- Email: [email protected]
M1512 Health Related Quality of Life and Clinical Outcome After Colonic Resection for Diverticular Disease: Long-Term Results
deepest histological layer with any histopathological change (inflammation, ablation, abnormal pattern, necrosis.) Results: We created 51 ablations zones in 16 patients. When comparing max depth of histological change in 2 vs. 4 APP, regardless of energy density, evidence of serosal change occurred in 0% (0/24) vs. 15% (4/27) of zones (p=0.11), whereas changes to the muscularis propria (MP) occurred in 25% (6/24) vs. 63% (17/27) of zones (p<0.05). Comparing energy density settings of 12, 15, and 20 J/cm2, regardless of APP, we observed an unexpected inverse relationship of energy vs depth, in that changes were present in MP in 74% (17/23), 35% (6/17), and 0% (0/11), respectively (P<0.05); and in serosa in 9% (2/ 23), 12% (2/17), and 0% (0/11) (P=0.517). No changes in serosa were seen in any 2 APP ablation zone at any energy density. Conclusions: We observed a direct correlation between APP and ablation effect depth for this device in the colon. All ablation zones at 2 APP demonstrated no changes to the serosa and only a 25% incidence of MP changes. We observed an unexpected inverse relationship between energy and ablation depth, counter to reports in similar trials involving the esophagus. This observed variability may be due to inconsistent electrode approximation to mucosa, variable colonic wall thickness, and possible coagulum formation on the electrode preventing conduction of energy. This evaluation has identified a safe treatment parameter (12 J/cm2, 2 APP) that penetrates no deeper than MP, and will guide follow-up trials for disorders of the lower GI tract, including hemorrhagic radiation proctitis.
M1513 Prognostic Factors for Survival in 61 Patients with Carcinoma of the Splenic Flexure Simon S. Ng, Janet F. Lee, Wing Wa Leung, Raymond Y. Yiu, Jimmy C. Li, Sophie S. Hon, K. L. Leung Background While carcinoma of the splenic flexure is uncommon, it is associated with a high risk of obstruction and a poor prognosis. The aim of this study was to evaluate the prognostic factors for recurrence and survival after surgery for carcinoma of the splenic flexure. Methods Between March 1986 and September 2007, a total of 2987 patients with colorectal carcinoma underwent surgery at our institution, of whom 61 (2%) had carcinoma of the splenic flexure. The clinicopathological factors possibly predicting survival among these 61 patients were retrospectively reviewed. Survival was calculated using Kaplan-Meier method and compared by log-rank test. Multivariate analysis was performed using Cox's regression model. Results Forty-five patients (73.8%) underwent curative surgery (leaving no residual or metastatic disease). Thirty-five patients (57.4%) presented with intestinal obstruction and underwent emergency surgery. Multivisceral resections were needed in 14 patients (23%). Postoperative morbidity and mortality developed in 26 (42.6%) and 6 (9.8%) patients, respectively. Among patients surviving surgery, the cancer-specific survival at 5 years was 47.1%. Postoperative morbidity (P=0.016), T4 tumour (P<0.001), and non-curative surgery (P<0.001) were found to be independent prognostic factors for poor cancer-specific survival. Thirteen patients developed recurrence after curative surgery, and the probability of being disease free at 5 years was 62%. Postoperative morbidity (P=0.020) and T4 tumour (P<0.001) were found to be independent predictors for recurrence. Intestinal obstruction and surgical approach were not predictors for poor survival. Conclusion In addition to curative surgery, T stage of tumour and postoperative morbidity are found to be independent prognostic factors for survival after surgery for carcinoma of the splenic flexure.
M1511 A Population-Based Study of Surgical Treatment of Colon Cancer in Ontario, Canada Rahima Nenshi, Marko Simunovic, Nancy N. Baxter, Nadia Gunraj, Erin Kennedy, Sue Schultz, Drew Wilton, David R. Urbach Background: Colorectal cancer is the third most common cause of cancer and the second most common cause of cancer death among Canadian men and women. In 2007, an estimated 8,129 persons in Ontario, Canada will be diagnosed with colorectal cancer and 2,793 will die from this disease. Surgical treatment is the cornerstone of the management of colorectal cancer; however there are few population-based reports of patterns of treatment. Laparoscopic colorectal surgery is also changing the surgical approach to the treatment of colorectal cancer. We used a population-based cancer registry and administrative health data to describe patterns of the surgical treatment of colon cancer in Ontario in the period 2003-2004. Methods: We linked data from administrative health databases (Canadian Institute for Health Information [CIHI] and the Ontario Health Insurance Plan [OHIP]) to a population-based cancer registry (the Ontario Cancer Registry [OCR]) to measure hospitalizations and surgical treatment received by all patients with a new diagnosis of colon cancer in Ontario from March 1 2003 to April 30 2004. Results: During this 1 year period, 5265 residents of Ontario were newly diagnosed with primary colon cancer. Of these, 50.9% were men and 20.3% were aged less than 60 years. 91.2% of all patients had a surgical procedure. Among persons aged less than 60 years, 1.3% (95% confidence interval [95% CI] 0.5-1.9) had a resection with a permanent stoma, 11.9% (95% CI 9.9-14) had a resection with creation of a reversible stoma, 69.1% (95% CI 66.2-71.9) had a resection with primary anastomosis and 17.8% (95% CI 15.4-20.1) had an “other” surgical procedure (intestinal bypass, local excision or other abdominal procedure). Among persons older than 60 years, 1.1% (95% CI 0.8-1.4) had a resection with a permanent stoma, 11.5% (95% CI 10.5-12.6) had a resection with creation of a reversible stoma, 70.7% (95% CI 69.3-72.1) had a resection with primary anastomosis and 16.7% (95% CI 15.5-17) had an “other” surgical procedure. 354 (7.4%) of all cases were done laparoscopically. Among persons aged <60 years, 8.8% (95% CI 7.1-10.6) had laparoscopic surgery compared to 7% (95% CI 6.2-7.8) in the older group (p for difference = 0.047). There was no difference in the rate of laparoscopic procedures between men and women. Conclusions: The majority of patients newly diagnosed with colon cancer in Ontario undergo resection without creation of a stoma. There was no significant difference in rates of the different types of surgery received according to age. Less than 10% of operations were done laparoscopically and younger patients were more likely to undergo laparoscopic procedures.
M1514
Purpose : Concerns pertaining to the risk of wound infection and subsequent need for mesh excision or recurrence deters the use of mesh to repair ventral hernia during colorectal resection. We evaluate the risk of infection and hernia recurrence after mesh repair in these patients over a prolonged follow up period. Methods : A retrospective review of 274 patients with mesh repair for ventral hernia during colorectal surgery from 1991-2007 was done. Patients who did not have a bowel resection and those with only parastomal hernia were excluded. Patients demographics, diagnosis, comorbidity, size of defect, mesh type, surgical technique and early complications were evaluated from medical records. Long term follow up was determined by telephone interviews. Patients who had recurrence were compared with those without recurrence using Fishers exact, Chi-squared and Wilcoxon tests as appropriate statistical tools. Results : 110 patients (56% male,mean age 59,median BMI 29) met the inclusion criteria. Diagnoses included colorectal cancer (n=34), Crohn's ( n=25), Diverticulosis (n=18), ulcerative colitis (n=16) and others (n=17). Goretex (n=39), Prolene (n=38), Permacol (n=23), Alloderm(n=4), Bard composite (n=3), Surgisis (n=1) and others (n=2) were used intraperitoneally with mean fascial defect of 10x11 cm. Mean follow up was 4 years. Rate of wound infection was 13.6% and recurrence 40%. Patients who had recurrence (n=44) and non-recurrence (n=66) had similar age(p=0.4), gender (p=0.2), BMI (p=0.4), smoking history (p= 0.8), pulmonary comorbidity (p=0.9), type of mesh (p=0.7) and drain use (p=0.5). A significantly greater proportion of recurrent group had hypertension (p<0.05), diabetes(p<0.01), larger fascial defect (p<0.05), steroid use (p<0.05), emergency surgery (76 vs 24%, p<0.001) and wound infection (7 vs 4%, p<0.05). On long term follow up, additional 6 patients (4 from recurrent group and 2 non-recurrent group) developed wound infection requiring readmission. 78% of patients were satisfied with their surgery. Quality of life for recurrent and non-recurrent group was comparable (p=0.5). Conclusions : Recurrence following mesh repair of ventral hernia during colorectal resection is associated with emergency surgery, large fascial defects, presence of comorbidities, perioperative steroids and wound infection. In these situations use of synthetic mesh may be best avoided until conditions are more favorable.
M1512 Health Related Quality of Life and Clinical Outcome After Colonic Resection for Diverticular Disease: Long-Term Results Marco Scarpa, Duilio Pagano, Cesare Ruffolo, Anna Pozza, Francesa Erroi, Lino Polese, Davide F. D'Amico, Imerio Angriman
M1515
Background and aims Colonic resection is mandatory in complicated colonic diverticular disease (DD). The most appropriate treatment in case of recurrent diverticulitis episodes, is less clear. The aim of the present study was to evaluate the long term clinical outcome and quality of life in patients affected by DD submitted to colonic resection compared to those who had only medical treatment. Patients and methods Seventy-one consecutive patients admitted in our department for left iliac pain and endoscopical or radiological diagnosis of diverticular disease were enrolled. During the hospital stay 25 of them underwent colonic resection while 46 were treated with medical therapy. Diseased severity was assessed with Hinchey scale. After a median follow up of 47 (3-102) months after colonic resection, they were interviewed and they answered to Cleveland Global Quality of Life (CGQL) questionnaire and to a symptoms questionnaire. Admittance and surgical procedures for DD were also investigated and surgery- and symptoms-free were calculated. Non parametric tests and survival analysis was used. Results After the follow up, CGQL total score obtained by the two patients were similar as well as the symptoms frequency. Only current quality of health item was significantly worse in patients who had undergone colonic resection (p=0.05). No difference was evidenced in the rate and in the timing of surgical procedures and hospital admitting for DD in the two groups. In particular the 9 patients who had been operated on for an Hinchey 1 class diverticulitis reported the same quality of life, symptoms frequency, operation and hospital admitting rate than those who had been admitted for an Hinchey 1 class diverticulitis and treated conservatively. Conclusions Our study did not show any long term advantage in submitting patients to colonic resection for DD. Thus, in our opinion, surgical resection should be reserved to patients who present with a complicated DD and not to patients who present a mere abdominal discomfort attributed to DD.
The Prognostic Significance of Circumferential Resection Margin Involvement in Colon Cancer Selman Sokmen, Mucahit Ozbilgin, Aras Emre Canda, Sulen Sarioglu, Ozgul Sagol, Mehmet Fuzun Purpose: Failure pattern after colon cancer surgery demonstrated that tumors localized at non-peritonealized part of the colon and sited adjacent to anatomically narrow mesentery were responsible for locoregional recurrent disease and reduced survival. The aim of this study was to assess the prognostic significance of circumferential resection margin (CRM) involvement in patients who underwent potentially curative resection for colonic cancer. Methods: Prospectively collected clinicopathological data of 107 patients (T3-T4 tumors) who underwent curative radical resection were analyzed. The CRM represents the retroperitoneal or peritoneal adventitial soft tissue margin closest to the deepest penetration of tumor. Results: CRM was not involved in 96 patients and involved in 11 patients. There was a significant association between CRM involvement and lymphatic vessel invasion, lymph node positivity, number of involved lymph nodes, and overall TNM stage (p<0.01). Number of involved lymph nodes and overall TNM stage were independent predictors of clinical outcome. CRM positive tumors were associated with increased local recurrence and distant metastasis (p<0.01). The median survival for patients with CRM involvement was only 13 months compared to 20 months without CRM involvement. CRM status had a significant prognostic value in T4 tumors (Figure 1). Conclusion: The CRM involvement in the colon can be considered to be representative of advanced tumor spread. The CRM status is an
A-863
SSAT Abstracts
SSAT Abstracts
Risk of Infection and Recurrence Over Prolonged Follow Up in Patients Undergoing Ventral Hernia Repair During Colorectal Resection - Can the Use of Mesh Be Justified? Levilester B. Salcedo, Ravi P. Kiran, Ian Lavery, James M. Church, Victor W. Fazio
M1513 Prognostic Factors for Survival in 61 Patients with Carcinoma of the Splenic Flexure Simon S. Ng, Janet F. Lee, Wing Wa Leung, Raymond Y. Yiu, Jimmy C. Li, Sophie S. Hon, K. L. Leung Background While carcinoma of the splenic flexure is uncommon, it is associated with a high risk of obstruction and a poor prognosis. The aim of this study was to evaluate the prognostic factors for recurrence and survival after surgery for carcinoma of the splenic flexure. Methods Between March 1986 and September 2007, a total of 2987 patients with colorectal carcinoma underwent surgery at our institution, of whom 61 (2%) had carcinoma of the splenic flexure. The clinicopathological factors possibly predicting survival among these 61 patients were retrospectively reviewed. Survival was calculated using Kaplan-Meier method and compared by log-rank test. Multivariate analysis was performed using Cox's regression model. Results Forty-five patients (73.8%) underwent curative surgery (leaving no residual or metastatic disease). Thirty-five patients (57.4%) presented with intestinal obstruction and underwent emergency surgery. Multivisceral resections were needed in 14 patients (23%). Postoperative morbidity and mortality developed in 26 (42.6%) and 6 (9.8%) patients, respectively. Among patients surviving surgery, the cancer-specific survival at 5 years was 47.1%. Postoperative morbidity (P=0.016), T4 tumour (P<0.001), and non-curative surgery (P<0.001) were found to be independent prognostic factors for poor cancer-specific survival. Thirteen patients developed recurrence after curative surgery, and the probability of being disease free at 5 years was 62%. Postoperative morbidity (P=0.020) and T4 tumour (P<0.001) were found to be independent predictors for recurrence. Intestinal obstruction and surgical approach were not predictors for poor survival. Conclusion In addition to curative surgery, T stage of tumour and postoperative morbidity are found to be independent prognostic factors for survival after surgery for carcinoma of the splenic flexure.
M1511 A Population-Based Study of Surgical Treatment of Colon Cancer in Ontario, Canada Rahima Nenshi, Marko Simunovic, Nancy N. Baxter, Nadia Gunraj, Erin Kennedy, Sue Schultz, Drew Wilton, David R. Urbach Background: Colorectal cancer is the third most common cause of cancer and the second most common cause of cancer death among Canadian men and women. In 2007, an estimated 8,129 persons in Ontario, Canada will be diagnosed with colorectal cancer and 2,793 will die from this disease. Surgical treatment is the cornerstone of the management of colorectal cancer; however there are few population-based reports of patterns of treatment. Laparoscopic colorectal surgery is also changing the surgical approach to the treatment of colorectal cancer. We used a population-based cancer registry and administrative health data to describe patterns of the surgical treatment of colon cancer in Ontario in the period 2003-2004. Methods: We linked data from administrative health databases (Canadian Institute for Health Information [CIHI] and the Ontario Health Insurance Plan [OHIP]) to a population-based cancer registry (the Ontario Cancer Registry [OCR]) to measure hospitalizations and surgical treatment received by all patients with a new diagnosis of colon cancer in Ontario from March 1 2003 to April 30 2004. Results: During this 1 year period, 5265 residents of Ontario were newly diagnosed with primary colon cancer. Of these, 50.9% were men and 20.3% were aged less than 60 years. 91.2% of all patients had a surgical procedure. Among persons aged less than 60 years, 1.3% (95% confidence interval [95% CI] 0.5-1.9) had a resection with a permanent stoma, 11.9% (95% CI 9.9-14) had a resection with creation of a reversible stoma, 69.1% (95% CI 66.2-71.9) had a resection with primary anastomosis and 17.8% (95% CI 15.4-20.1) had an “other” surgical procedure (intestinal bypass, local excision or other abdominal procedure). Among persons older than 60 years, 1.1% (95% CI 0.8-1.4) had a resection with a permanent stoma, 11.5% (95% CI 10.5-12.6) had a resection with creation of a reversible stoma, 70.7% (95% CI 69.3-72.1) had a resection with primary anastomosis and 16.7% (95% CI 15.5-17) had an “other” surgical procedure. 354 (7.4%) of all cases were done laparoscopically. Among persons aged <60 years, 8.8% (95% CI 7.1-10.6) had laparoscopic surgery compared to 7% (95% CI 6.2-7.8) in the older group (p for difference = 0.047). There was no difference in the rate of laparoscopic procedures between men and women. Conclusions: The majority of patients newly diagnosed with colon cancer in Ontario undergo resection without creation of a stoma. There was no significant difference in rates of the different types of surgery received according to age. Less than 10% of operations were done laparoscopically and younger patients were more likely to undergo laparoscopic procedures.
M1514
Purpose : Concerns pertaining to the risk of wound infection and subsequent need for mesh excision or recurrence deters the use of mesh to repair ventral hernia during colorectal resection. We evaluate the risk of infection and hernia recurrence after mesh repair in these patients over a prolonged follow up period. Methods : A retrospective review of 274 patients with mesh repair for ventral hernia during colorectal surgery from 1991-2007 was done. Patients who did not have a bowel resection and those with only parastomal hernia were excluded. Patients demographics, diagnosis, comorbidity, size of defect, mesh type, surgical technique and early complications were evaluated from medical records. Long term follow up was determined by telephone interviews. Patients who had recurrence were compared with those without recurrence using Fishers exact, Chi-squared and Wilcoxon tests as appropriate statistical tools. Results : 110 patients (56% male,mean age 59,median BMI 29) met the inclusion criteria. Diagnoses included colorectal cancer (n=34), Crohn's ( n=25), Diverticulosis (n=18), ulcerative colitis (n=16) and others (n=17). Goretex (n=39), Prolene (n=38), Permacol (n=23), Alloderm(n=4), Bard composite (n=3), Surgisis (n=1) and others (n=2) were used intraperitoneally with mean fascial defect of 10x11 cm. Mean follow up was 4 years. Rate of wound infection was 13.6% and recurrence 40%. Patients who had recurrence (n=44) and non-recurrence (n=66) had similar age(p=0.4), gender (p=0.2), BMI (p=0.4), smoking history (p= 0.8), pulmonary comorbidity (p=0.9), type of mesh (p=0.7) and drain use (p=0.5). A significantly greater proportion of recurrent group had hypertension (p<0.05), diabetes(p<0.01), larger fascial defect (p<0.05), steroid use (p<0.05), emergency surgery (76 vs 24%, p<0.001) and wound infection (7 vs 4%, p<0.05). On long term follow up, additional 6 patients (4 from recurrent group and 2 non-recurrent group) developed wound infection requiring readmission. 78% of patients were satisfied with their surgery. Quality of life for recurrent and non-recurrent group was comparable (p=0.5). Conclusions : Recurrence following mesh repair of ventral hernia during colorectal resection is associated with emergency surgery, large fascial defects, presence of comorbidities, perioperative steroids and wound infection. In these situations use of synthetic mesh may be best avoided until conditions are more favorable.
M1512 Health Related Quality of Life and Clinical Outcome After Colonic Resection for Diverticular Disease: Long-Term Results Marco Scarpa, Duilio Pagano, Cesare Ruffolo, Anna Pozza, Francesa Erroi, Lino Polese, Davide F. D'Amico, Imerio Angriman
M1515
Background and aims Colonic resection is mandatory in complicated colonic diverticular disease (DD). The most appropriate treatment in case of recurrent diverticulitis episodes, is less clear. The aim of the present study was to evaluate the long term clinical outcome and quality of life in patients affected by DD submitted to colonic resection compared to those who had only medical treatment. Patients and methods Seventy-one consecutive patients admitted in our department for left iliac pain and endoscopical or radiological diagnosis of diverticular disease were enrolled. During the hospital stay 25 of them underwent colonic resection while 46 were treated with medical therapy. Diseased severity was assessed with Hinchey scale. After a median follow up of 47 (3-102) months after colonic resection, they were interviewed and they answered to Cleveland Global Quality of Life (CGQL) questionnaire and to a symptoms questionnaire. Admittance and surgical procedures for DD were also investigated and surgery- and symptoms-free were calculated. Non parametric tests and survival analysis was used. Results After the follow up, CGQL total score obtained by the two patients were similar as well as the symptoms frequency. Only current quality of health item was significantly worse in patients who had undergone colonic resection (p=0.05). No difference was evidenced in the rate and in the timing of surgical procedures and hospital admitting for DD in the two groups. In particular the 9 patients who had been operated on for an Hinchey 1 class diverticulitis reported the same quality of life, symptoms frequency, operation and hospital admitting rate than those who had been admitted for an Hinchey 1 class diverticulitis and treated conservatively. Conclusions Our study did not show any long term advantage in submitting patients to colonic resection for DD. Thus, in our opinion, surgical resection should be reserved to patients who present with a complicated DD and not to patients who present a mere abdominal discomfort attributed to DD.
The Prognostic Significance of Circumferential Resection Margin Involvement in Colon Cancer Selman Sokmen, Mucahit Ozbilgin, Aras Emre Canda, Sulen Sarioglu, Ozgul Sagol, Mehmet Fuzun Purpose: Failure pattern after colon cancer surgery demonstrated that tumors localized at non-peritonealized part of the colon and sited adjacent to anatomically narrow mesentery were responsible for locoregional recurrent disease and reduced survival. The aim of this study was to assess the prognostic significance of circumferential resection margin (CRM) involvement in patients who underwent potentially curative resection for colonic cancer. Methods: Prospectively collected clinicopathological data of 107 patients (T3-T4 tumors) who underwent curative radical resection were analyzed. The CRM represents the retroperitoneal or peritoneal adventitial soft tissue margin closest to the deepest penetration of tumor. Results: CRM was not involved in 96 patients and involved in 11 patients. There was a significant association between CRM involvement and lymphatic vessel invasion, lymph node positivity, number of involved lymph nodes, and overall TNM stage (p<0.01). Number of involved lymph nodes and overall TNM stage were independent predictors of clinical outcome. CRM positive tumors were associated with increased local recurrence and distant metastasis (p<0.01). The median survival for patients with CRM involvement was only 13 months compared to 20 months without CRM involvement. CRM status had a significant prognostic value in T4 tumors (Figure 1). Conclusion: The CRM involvement in the colon can be considered to be representative of advanced tumor spread. The CRM status is an
A-863
SSAT Abstracts
SSAT Abstracts
Risk of Infection and Recurrence Over Prolonged Follow Up in Patients Undergoing Ventral Hernia Repair During Colorectal Resection - Can the Use of Mesh Be Justified? Levilester B. Salcedo, Ravi P. Kiran, Ian Lavery, James M. Church, Victor W. Fazio