- Email: [email protected]
gastric Surgery?
ABSTRACTS
871
(continued )
Stage (TNM * 7^ed.)
Gastrectomy Multivisceral Resection Lymph node dissection (site) Lymph node dissection (number) R
I II III IV Subtotal Total Yes No D1 D2 <16 >16 R0 R+
70 years (n¼927)
>70 years (n¼538)
p
306 (33.5%) 208 (22.8%) 304 (33.3%) 95 (10.4%) 538 (65.1%) 289 (34.9%) 151 (18.3%)
162 (30.3%) 142 (26.6%) 184 (34.5%) 46 (8.6%) 335 (68.4%) 302 (31.6%) 77 (15.7%)
ns*
293 630 220 707 703 224
206 332 162 376 400 138
486. Does Incentive Spirometry Influence Lung Functions in Patients Awaiting Major Oesophageal/gastric Surgery? A. Bagul1, Y.M. Koay1, S. Jack2, M. Shrotri3 1 Aintree University Hospital Liverpool, UGI Surgery, Liverpool, United Kingdom 2 Aintree University Hospital Liverpool, Thoracic Medicine, Liverpool, United Kingdom 3 Aintree University Hospital Liverpool, Upper GI Surgery, Liverpool, United Kingdom Introduction: Pulmonary complications are a significant problem (2030%) after oesophageal/gastric cancer (OGC) surgery, resulting in a fourfold increase in mortality. These are attributed to inadequate lung inflation and reduced cough effort secondary to shallow breathing, diaphragmatic splinting, prolonged immobilisation and impaired muco-ciliary clearance. Incentive spirometry in the preoperative period may increase the capacity and ability of patients to clear secretions and therefore reduce the risk of pulmonary complications. Definitive OGC surgery is carried out after a period of recovery following neoadjuvant chemotherapy (NAC). This period with/after NAC provides a 9-12 week window for such intervention, which could provide an opportunity to optimise lung function before major surgery. Aim: To analyse the effect of incentive spirometry on lung function in patients having NAC prior to OGC surgery. Methods: Pulmonary function tests (PFT) data were collected on consecutive patients identified at OGC multi-disciplinary meeting, who were suitable for NAC followed by OGC surgery. Eligible, consented patients were trained by physiotherapist to use the incentive spirometer (Mediflow Duo Incentive Spirometer with PEP [positive expiratory pressure]), and kept a diary of use during the pre-operative period. PFT were repeated just before surgery to compare with the baseline PFT. Ethical approval for this pilot study was granted by NHS Research Ethics Committee (applied through the Sefton Local Research Ethics Committee). Results: A total number of 23 patients were recruited. 16 case notes with complete set of details were available for analysis. The median age was 64 (range 45-82) years, 54% were male. The mean Pre and post% FEV/FVC were 78.6 (63-83) and 78(61-83) respectively. Non parametric test showed no statistical significance between two period tests. Conclusion: Use of incentive spirometry in patients having NAC and waiting to have surgery is a novel way of intervention in an attempt to improve respiratory function. Our pilot study shows a trend in improvement of PFT, although these were not statistically significant. We know from our brief experience that NAC reduces cardio-pulmonary performance and this intervention may thus help in maintaining the pulmonary component intact. A larger randomised study may be needed to confirm our study findings and whether this can clinically result in reduced pulmonary complications.
(23.8%) (76.2%) (14.2%) (85.8%) (75.8%) (24.2%)
(32.2%) (67.8%) (22.8%) (77.2%) (74.4%) (25.6%)
ns* ns* p¼0.001* p<0.001* ns*
487. Solitary Fibrous Tumour, an Inusual Presentation as a Subepitelial Gastric Tumour in the Stomach V. Gumbau1, M. Cantos1, J. Puche1, M. Bruna1, A. Vazquez1, C. Mulas1, M. Oviedo1, D. Davila1 1 Hospital General Universitario de Valencia, Surgery, Valencia, Spain Introduction: Solitary fibrous tumour (SFT) is a rare neoplasm, originally described in the pleura (mesothelioma). The gastric localization is rare and we must make differential diagnosis with GIST tumours. Material and methods: Descriptive analysis of two cases of SFT found in a retrospective research of all gastric neoplasms that underwent surgery in the past ten years was carried out. Results: Case 1: Sixty-five years old woman who looked for medical attention for symptomatic anaemia. An endoscopy showed an antral subepitelial tumour of 2,5 cm. Echo-endoscopy images demonstrated a tough, hypoechoic, homogeneous and semipedunculated neoplasia that depended of muscularis mucosae, which suggested a mesenchymal tumor (GIST). Laparoscopic gastrostomy was performed assisted by intraoperative endoscopy and the neoplasia was removed with harmonic scalpel. The patient was discharged from the hospital on the third day. The pathological anatomy reported an homogeneous and well delimited lesion with spindle benign cells and collagen bands. Case 2: Male aged forty-one that complains of melaenas. Gastroscopy evidenced a subepitelial tumour in the gastric body, with a size of 8 cm. Echo-endoscopy displayed an hypoechoic well delimited subepitelial tumour. Subtotal gastrectomy with lymphadenectomy D1 was performed. Histopathological analysis confirmed a reddish meaty friable mass. Morphological description evidenced epithelioid and fusiform cells. Chirurgical edges were free for tumoral infiltration and also all of eleven adenopathies removed. Immunohistochemical study, in both patients, proved positivity for CD34, BCL and vimentin and negative results for CD117, S-100, desmin and actin. Conclusions: Solitary fibrous tumours represent less than 2% of soft tissues neoplasms. In the last twenty years, the number of these tumours has increased in relation to the development of new immunohistochemical techniques. After removing the neoplasm, the prognosis is favorable with low grade of recurrence or distant metastasis. The factors described as responsible of a poor prognosis are the size greater than 10 cm, unfavorable histological aspect and positive resection edges. It is necessary to make an intensive monitoring for a long time.
488. Early Results with the Perioperative MAGIC Regimen for the Treatment of Adenocarcinoma of the Stomach and Cardia na3, A. Martinez-Blasco1, J. Lacueva1, F. Mingol1, J. Gallego2, A. Ordu~ 4 1 1 nanzas , P. Exposito3, R. Calpena1 J. Sola-Vera , I. Oliver , L. Arma~ 1 Hospital General Universitario de Elche, Servicio de Cirugia General, Elche, Spain
871
(continued )
Stage (TNM * 7^ed.)
Gastrectomy Multivisceral Resection Lymph node dissection (site) Lymph node dissection (number) R
I II III IV Subtotal Total Yes No D1 D2 <16 >16 R0 R+
70 years (n¼927)
>70 years (n¼538)
p
306 (33.5%) 208 (22.8%) 304 (33.3%) 95 (10.4%) 538 (65.1%) 289 (34.9%) 151 (18.3%)
162 (30.3%) 142 (26.6%) 184 (34.5%) 46 (8.6%) 335 (68.4%) 302 (31.6%) 77 (15.7%)
ns*
293 630 220 707 703 224
206 332 162 376 400 138
486. Does Incentive Spirometry Influence Lung Functions in Patients Awaiting Major Oesophageal/gastric Surgery? A. Bagul1, Y.M. Koay1, S. Jack2, M. Shrotri3 1 Aintree University Hospital Liverpool, UGI Surgery, Liverpool, United Kingdom 2 Aintree University Hospital Liverpool, Thoracic Medicine, Liverpool, United Kingdom 3 Aintree University Hospital Liverpool, Upper GI Surgery, Liverpool, United Kingdom Introduction: Pulmonary complications are a significant problem (2030%) after oesophageal/gastric cancer (OGC) surgery, resulting in a fourfold increase in mortality. These are attributed to inadequate lung inflation and reduced cough effort secondary to shallow breathing, diaphragmatic splinting, prolonged immobilisation and impaired muco-ciliary clearance. Incentive spirometry in the preoperative period may increase the capacity and ability of patients to clear secretions and therefore reduce the risk of pulmonary complications. Definitive OGC surgery is carried out after a period of recovery following neoadjuvant chemotherapy (NAC). This period with/after NAC provides a 9-12 week window for such intervention, which could provide an opportunity to optimise lung function before major surgery. Aim: To analyse the effect of incentive spirometry on lung function in patients having NAC prior to OGC surgery. Methods: Pulmonary function tests (PFT) data were collected on consecutive patients identified at OGC multi-disciplinary meeting, who were suitable for NAC followed by OGC surgery. Eligible, consented patients were trained by physiotherapist to use the incentive spirometer (Mediflow Duo Incentive Spirometer with PEP [positive expiratory pressure]), and kept a diary of use during the pre-operative period. PFT were repeated just before surgery to compare with the baseline PFT. Ethical approval for this pilot study was granted by NHS Research Ethics Committee (applied through the Sefton Local Research Ethics Committee). Results: A total number of 23 patients were recruited. 16 case notes with complete set of details were available for analysis. The median age was 64 (range 45-82) years, 54% were male. The mean Pre and post% FEV/FVC were 78.6 (63-83) and 78(61-83) respectively. Non parametric test showed no statistical significance between two period tests. Conclusion: Use of incentive spirometry in patients having NAC and waiting to have surgery is a novel way of intervention in an attempt to improve respiratory function. Our pilot study shows a trend in improvement of PFT, although these were not statistically significant. We know from our brief experience that NAC reduces cardio-pulmonary performance and this intervention may thus help in maintaining the pulmonary component intact. A larger randomised study may be needed to confirm our study findings and whether this can clinically result in reduced pulmonary complications.
(23.8%) (76.2%) (14.2%) (85.8%) (75.8%) (24.2%)
(32.2%) (67.8%) (22.8%) (77.2%) (74.4%) (25.6%)
ns* ns* p¼0.001* p<0.001* ns*
487. Solitary Fibrous Tumour, an Inusual Presentation as a Subepitelial Gastric Tumour in the Stomach V. Gumbau1, M. Cantos1, J. Puche1, M. Bruna1, A. Vazquez1, C. Mulas1, M. Oviedo1, D. Davila1 1 Hospital General Universitario de Valencia, Surgery, Valencia, Spain Introduction: Solitary fibrous tumour (SFT) is a rare neoplasm, originally described in the pleura (mesothelioma). The gastric localization is rare and we must make differential diagnosis with GIST tumours. Material and methods: Descriptive analysis of two cases of SFT found in a retrospective research of all gastric neoplasms that underwent surgery in the past ten years was carried out. Results: Case 1: Sixty-five years old woman who looked for medical attention for symptomatic anaemia. An endoscopy showed an antral subepitelial tumour of 2,5 cm. Echo-endoscopy images demonstrated a tough, hypoechoic, homogeneous and semipedunculated neoplasia that depended of muscularis mucosae, which suggested a mesenchymal tumor (GIST). Laparoscopic gastrostomy was performed assisted by intraoperative endoscopy and the neoplasia was removed with harmonic scalpel. The patient was discharged from the hospital on the third day. The pathological anatomy reported an homogeneous and well delimited lesion with spindle benign cells and collagen bands. Case 2: Male aged forty-one that complains of melaenas. Gastroscopy evidenced a subepitelial tumour in the gastric body, with a size of 8 cm. Echo-endoscopy displayed an hypoechoic well delimited subepitelial tumour. Subtotal gastrectomy with lymphadenectomy D1 was performed. Histopathological analysis confirmed a reddish meaty friable mass. Morphological description evidenced epithelioid and fusiform cells. Chirurgical edges were free for tumoral infiltration and also all of eleven adenopathies removed. Immunohistochemical study, in both patients, proved positivity for CD34, BCL and vimentin and negative results for CD117, S-100, desmin and actin. Conclusions: Solitary fibrous tumours represent less than 2% of soft tissues neoplasms. In the last twenty years, the number of these tumours has increased in relation to the development of new immunohistochemical techniques. After removing the neoplasm, the prognosis is favorable with low grade of recurrence or distant metastasis. The factors described as responsible of a poor prognosis are the size greater than 10 cm, unfavorable histological aspect and positive resection edges. It is necessary to make an intensive monitoring for a long time.
488. Early Results with the Perioperative MAGIC Regimen for the Treatment of Adenocarcinoma of the Stomach and Cardia na3, A. Martinez-Blasco1, J. Lacueva1, F. Mingol1, J. Gallego2, A. Ordu~ 4 1 1 nanzas , P. Exposito3, R. Calpena1 J. Sola-Vera , I. Oliver , L. Arma~ 1 Hospital General Universitario de Elche, Servicio de Cirugia General, Elche, Spain