50. Cytoreductive surgery and HIPEC in treatment of colorectal peritoneal carcinomatosis: Experimental or standard care? A survey of surgical oncologists and medical oncologists

S28 partial ureteral resection in 13 patients and nephrectomy in one patient. Partial cystectomy was performed in 21 patients, and complete cystectomy with urinary diversion according to Bricker in 3 patients. At a median follow-up of 26.7 months, 160 patients (60%) were alive. The overall median survival was 32.0 months. There was no significant difference in overall survival following CRS+HIPEC between patients with and without involvement of the urological tract (median survival: 26.9 versus 32.1 months, P ¼ 0.29). In patients with an urological procedure during CRS+HIPEC, severe complications (grade3) occurred in 18 patients (47%), compared to 20% in patients without urological resection (OR 3.58, 95%-CI: 1.75 e 7.31, P < 0.001). In patients with an urological procedure, the most frequent complications were gastrointestinal leakage (n¼9) or intra-abdominal abscess formation (n¼5). In univariate analysis the following variables were significantly correlated to severe postoperative complications: regional PC score (OR 1.22, 95%-CI: 1.00 e 1.48, P ¼ 0.05), intraoperative blood loss (OR 1.36, 95%-CI: 1.05 e 1.78, P ¼ 0.02), operating time (OR 1.45, 95%-CI: 1.20 e 1.76, P < 0.001) and urological procedures (OR 3.58, 95%-CI: 1.75 e 7.31, P <0.001). In multivariate analysis, operating time (OR 1.38, 95%-CI: 1.08 e 1.77, P ¼ 0.01) and an urological procedure (OR 2.66, 95%-CI: 1.16-6.11, P ¼ 0.021) were significantly correlated to severe postoperative complications. Conclusions: Urological resections during cytoreduction and HIPEC in patients with peritoneal carcinomatosis of colorectal origin are feasible and effective. Severe complications are prevalent in these patients, mainly due to the more extensive visceral resections, but the overall and disease-free survival are comparable to patients without involvement of the urinary system. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.046 50. Cytoreductive surgery and HIPEC in treatment of colorectal peritoneal carcinomatosis: Experimental or standard care? A survey of surgical oncologists and medical oncologists H. Braam1, D. Boerma1, M.J. Wiezer1, B. Van Ramshorst1 1 St. Antonius Hospital, Surgery, Nieuwegein, Netherlands Background: Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is increasing applied in patients with peritoneal metastasis of colorectal carcinoma. Although the treatment in recommended in the Dutch guideline, in current daily practice there still appears to be controversy regarding its indication and effectiveness. The goal of the current study was to evaluate the opinion about this treatment among Dutch gastroenterological surgeons and medical oncologists. Methods: An online survey, with 10 general questions and 6 cases, was sent to all known Dutch oncologic or gastroenterological surgeons (N¼459) and medical oncologists (N¼363) located in 84 hospitals. The questions concerned effectiveness of HIPEC, risk of complications, and patient selection. A comparison was made between surgeons and medical oncologists. Results: In total we received 185 eligible responses of 71 hospitals, resulting in an overall response rate of 23% and a response rate of 85% of the hospitals. Overall, 65% of respondents regarded CRS+HIPEC as effective with sufficient evidence for its effect. 29% responded that CRS+HIPEC is probably effective without sufficient evidence, and 7% of respondents regards HIPEC as probably ineffective with insufficient evidence of effect. Medical oncologists were significantly less convinced of the effect of CRS+HIPEC compared to surgeons (51%, 41%, 9%, vs. 74%, 21%, 6%, P ¼ 0.006). In our study, 68% of respondents indicated that they regard CRS+HIPEC as standard treatment in patients with peritoneal dissemination of colorectal carcinoma (77% of surgeons vs. 54% of medical oncologists, P ¼ 0.001). Additionally, a quantification of the

ABSTRACTS effect of HIPEC was asked, overall 68% of respondents regards CRS+HIPEC as potentially curative. Again surgeons were more in favour of this treatment compared to medical oncologists (77% versus 54%, P ¼ 0.001) Conclusions: Although CRS+HIPEC is currently advised in the Dutch guideline in patients with peritoneal dissemination of colorectal cancer, approximately 30% of physicians, who treat colorectal carcinoma, does not regards this treatment as standard care. Surgeons appear significantly more in favour of this treatment compared to medical oncologists. This study shows that there is a need for a widely accepted consensus regarding the position of this treatment in patients with peritoneal dissemination of colorectal cancer. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.047

51. Infrared thermography monitoring in closed hyperthermic intraperitoneal chemotherapy: A novel technique to maintain therapeutic intraperitoneal temperature distribution T. Ja¨ger1, A. Dinnewitzer1, C. Augsch€oll1, C. Rabl1, D. Neureiter2, S. Sta¨ttner1, D. Ofner1 1 Paracelsus Medical University, Surgery, Salzburg, Austria 2 Paracelsus Medical University, Pathology, Salzburg, Austria Background: Primary and secondary peritoneal malignancies have an extremely poor prognosis. There is a growing body of evidence that cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is the optimal treatment for selected patients with peritoneal surface malignancies. There are basically two methods to deliver the heated chemotherapy: the open-abdomen and the closedabdomen technique. Due to growing concern about toxic side effects of chemotherapeutic agents on medical staff during open-abdomen HIPEC, the closed technique is increasingly used. The main drawback of the closed technique is the loss of manual temperature control within the peritoneal cavity with a possible insufficient intraperitoneal temperature distribution during the HIPEC procedure. We present a novel new technique to visualize and maintain a constant and therapeutic intraperitoneal temperature distribution during closed HIPEC. Methods and materials: An infrared thermography camera was used to measure and display the superficial thermal distribution on the abdominal wall during closed HIPEC procedure. The live on-screen visualized mapping was directly correlated with the intraperitoneal temperature measured by three intraabdominal, one inflow and one outflow temperature probes. In case of low correlation the ’shake and bake’ method was applied to maintain an equally distributed intraperitoneal heated chemotherapy. Results: From April 2013 to April 2014 this novel technique was used during 10 closed HIPEC procedures. Colorectal cancer n¼4, gynecological tumor n¼2, mesothelioma n ¼ 3, gastric cancer n ¼ 1 and pseudomyxoma peritonei n¼1. On the basis of our preliminary results, both qualitative, as well as quantitative statements could be obtained regarding the distribution of the intra-abdominal temperature during closed HIPEC. Conclusion: Infrared thermography temperature control of the abdominal surface during closed HIPEC is a novel and feasible method. Its use provides a better control for constant therapeutic intraperitoneal temperature distribution of the heated chemotherapy, and gives the surgeon the ability to react immediately and targeted to avoid severe acute or late systemic side effects. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.048