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607. Gastroduodenal gastrointestinal stromal tumor: A case series
ABSTRACTS 605. Use of systemic inflammatory markers for prognostication of gastric cancer Z.J. Lee1, C.H. Lim2, A. Eng2, W.H. Chan2, H.S. Ong2, W.K. Wong2 1 Singapore General Hospital, Department of General Surgery, Singapore, Singapore 2 Singapore General Hospital, Department of Upper GI and Bariatric Surgery, Singapore, Singapore Background: Carcinoma has been postulated to enhance chronic inflammation leading to tumour growth, invasion, metastases and hence, poorer outcomes. With the aid of hematological investigations, this study aims to establish an association between systemic inflammation and disease free survival in invasive gastric cancer patients. Materials and methods: A retrospective review of a prospectively collected database of 332 patients with invasive gastric cancer was performed from 1st February 1996 to 31st December 2005. The neutrophil and lymphocyte ratio (NLR), and the platelet and lymphocyte ratio (PLR), which is derived by taking the absolute neutrophil and platelet counts respectively, divided by the absolute lymphocyte counts were compared against the patient’s disease free survival and disease specific survival. Results: A cut off value of 3.111 for the NLR and a value of 11.295 for the PLR were decided as the optimum value according to the Receiver Operating Characteristics (ROC) curve. Patients with NLR >3.111 had significantly lower disease free survival (37% vs 63%; p ¼ 0.001) while patients with PLR >11.295 also had significantly lower disease free survival (39.7% vs 71.4%; p ¼ 0.001). Patients with NLR >3.111 had poorer overall survival (13.1% vs 34.2%; p 0.001) and patients with PLR >11.295 also presented with poorer overall survival (14.4% vs 38.6%; p < 0.001). Cox proportional multivariate hazard model for disease specific survival revealed that NLR >3.111 and PLR >11.295 were independently correlated with poor prognosis with hazard ratio of 2.57 (p ¼ 0.007) and 3.683 (p ¼ 0.001), respectively. When analyzing for overall survival, it was also found that NLR >3.111 and PLR >11.295 were independently correlated with poor overall survival with hazard ratio of 2.336 (p ¼ 0.048) and 2.644 (p ¼ 0.035), respectively. Our results show that elevated NLR of >3.111 and PLR of 11.295 at initial clinical presentation were independent factors for poorer disease free survival. Conclusions: We conclude that higher NLR and PLR are related to poorer disease free survival. This significant association sets the stage for preoperative haematological investigation to take a more significant role in the prognostication of patients with invasive gastric cancers. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.325
607. Gastroduodenal gastrointestinal stromal tumor: A case series D. Dahiya, L. Kaman PGIMER, Department of Surgery, Chandigarh, India Introduction: Gastrointestinal stromal tumor (GIST) is the most common non-epithelial mesenchymal tumor of the gastrointestinal (GI) tract comprising only 0.1e3% of all GI tract tumors. Stomach is the commonest site (60e70%) while only 4.5% of these are located in the duodenum. GIST originates from the intestinal cells of Cajal (ICC) and expresses CD 117 (c-kit), a proto-oncogenic protein. C-kit positivity distinguishes GIST from other mesenchymal tumors of GI tract. Clinical presentation of gastroduodenal GIST is variable and mainly depends upon its size and site. Most common symptom is occult bleeding. Early diagnosis is important as complete surgical resection for resectable non-metastatic GIST offers good outcome. Methods: We retrospectively analysed cases of gastroduodenal GIST who received treatment between January 2012 to December 2015 in the Department of Surgery (unit III) at Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh.
S181 Age, gender, clinical symptoms, upper GI endoscopic findings, operative procedure, role of Imatinib was analysed in this group of patients. The operative procedure was sleeve resection or gastrectomy for gastric GIST and limited resection or pancreatcoduodenectomy for duodenal GIST depending on their location. Diagnosis of GIST was based on histopathological examination and immunohistochemistry for CD 117. All patients were followed up every 3 months for first 2 years and 6 monthly thereafter. Results: During this period 12 patients who had gastroduodenal GIST received treatment. Common presentation was GI bleed (66.66%), 66.66% had gastric and 33.33% had duodenal GIST. One each of gastric or duodenal GIST had peritoneal or liver metastasis respectively. Sleeve resection for gastric GIST was done in six patients and antrectomy in one patient. Antral GIST with peritoneal metastasis and ascites was present in one patient who received palliative treatment and Imatinib. Limited resection was done in two and pancreaticoduodenectomy was done in one patient of duodenal GIST. Duodenal GIST with liver metastasis was present in one patient who was treated with Imatinib. There was no response to imatinib in metastatic group and their disease kept on increasing on follow up. Patients who underwent curative surgery are well on follow up ranging 3 months to 3 years. Only one of the patients in surgically treated group had high grade GIST and received Imatinib. Conclusion: Complete surgical resection for resectable non-metastatic GIST offers good outcome. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.327
608. Risk factors associated with complications of open gastrectomy for gastric cancer e Analysis of data based on the ClavieneDindo classification R. Pach, P. Kulig, M. Sierzega, P. Kolodziejczyk, J. Kulig Jagiellonian University, Department of General e Oncological and Gastrointestinal Surgery, Cracow, Poland Background: In previously published reports the complication rate after gastrectomy varied from 15% to 25%. The majority of studies demonstrated data from retrospective analysis of patient’s files with different criteria of complications. Moreover, the severity of symptoms was mostly not taken into consideration. The approach proposed by Dindo et al. enables simple, reproducible and applicable irrespective of the cultural background, reporting of data on postoperative complications based on the therapy required to treat them. Since its introduction only few centres published data on severity of gastric cancer complications based on limited numbers of patients. Material and methods: All data on consecutive patients with gastric adenocarcinoma were collected prospectively at Department of Surgery between 2006 and 2013. Detailed data on clinicopathological features (age, sex, weight, comorbidities, previous surgery, 7th TNM staging), surgery (type of operation, extent of lymph node dissection, volume of red blood cells transfused, operation time, extent of resection) and postoperative course were collected through medical records and saved in a database. The complications were classified retrospectively according to the severity according to the revised version of the Clavien-Dindo classification. Results: A total of 626 patients were included in the study. The majority of patients (52.3%) underwent R0 resection and D1 lymphadenectomy (54.2%) according to Japanese Gastric Cancer Treatment Guidelines 2010 (version3). Of the 626 analysed patients, 298 (47.6%) developed complications. The numbers of ClavieneDindo grade I, II, IIIA, IIIB, IVA, IVB and V complications were 8 (1.3%), 157 (25.1%), 46 (7.3%), 9 (1.4%), 22 (3.5%), 16 (2.6%) and 40 (6.4%), respectively. In multivariate analysis two significant risk factors for overall complications were identified: preoperative anaemia (odds ratio 2.09; 95% confidence interval 1.45 e 3.02, p ¼ 0.0001) and duration of operation >180 min (odds ratio 1.73; 95% confidence interval 1.2 e 2.47, p ¼ 0.002). Three significant risk factors for severe complications were identified: extended gastrectomy (odds ratio
607. Gastroduodenal gastrointestinal stromal tumor: A case series D. Dahiya, L. Kaman PGIMER, Department of Surgery, Chandigarh, India Introduction: Gastrointestinal stromal tumor (GIST) is the most common non-epithelial mesenchymal tumor of the gastrointestinal (GI) tract comprising only 0.1e3% of all GI tract tumors. Stomach is the commonest site (60e70%) while only 4.5% of these are located in the duodenum. GIST originates from the intestinal cells of Cajal (ICC) and expresses CD 117 (c-kit), a proto-oncogenic protein. C-kit positivity distinguishes GIST from other mesenchymal tumors of GI tract. Clinical presentation of gastroduodenal GIST is variable and mainly depends upon its size and site. Most common symptom is occult bleeding. Early diagnosis is important as complete surgical resection for resectable non-metastatic GIST offers good outcome. Methods: We retrospectively analysed cases of gastroduodenal GIST who received treatment between January 2012 to December 2015 in the Department of Surgery (unit III) at Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh.
S181 Age, gender, clinical symptoms, upper GI endoscopic findings, operative procedure, role of Imatinib was analysed in this group of patients. The operative procedure was sleeve resection or gastrectomy for gastric GIST and limited resection or pancreatcoduodenectomy for duodenal GIST depending on their location. Diagnosis of GIST was based on histopathological examination and immunohistochemistry for CD 117. All patients were followed up every 3 months for first 2 years and 6 monthly thereafter. Results: During this period 12 patients who had gastroduodenal GIST received treatment. Common presentation was GI bleed (66.66%), 66.66% had gastric and 33.33% had duodenal GIST. One each of gastric or duodenal GIST had peritoneal or liver metastasis respectively. Sleeve resection for gastric GIST was done in six patients and antrectomy in one patient. Antral GIST with peritoneal metastasis and ascites was present in one patient who received palliative treatment and Imatinib. Limited resection was done in two and pancreaticoduodenectomy was done in one patient of duodenal GIST. Duodenal GIST with liver metastasis was present in one patient who was treated with Imatinib. There was no response to imatinib in metastatic group and their disease kept on increasing on follow up. Patients who underwent curative surgery are well on follow up ranging 3 months to 3 years. Only one of the patients in surgically treated group had high grade GIST and received Imatinib. Conclusion: Complete surgical resection for resectable non-metastatic GIST offers good outcome. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.327
608. Risk factors associated with complications of open gastrectomy for gastric cancer e Analysis of data based on the ClavieneDindo classification R. Pach, P. Kulig, M. Sierzega, P. Kolodziejczyk, J. Kulig Jagiellonian University, Department of General e Oncological and Gastrointestinal Surgery, Cracow, Poland Background: In previously published reports the complication rate after gastrectomy varied from 15% to 25%. The majority of studies demonstrated data from retrospective analysis of patient’s files with different criteria of complications. Moreover, the severity of symptoms was mostly not taken into consideration. The approach proposed by Dindo et al. enables simple, reproducible and applicable irrespective of the cultural background, reporting of data on postoperative complications based on the therapy required to treat them. Since its introduction only few centres published data on severity of gastric cancer complications based on limited numbers of patients. Material and methods: All data on consecutive patients with gastric adenocarcinoma were collected prospectively at Department of Surgery between 2006 and 2013. Detailed data on clinicopathological features (age, sex, weight, comorbidities, previous surgery, 7th TNM staging), surgery (type of operation, extent of lymph node dissection, volume of red blood cells transfused, operation time, extent of resection) and postoperative course were collected through medical records and saved in a database. The complications were classified retrospectively according to the severity according to the revised version of the Clavien-Dindo classification. Results: A total of 626 patients were included in the study. The majority of patients (52.3%) underwent R0 resection and D1 lymphadenectomy (54.2%) according to Japanese Gastric Cancer Treatment Guidelines 2010 (version3). Of the 626 analysed patients, 298 (47.6%) developed complications. The numbers of ClavieneDindo grade I, II, IIIA, IIIB, IVA, IVB and V complications were 8 (1.3%), 157 (25.1%), 46 (7.3%), 9 (1.4%), 22 (3.5%), 16 (2.6%) and 40 (6.4%), respectively. In multivariate analysis two significant risk factors for overall complications were identified: preoperative anaemia (odds ratio 2.09; 95% confidence interval 1.45 e 3.02, p ¼ 0.0001) and duration of operation >180 min (odds ratio 1.73; 95% confidence interval 1.2 e 2.47, p ¼ 0.002). Three significant risk factors for severe complications were identified: extended gastrectomy (odds ratio