Background The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown.

Purpose The B-MaP-C study investigated changes to breast cancer care that were necessitated by the COVID-19 pandemic. Here we present a follow-up analysis of those patients commenced on bridging endocrine therapy (BrET), whilst they were awaiting surgery due to reprioritisation of resources. Methods This multicentre, multinational cohort study recruited 6045 patients from the UK, Spain and Portugal during the peak pandemic period (Feb–July 2020). Patients on BrET were followed up to investigate the duration of, and response to, BrET. This included changes in tumour size to reflect downstaging potential, and changes in cellular proliferation (Ki67), as a marker of prognosis. Results 1094 patients were prescribed BrET, over a median period of 53 days (IQR 32–81 days). The majority of patients (95.6%) had strong ER expression (Allred score 7–8/8). Very few patients required expedited surgery, due to lack of response (1.2%) or due to lack of tolerance/compliance (0.8%). There were small reductions in median tumour size after 3 months’ treatment duration; median of 4 mm [IQR − 20, 4]. In a small subset of patients (n = 47), a drop in cellular proliferation (Ki67) occurred in 26 patients (55%), from high (Ki67 ≥ 10%) to low (< 10%), with at least one month’s duration of BrET. Discussion This study describes real-world usage of pre-operative endocrine therapy as necessitated by the pandemic. BrET was found to be tolerable and safe. The data support short-term (≤ 3 months) usage of pre-operative endocrine therapy. Longer-term use should be investigated in future trials.

Case-matched comparison of short and middle term survival after laparoscopic versus open rectal 303 1 3 SummaryBackground Individual surgeons' experience and surgical outcome remain major contributors towards the successful treatment of rectosigmoid malignancy.Methods Only elective and curative resections (i.e. absence of distant metastases) were selected into each group to ascertain homogeneity and match for tumour stage. In all, 100 successive open rectal and rectosigmoid resections were compared with 100 similar laparoscopic procedures between 1st February 2005 and 31st December 2009 performed. A retrospective analysis was carried out and the patients were subsequently followed up until 30th April 2012.Results Anastomotic insufficiency was found in two patients (laparoscopic) and in five patients (open). The two groups were also compared for hospital stay and operating time (laparoscopic group spent statistically significant less time, operating time were statistically significant shorter). During the follow-up period (laparoscopic group 41.6 months, open group 39.8 months) similar survival and recurrence rates were found: locoregional recurrence 1 and 4, distant metastases 20 and 22, respectively. There were 13 cancer deaths in laparoscopic group to 19 in open group, the average 3-year survival being 76 % and 69 %, respectively. The long-term oncological results in more advanced tumours are superior, albeit not significantly. The difference in incidence of incisional herniae (laparoscopic:open = 4:18) identified during the follow-up period was found significant.Conclusion When comparing laparoscopic with open rectal and rectosigmoid resections there could be no inferior oncological outcome identified, hence the two techniques can be considered equivalent; in fact, due to its advantages laparoscopic rectosigmoid cancer surgery is the preferred option over open. Review304 Case-matched comparison of short and middle term survival after laparoscopic versus open rectal

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