IntroductionDespite documented low risk (<1%) of stomal metastases and limited evidence-base, current BSG guidelines advocate a direct puncture approach to gastrostomy in head & neck cancers (HNC).1 We hypothesised that there would be a variation in the gastrostomy insertion practices for HNC and surveyed hospitals in our region and aimed to retrospectively determine the incidence of PEG site metastases at our centre where pull-through technique PEG is often the first line approach in HNC.MethodsFirstly, an electronic survey on gastrostomy insertion practices in HNC was circulated to all members of the regional Gastroenterology network (representing 11 NHS hospital trusts in the North West of England). Secondly, in a retrospective study, all PEG placements using pull-through technique for HNC at Lancashire Teaching Hospitals between 2011–2014 were reviewed. Data including patient demographics, tumour site, size, stage and histology, HNC treatments before and after PEG, PEG insertion details, length of follow-up, imaging of the PEG site post procedure and sites of recurrence, were recorded. Data are expressed as the mean (± standard error of the mean) unless stated otherwise.ResultsThe survey of endoscopists (n = 30, 11 consultants) from ten NHS trusts in the North West revealed that seven centres were compliant with BSG guidance (six using radiologically inserted gastrostomy techniques and one offering endoscopic gastropexy as first-line). Three centres use the pull-through technique for HNC. Only 2/30 (7%) of respondents (both consultants) have ever encountered a case of PEG site metastases in their careers post pull-through PEG insertion for HNC. In the retrospective study, 106 HNC patients (age 60 ± 1 years, 77 male, 29 female) were followed-up for 784 ± 40 days post pull-through PEG insertion. Most patients had tumours within the oral cavity (70%), 22% had tumours in the pharynx or below, with the remainder having neck lesions. Overall, in 92% of cases PEG placements were prophylactic (pre-treatment), 49% had documented peg removal at a mean time of 499 ± 45 days, 29% developed recurrent/ metastatic disease and 25% died at 488 ±54 days post PEG insertion. There were no cases of PEG site metastases identified, however only 36% had imaging of the PEG site post-procedure with most recent imaging available at 682 ± 102 days post-procedure.ConclusionOur survey highlights a variation in gastrostomy practices for HNC across the region. Despite the BSG guidelines, some centres still use the pull-through approach and our data suggest the risk of seeding with this approach is low.Reference1 Westaby D, et al. Gut 2010;59(12):1592–605.Disclosure of InterestNone Declared

PURPOSE Bladder-sparing trimodal therapy (TMT) is an alternative to radical cystectomy (RC) according to international guidelines. However, there are limited data to guide management of nonmetastatic clinically node-positive bladder cancer (cN+ M0 BCa). We performed a multicenter retrospective analysis of survival outcomes in node-positive patients to inform practice. METHODS Data from patients diagnosed with cN+ M0 BCa were collected from participating UK Oncology centers offering both TMT and RC. Overall survival (OS) and progression-free survival (PFS) outcomes were collected with details of treatment and clinical factors. RESULTS A total of 287 patients with cN+ M0 BCa were included in the survival analysis. Median OS across all patients was 1.55 years (95% CI, 1.35 to 1.82 years). Receiving radical treatments was associated with improved OS (hazard ratio [HR], 0.32; 95% CI, 0.23 to 0.44; P < .001) compared with receiving palliative treatment. Radically treated patients (n = 163) received RC (n = 76) or radical dose radiotherapy (RT, n = 87); choice of radical treatment showed no association with OS (HR, 0.94; 95% CI, 0.63 to 1.41; P = .76) or PFS (HR, 0.74; 95% CI, 0.50 to 1.08; P = .12) on multivariable analysis. CONCLUSION Patient cohorts with cN+ M0 BCa had equivalent survival outcomes whether treated with surgery or radical RT. Given the known morbidities of RC—in a patient group with poor survival—this study confirms that bladder-sparing TMT treatment should be a treatment option available to all patients with cN+ M0 BCa.

We present a newly recognized, likely autosomal recessive, pleiotropic disorder seen in four individuals (three siblings and their nephew) from a consanguineous family of Pakistani origin. The condition is characterized by hypogonadotropic hypogonadism, severe microcephaly, sensorineural deafness, moderate learning disability, and distinctive facial dysmorphic features. Autozygosity mapping using SNP array genotyping defined a single, large autozygous region of 13.1 Mb on chromosome 3p21 common to the affected individuals. The critical region contains 227 genes and initial sequence analysis of a functional candidate gene has not identified causative mutations.