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15th International Coloproctology Meeting Turin, April 17–18, 2018 PREOPERATIVE RADIOCHEMOTHERAPY AFFECTS POSTOPERATIVE OUTCOMES AND FUNCTIONAL RESULTS AT 1 YEAR IN PATIENTS TREATED BY TEM FOR RECTAL NEOPLASMS G. Rizzo, C. Mattana, D. P. Pafundi, F. Sionne, L. Amodio, M. A. Gambacorta*, V. Valentini*, C. Coco Polo Apparato Digerente e Sistema Endocrino-Metabolico Area Chirurgica Addominale, *Polo Oncologia e Ematologia Area Radioterapia, Fondazione Policlinico Universitario ‘‘Agostino Gemelli’’ Università Cattolica del Sacro Cuore Rome, Italy Background The aim of this study was to quantify the incidence of short-term (within 30 days) postoperative (p.o.) complications and functional disorders at 1 year after transanal endoscopic microsurgery (TEM). The secondary objective was to analyze the effect of preoperative radiochemotherapy (RCT) on the morbidity rate and the longterm functional outcome, by a comparative analysis of patients undergoing TEM after RCT and those treated by TEM without preoperative RCT. Methods All patients treated with TEM at our institution from 2000 to 2015 for rectal adenoma or early rectal cancer (no RCT group) and for locally advanced extraperitoneal rectal cancer after major or complete clinical response after preoperative RCT (RCT group) were included in the study. Short-term p.o. morbidity and mortality after TEM were recorded, and complications were graded according to the Clavien-Dindo classification. At 1 year from surgery the functional results after TEM were evaluated according to the Wexner incontinence score and Cleveland Clinic evacuation score which is a 0–28 score (28 = no evacuatory problem) devised to assess function of colonic J pouch [1]. A statistical analysis uniand multivariate analysis of factors influencing morbidity, suture dehiscence, incontinence and constipation score was performed. In particular, we analyzed the role of preoperative RCT on functional outcomes. Results Ninety-seven patients entered the study (RCT group: 36 and no RCT group: 61). No postoperative mortality occurred. The rate of postoperative complications was 20.6%, significantly higher in the RCT group (41.7 vs 8.2%; p\ 0.001), but only 2.1% were grade C 3 according to the Clavien-Dindo classification. At multivariate analysis of factors predicting complications, only preoperative RCT was significantly related to morbidity (p 0.007; OR 9.697). The most frequent complication was suture dehiscence (12.4%), significantly higher in the RCT group (27.8 vs 1.9% in no RCT group; p\ 0.001). Preoperative RCT (p 0.005; OR 29.220) and more than 1 involved rectal quadrants (p 0.026; OR 7.113) were significantly related (at multivariate analysis) to suture dehiscence. At 1 year after surgery the overall mean Wexner and Cleveland Clinic scores were, respectively 1 ± 1.761 and 25 ± 2.966. These scores were significantly worse in previously irradiated patients (Wexner score: 1.633 ± 1.866 vs 0.768 ± 1.629 in the noRCT group, p 0.015; Cleveland Clinic evacuation score: 24.100 ± 2.820 vs 25.714 ± 2.909 in the no RCT group, p 0.028). At multivariate analysis preoperative RCT was the only indipendent variable significantly related to a worse Wexner score (p 0.029; OR 2.217). Female gender was the only variable significantly related to a worse evacuation score (p 0.034; OR 2.157). Conclusions TEM is a safe procedure with low risk of severe postoperative morbidity. Suture dehiscence is the most frequent complication. Preoperative RCT seems to be related to a higher rate of morbidity and, particularly, to a higher rate of suture dehiscence. Functional results at 1 year from TEM are satisfactory both in RCT and no RCT groups. However, preoperative RCT seems to affect functional outcome, especially the Wexner score. Table 1 Outcome and functional results at 1 year in the RCT and no RCT groups Outcome RCT group No RCT group P value N. of patients 36 61 – Intra-operative complications 0% 0% 1.0