Although this study has not confirmed that laparoscopic surgery reduces rates of AIO and IH after colorectal cancer surgery, trends suggest that a reduction in conversion to open surgery and elimination of port-site hernias may produce such an effect. Registration number for CLASICC trial: ISRCTN74883561 (http://www.controlled-trials.com).

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abdomen and pelvis showed a necrotic mass in the left aspect of the pelvis that appeared to erode the sigmoid colon (Figure A). A sigmoidoscopy revealed a 2 cm area in the sigmoid colon with direct communication to a mass that was biopsied (Figure B). The pathology findings were consistent with RCC (Figure C). A transverse colostomy with mucous fistula was successful. She completed 14 days of antibiotic therapy and the fever resolved. Five months later she has had no complications and continued treatment with immunotherapy and radiation. Discussion: GI involvement by RCC is very rare and mostly occurs by metastatic spread to the small bowel. Approximately 5-15% of RCCs spread to nearby structures and 20-30% of patients have metastasis at the time of diagnosis. Formation of a TBF might occur spontaneously from tumor eroding to the bowel or as a consequence of chemotherapy and/or radiotherapy. Due to the retroperitoneal location of the kidney, the colon is almost never affected. From rare reported cases, patients mainly present with lower GI bleeding. In our patient, migration of colonic contents to the tumor mass via TBF may have led to superinfection of the mass. In the presence of intra-abdominal tumors, especially several metastatic masses, the presence of fever can be a sign of TBF and appropriate imaging with CT scan and careful endoscopic examination are necessary to establish a diagnosis and guide the surgical management.[2158] Figure 1. (A) CT scan of the abdomen and pelvis shows a necrotic mass in the left aspect of the pelvis that appears to erode the wall of the sigmoid colon; (B) Flexible sigmoidoscopy revealing a 2 cm erosion of the sigmoid colon with direct communication to the mass; (C) H&E image of the colon biopsy. The large cells with variably sized nuclei, sometimes prominent nucleoli and abundant eosinophilic cytoplasm form a sheet of neoplastic cells. On the right-hand side of the image the smaller cells are plasma cells and lymphocytes with a few neutrophils.

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e15597 Background: Patients with locally advanced rectal cancer (LARC) typically receive chemoradiation prior to surgery, followed by adjuvant chemotherapy (standard). Recently there has been a growing trend toward total neoadjuvant therapy (TNT), in which all chemotherapy is given in the neoadjuvant setting, having the advantage of higher chemotherapy completion rates. Data exploring adherence to both standard therapy and TNT within a vulnerable, underserved population is lacking. Within our safety-net hospital, we determined the chemotherapy completion rates for LARC patients who received TNT vs standard treatment. We also compared two populations within the standard treatment group- those who received all doses of prescribed adjuvant chemotherapy (AC) and those who did not. Methods: A retrospective chart review was performed for all patients with LARC (stage II or III) presenting to Los Angeles County + USC Medical Center from 2015 to 2020. Patients who progressed prior to receiving their first dose of chemotherapy and patients lost to follow-up were excluded. Patient demographics, stage, neoadjuvant/adjuvant treatment, operative characteristics, and postoperative course were abstracted. T-tests and Wilcoxon rank-sum tests were used to compare means and medians, respectively; chi-squared tests were used to compare categorical variables. Results: 67 patients were included- 59 in the standard group and 8 in the TNT group. Mean follow-up was 30 months. All patients in the TNT group completed neoadjuvant chemotherapy. In the standard treatment group, the overall AC completion rate was 81% (n = 48) (Complete Group). 19% (n = 11) did not receive all prescribed doses of AC (Incomplete Group). Compared to patients in the Incomplete Group, patients in the Complete Group were significantly older (mean age 55 vs 48, p = 0.017), had a shorter mean time interval from surgery to initiation of AC (9 weeks vs 13 weeks, p = 0.016), and were less likely to experience a delay in receiving AC > 90 days (15% vs 46%, p = 0.022). In total, 12 patients (20%) in the standard group experienced a delay in AC, of which six (50%) were due to anastomotic leak and/or pelvic abscess. Three of those patients who experienced a delay (25%) required either drain placement or re-operation to address their complication. More patients in the Complete Group went on to have their temporary stomas reversed compared to those in the Incomplete Group (94% vs 70%, p = 0.031). Conclusions: While this population had a high AC completion rate, a meaningful proportion of all patients (though more in the Incomplete Group) experienced a delay in AC > 90 days, with surgical complications responsible for the delay in half of these patients. In contrast, all patients who received TNT completed neoadjuvant chemotherapy. TNT may be a reasonable alternative to reduce therapy delays and further improve chemotherapy completion rates in an underserved population.