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2081 Synchronous colorectal liver metastases surgical treatment outcomes: Oncological coloproctological unit experience
Abstracts 2079 POSTER Risk factors for metachronous colorectal cancer following a primary colorectal cancer: A prospective cohort study H. Jayasekara1 , J. Reece1 , S.G. Dashti1 , D. Buchanan2 , C. Rosty2 , F. Macrae3 , A. Boussioutas3 , G. Giles4 , D. Ahnen5 , J. Lowery6 , G. Casey7 , R. Haile8 , S. Gallinger9 , L. Le Marchand10 , P. Newcomb11 , N. Lindor12 , J. Hopper1 , S. Parry13 , M. Jenkins1 , A. Win1 . 1 The University of Melbourne, Melbourne School of Population and Global Health, Melbourne, Australia; 2 The University of Melbourne, Department of Pathology, Melbourne, Australia; 3 The University of Melbourne, Department of Medicine, Melbourne, Australia; 4 Cancer Council Victoria, Cancer Epidemiology Centre, Melbourne, Australia; 5 University of Colorado School of Medicine, Department of Medicine, Denver, USA; 6 University of Colorado School of Public Health, Department of Epidemiology, Denver, USA; 7 University of Southern California, Department of Preventive Medicine, Keck School of Medicine and Norris Comprehensive Cancer Center, Los Angeles, USA; 8 Stanford University, Stanford Cancer Institute, Stanford, USA; 9 University of Toronto, Lunenfeld Tanenbaum Research Institute, Toronto, Canada; 10 University of Hawaii, University of Hawaii Cancer Center, Honolulu, USA; 11 Fred Hutchinson Cancer Research Center, Public Health Sciences Division, Seattle, USA; 12 Mayo Clinic Arizona, Department of Health Science Research, Phoenix, USA; 13 Auckland City Hospital, New Zealand Familial Gastrointestinal Cancer Service, Auckland, New Zealand Background: Individuals diagnosed with a colorectal cancer are at a higher risk of developing a metachronous colorectal cancer. We examined the associations between personal, tumor-related and lifestyle risk factors, and the risk of metachronous colorectal cancer. Materials and Methods: A total of 8,037 participants from the Colon Cancer Family Registry diagnosed with incident colon or rectal cancer between 1997 and 2010 were followed up approximately every 5 years. High-risk participants including those with Lynch syndrome and familial adenomatous polyposis were excluded. We estimated the risk of metachronous colorectal cancer, defined as an incident new primary colorectal cancer after an interval of at least one year following the initial colorectal cancer diagnosis. Cox regression was used to derive hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between personal, tumor-related and lifestyle factors, and the risk of metachronous colorectal cancer. Results: During a mean follow-up of 6.6 years, 150 metachronous colorectal cancers were diagnosed at a mean age of 59.8 (standard deviation, 12.5) years and an incidence of 2.8 per 1000 person-years. An increased risk of metachronous colorectal cancer was associated with the presence of a synchronous colorectal cancer at initial diagnosis (HR: 2.37, 95% CI: 1.20–4.67) and the location of the initial colorectal cancer in the proximal colon (compared with distal colon or rectum, HR, 4.15; 95% CI, 2.83–6.09). There was no evidence for associations between lifestyle factors and the risk of metachronous colorectal cancer. Conclusions: Our findings suggest that the presence of a synchronous colorectal cancer at initial diagnosis and the location of the initial colorectal cancer should be considered when deciding on the intensity of surveillance colonoscopy in individuals diagnosed with colorectal cancer. No conflict of interest. 2080 POSTER Long-term results of oncological and functional outcome after intersphincteric resection for low rectal cancer: It’s sphincter preservation!? 1 ¨ , J. Klose1 , T. Bruckner2 , Y. Kulu1 , S. Trefz1 , M. Schneider1 , M. Buchler A. Ulrich1 . 1 Uniklinik Heidelberg, General Surgery, Heidelberg, Germany; 2 Uniklinik Heidelberg, Medical Biometry and Informatics, Heidelberg, Germany
Background: Intersphincteric resection (ISR) represents a surgical approach to preserve sphincter function in contrast to abdominoperineal resection (APR) for patients with low rectal cancer. Although it is assumed that the oncological outcome after ISR is acceptable, the benefit of sphincter preserving surgery concerning functional outcome and its impact on patients’ quality of life (QoL) is still under debate. This study aimed to investigate the oncological and functional long-term results and QoL of patients with low rectal cancer who underwent ISR. Material and Methods: Patients who underwent ISR or APR for low rectal cancer between October 2001 and December 2012 were identified from a retrospective rectal cancer database. Postoperative complications were classified according to the Clavien–Dindo score. The Wexner incontinence score was used to assess sphincter function. Functional outcome and QoL was further determined by using the European Organization for Research
S355 and Treatment of Cancer (EORTC) QLQ-CR29 and C30 questionnaires. Univariate and multivariate analysis using Cox regression were used to determine relevant clinical variables and independent predictors for oncological and functional outcome. Results: 60 ISRs and 83 APRs were performed. There was no difference in postoperative complications (p = 0.92). 3-/5-year survival rates after ISR and APR were 85%/84% and 80%/70%, respectively. 3-/5-year disease-free survival rates were 75%/76% and 69%/64%, respectively (p = 0.2872 and p = 0.4635, respectively). Tumour recurrence was more often observed in patients who underwent ISR (p = 0.02). Results of the Wexner score (mean 10.6 points) and QLQ-CR29 and C30 questionnaires indicated accumulated incidence of fecal incontinence among patients who underwent ISR. However, QoL was superior to patients after APR (60 vs. 50.9 points). UICC stage and the absence of tumour recurrence were associated with prolonged survival in univariate and multivariate analysis (each p < 0.001). Long-course chemoradiation was the only variable associated with poor functional results (p = 0.027). Conclusions: ISR for low rectal cancer achieves acceptable longterm oncological results. Although patients after ISR complained about limitations in based on impaired fecal function, general satisfaction and QoL after surgery was observed in the majority of the patients. ISR remains an alternative surgical technique for low rectal cancer. Impaired functional outcome should be discussed with the patient individually in advance to avoid disaffection. No conflict of interest. 2081 POSTER Synchronous colorectal liver metastases surgical treatment outcomes: Oncological coloproctological unit experience I. Rebeko1 , D. Hapanovich2 , D. Michnuk2 , D. Chizh2 . 1 N.N. Alexandrov National Cancer Centre, Oncopathology of Hepatopancreatobiliary System department, Minsk, Belarus; 2 N.N. Alexandrov National Cancer Centre, Oncological Coloproctological department, Minsk, Belarus Background: The rationality of simultaneous operations or neoadjuvant treatment and/or two-stage surgery of synchronous colorectal liver metastases (sCRLM) remains debatable. Material and Methods: A prospective study was conducted to analyze the data of 244 patients with sCRLM undergoing treatment from 2002 to 2013 in oncological coloproctological unit. The patients were divided into a surgery group (SG, n = 79) with simultaneous operations and a group undergoing neoadjuvant treatment or two-stage surgery (NT/TSSG, n = 165). Groups were comparable by age, sex, number of metastasis, frequency of bilobal and extrahepatic metastasis. Results: Total postoperative mortality rate has amounted to 2,9% (1,3% in SG; 3,7% in NT/TSSG, p=0,43). Intraoperative blood loss and average metastases size were lower in SG (350,0 ml vs 400,0 ml, p = 0.02; 2,0 cm vs 2,7 cm, p = 0.002). Median and overall 5-year survival have amounted to 40,1 months and 0,37 in NT/TSSG vs 49,4 and 0,36 in SG (p=0,69). Median and 5-year recurrence free survival have amounted to 27,6 months and 0,15 in NT/TSSG vs 27,5 and 0,14 in SG (p=0,69). Conclusions: We conclude that simultaneous surgery in sCRLM has no disadvantages, in comparison with the two stage surgery or surgery with neoadjuvant therapy, in illustrating acceptable short- and long-term sCRLM treatment results and is also cheaper, because no more than one hospitalization is needed. No conflict of interest. 2083 POSTER Resection of lung metastases from colorectal cancer: Analysis of outcome and prognostic factors A. Cassano1 , M.T. Congedo2 , E. D’Argento3 , C. Pozzo3 , E. Rossi3 , S. Margaritora2 , D. Nachira2 , A. Orlandi3 , G. Schinzari3 , M. Quirino3 , C. Bagala` 3 , P. Granone2 , C. Barone3 . 1 Policlinico A. Gemelli, Universita` Cattolica del Sacro Cuore, Oncologia Medica, Rome, Italy; 2 Policlinico Universitario A. Gemelli, Thoracic Surgery Unit, Rome, Italy; 3 Policlinico Universitario A. Gemelli, Oncologia Medica, Rome, Italy Background: Surgical removal of liver metastases can provide a chance of cure for selected patients (pts) with metastatic colorectal cancer (CRC). Less data are currently available on CRC lung metastases resection. The aim of our study was to analyse the effectiveness of CRC lung or lung and hepatic metastases resection. Methods: We retrospectively analysed outcome and clinicopathologic features of 79 pts who underwent only lung or both liver and lung resection for metastatic CRC from 2000 to 2014 at our institution.
Background: Intersphincteric resection (ISR) represents a surgical approach to preserve sphincter function in contrast to abdominoperineal resection (APR) for patients with low rectal cancer. Although it is assumed that the oncological outcome after ISR is acceptable, the benefit of sphincter preserving surgery concerning functional outcome and its impact on patients’ quality of life (QoL) is still under debate. This study aimed to investigate the oncological and functional long-term results and QoL of patients with low rectal cancer who underwent ISR. Material and Methods: Patients who underwent ISR or APR for low rectal cancer between October 2001 and December 2012 were identified from a retrospective rectal cancer database. Postoperative complications were classified according to the Clavien–Dindo score. The Wexner incontinence score was used to assess sphincter function. Functional outcome and QoL was further determined by using the European Organization for Research
S355 and Treatment of Cancer (EORTC) QLQ-CR29 and C30 questionnaires. Univariate and multivariate analysis using Cox regression were used to determine relevant clinical variables and independent predictors for oncological and functional outcome. Results: 60 ISRs and 83 APRs were performed. There was no difference in postoperative complications (p = 0.92). 3-/5-year survival rates after ISR and APR were 85%/84% and 80%/70%, respectively. 3-/5-year disease-free survival rates were 75%/76% and 69%/64%, respectively (p = 0.2872 and p = 0.4635, respectively). Tumour recurrence was more often observed in patients who underwent ISR (p = 0.02). Results of the Wexner score (mean 10.6 points) and QLQ-CR29 and C30 questionnaires indicated accumulated incidence of fecal incontinence among patients who underwent ISR. However, QoL was superior to patients after APR (60 vs. 50.9 points). UICC stage and the absence of tumour recurrence were associated with prolonged survival in univariate and multivariate analysis (each p < 0.001). Long-course chemoradiation was the only variable associated with poor functional results (p = 0.027). Conclusions: ISR for low rectal cancer achieves acceptable longterm oncological results. Although patients after ISR complained about limitations in based on impaired fecal function, general satisfaction and QoL after surgery was observed in the majority of the patients. ISR remains an alternative surgical technique for low rectal cancer. Impaired functional outcome should be discussed with the patient individually in advance to avoid disaffection. No conflict of interest. 2081 POSTER Synchronous colorectal liver metastases surgical treatment outcomes: Oncological coloproctological unit experience I. Rebeko1 , D. Hapanovich2 , D. Michnuk2 , D. Chizh2 . 1 N.N. Alexandrov National Cancer Centre, Oncopathology of Hepatopancreatobiliary System department, Minsk, Belarus; 2 N.N. Alexandrov National Cancer Centre, Oncological Coloproctological department, Minsk, Belarus Background: The rationality of simultaneous operations or neoadjuvant treatment and/or two-stage surgery of synchronous colorectal liver metastases (sCRLM) remains debatable. Material and Methods: A prospective study was conducted to analyze the data of 244 patients with sCRLM undergoing treatment from 2002 to 2013 in oncological coloproctological unit. The patients were divided into a surgery group (SG, n = 79) with simultaneous operations and a group undergoing neoadjuvant treatment or two-stage surgery (NT/TSSG, n = 165). Groups were comparable by age, sex, number of metastasis, frequency of bilobal and extrahepatic metastasis. Results: Total postoperative mortality rate has amounted to 2,9% (1,3% in SG; 3,7% in NT/TSSG, p=0,43). Intraoperative blood loss and average metastases size were lower in SG (350,0 ml vs 400,0 ml, p = 0.02; 2,0 cm vs 2,7 cm, p = 0.002). Median and overall 5-year survival have amounted to 40,1 months and 0,37 in NT/TSSG vs 49,4 and 0,36 in SG (p=0,69). Median and 5-year recurrence free survival have amounted to 27,6 months and 0,15 in NT/TSSG vs 27,5 and 0,14 in SG (p=0,69). Conclusions: We conclude that simultaneous surgery in sCRLM has no disadvantages, in comparison with the two stage surgery or surgery with neoadjuvant therapy, in illustrating acceptable short- and long-term sCRLM treatment results and is also cheaper, because no more than one hospitalization is needed. No conflict of interest. 2083 POSTER Resection of lung metastases from colorectal cancer: Analysis of outcome and prognostic factors A. Cassano1 , M.T. Congedo2 , E. D’Argento3 , C. Pozzo3 , E. Rossi3 , S. Margaritora2 , D. Nachira2 , A. Orlandi3 , G. Schinzari3 , M. Quirino3 , C. Bagala` 3 , P. Granone2 , C. Barone3 . 1 Policlinico A. Gemelli, Universita` Cattolica del Sacro Cuore, Oncologia Medica, Rome, Italy; 2 Policlinico Universitario A. Gemelli, Thoracic Surgery Unit, Rome, Italy; 3 Policlinico Universitario A. Gemelli, Oncologia Medica, Rome, Italy Background: Surgical removal of liver metastases can provide a chance of cure for selected patients (pts) with metastatic colorectal cancer (CRC). Less data are currently available on CRC lung metastases resection. The aim of our study was to analyse the effectiveness of CRC lung or lung and hepatic metastases resection. Methods: We retrospectively analysed outcome and clinicopathologic features of 79 pts who underwent only lung or both liver and lung resection for metastatic CRC from 2000 to 2014 at our institution.