from clinicians, diagnostic pathologists and researchers alike.