A 65-year-old man with a 2-month history of left-sided neck swelling presented through the cancer pathway. There was no associated 'red flag' symptoms, and clinical examination revealed a left anterior triangle, non-pulsatile firm swelling atypical of a lymph node. Ultrasound scan imaging confirmed a complex structure with an echogenic centre and hypoechoic periphery, which was confirmed on CT as an osteoma of the hyoid. This is an extremely unusual cause of a neck lump, and an extensive literature review revealed only two previously documented cases.

Aim: To evaluate the effects of profunda revascularisation in patients with critical limb ischaemia. Method: A retrospective cohort study, of consecutive patient over a 2-year period, selected based on the presence of critical limb ischaemia (rest-pain or minor tissue loss pre-operatively). The benefits of three revascularisa tion procedures targeting the profunda femoris artery were assessed: common femoral endarterectomy with profundaplasty(CFE), femoral femoral crossover with profundaplasty (FFXO) and axillo-bifemoral bypass with profundaplasty (AxBiF). Demographics, ABPI and clinical outcome were obtained. Result: 41 patients recruited; the group with pre-op rest-pain (n¼18) were subdivided into CFE (n¼10), FFXO (n¼5) and AxBiF (n¼3) and compared to the group with pre-op minor tissue loss undergoing CFE (n¼18), FFXO (n¼4) and AxBiF (n¼1). In the rest-pain group symptomatic relief was acheived in 17 patients (94%). In comparison, the group with minor tissue loss showed tissue healing in 74% (n¼17). ABPI measurements recorded from 7 patients (17%) all showing improvement post-op; mean improvement in ABPI of 0.3 and a range of 0.18-0.51. Conclusion: Profunda revascularisation enables symptomatic relief and limb salvage.

Introduction: Oncotype DX® analyses the expression of 21 genes within tumour tissue to determine a Recurrence Score® (RS). RS is a marker of risk for distant recurrence in oestrogen receptor-positive early breast cancer, allowing patient-specific benefit of chemotherapy to be evaluated. Our aim was to determine whether the introduction of Oncotype DX led to a net reduction in chemotherapy use. Methods: Consecutive patients that underwent Oncotype DX at Warwick Hospital were reviewed. Patients were anonymised and re-discussed at a multidisciplinary team meeting (MDM; without RS), and treatment recommendations were recorded. This was compared to the original MDM outcome (recommendations made with RS). Differences were analysed using Wilcoxon signed-rank test. Results: 67 patients were identified. Proportions of high, intermediate and low risk were 28, 33 and 39% (n = 19/22/26), respectively. Without RS, 56 (84%) patients were recommended for chemotherapy and 3 were not. The remaining 8 patients were deemed borderline for requiring chemotherapy and referred for discussion with an oncologist. With availability of RS, 34 (50%) patients were recommended for chemotherapy, and 24 (43%) patients were spared chemotherapy (p < 0.0005). The net reduction in chemotherapy was 33%. Conclusion: There has been a significant reduction in chemotherapy usage in patients at Warwick since the introduction of Oncotype DX. Keywords: Chemotherapy; Multigene assay; Oncotype DX; Recurrence Score.

This Association of Breast Surgery Conference abstract discusses the impact of the TAILORx Breast Cancer Trial on the recommendation of chemotherapy at Warwick Hospital.

This conference abstract from the 15th Scientific and Annual Meeting of the European Society of Coloproctology reports on a retrospective cohort study into the colorectal cancer diagnosis rate within 3 years of a normal lower gastrointestinal endoscopy.

This abstract from an Association of Breast Surgery 2020 presentation addresses the question of whether the pathological response in patients undergoing neoadjuvant chemotherapy corresponds to the apparent radiological response.

Poster presentation reporting a single-centre experience of telephone assessment of patients referred to two week-wait colorectal surgery clinics in England.

Introduction Laparoscopic Cholecystectomy (LC) is the gold standard treatment for symptomatic gallstones. The British Association of Day Surgery (BADS) recommend that at least 60% of LCs are performed as day cases. We investigated the rate of successful discharge for LCs and factors contributing to unexpected overnight stays. Methods Retrospective data analysis was performed on elective LCs between June-November 2019. Electronic records were reviewed for: admission and discharge date; time of procedure; length of procedure; training grade of the surgeon; use of total intravenous anaesthesia (TIVA) or volatile anaesthesia; use of IV morphine in theatre/recovery and reasons for failed discharge. Results A total of 119 patients underwent elective LC, of which 63 were planned day cases. 46 patients (73.0%) listed as day cases were successfully discharged the same day. LCs performed before 1pm had a success rate of 78.8% compared to 45.5% after 1pm (p < 0.05). There was no statistically significant difference in success rates due to length of procedure; training grade of the surgeon; method of induction (TIVA or Volatile) or use of IV morphine in theatre/recovery. 17 planned day cases failed same day discharge. 7 of these patients (41.2%) reported pain and 4 (23.3%) reported nausea, vomiting or dizziness. Conclusion This centre successfully discharged 73.0% of planned day case LCs, although only 52.9% of elective LCs were listed as day cases. Success rates were positively associated with am procedures compared to pm. We recommend a review of operation scheduling and evening staffing in order to increase the probability of discharge on the same day.

A conference poster on the use of isotope bone scans in asymptomatic patients with advanced breast cancer.

This is a teaching video for surgical trainees that takes a look at the pros and cons of early surgery for Crohn's disease and the influence of the L!RIC Trial on our thinking. The video is presented by both a surgeon and a gastroenterologist. The video is referenced and contains laparoscopic and endoscopic video as well as stills. The video lasts 4 minutes.