Sarcopenia outperforms the Charlson Comorbidity Index in risk prediction in patients undergoing pancreatic resections

Poster Session, Sunday 29 January 2017 was required in only 1 case in D2 group. The postoperative mortality was 0% in both groups. Conclusion: There is no significant difference in the complications between D2+CME group and traditional D2 group. Therefore, we ensure that this trial is safe and thus ongoing. No conflict of interest. 544 ORAL Sarcopenia outperforms the Charlson Comorbidity Index in risk prediction in patients undergoing pancreatic resections D. Wagner1 , K. Marsoner1 , A. Tomberger2 , H. Cerwenka1 , G. Werkgartner1 , H.J. Mischinger1 , P. Kornprat1 . 1 Landeskrankenhaus Univ. Klinikum Graz, Department of Surgery- Division for General Surgery, Graz, Austria; 2 Medical University of Graz, Department of Surgery- Division for General Surgery, Graz, Austria Introduction: Sarcopenia is a known predictor in patients undergoing major pancreatic surgeries. We sought to combine sarcopenia with established risk predictors to improve their prognostic capacity for postoperative outcome and morbidity. Methods: As established parameters to predict preoperative mortality risk for patients, the ASA classification and the Charlson Comorbidity Index (CCI) were used. The Hounsfield Units Average Calculation (HUAC) was measured to define sarcopenia in 424 patients undergoing pancreatic resections for malignancies. Patients in the lowest sex-adjusted quartile for HUAC were defined as having sarcopenia (muscle wasting). Multivariable Cox regression analysis was utilized to identify preoperative risk factors associated with postoperative morbidity. Results: Median patient age was 63 years (19−87), 47.9% patients were male, and half the cohort had multiple comorbidities (Charlson Comorbidity Index [CCI] >6, 63.2%), 30-day mortality was 10.3% and 126 (29.7%). Median HUAC was 19.78 HU (IQR: 15.94–23.54) with 145 patients (34.2%) having sarcopenia. Preoperative frailty defined by sarcopenia was associated with an increased risk for postoperative complications (OR 1.55, 95% CI 0.98–2.45, p = 0.014), and a higher 30-day mortality (HR 5.17, 95% CI 1.57–16.69, p = 0.004). With an AUC of 0.85 HUAC showed the highest predictability for 30-day mortality (95% CI 0.78–0.91, p = 0.0001). Patients with CCI 6 and sarcopenia defined by the HUAC had a 9.78 higher risk of dying in the immediate postoperative phase (HR 9.78, 95% CI 2.98−32, p = 0.0001). Conclusion: Sarcopenia predicts postoperative mortality and complications best and it should be incorporated to conventional risk scores to identify high risk patients. No conflict of interest.

Poster Session (Sunday 29 January 2017) Gastrointestinal Malignancies − Upper GI 596 POSTER Adjvant HIPEC in gastric cancer patients with high risk of peritoneal carcinomatosis A. Aladashvili1 , R. Croner2 , I. Pantsulaia3 . 1 NCC, GI cancer, Tbilisi, Georgia; 2 FAU, General Surgery, Erlangen, Germany; 3 TSMU, Microbiology and Immunology, Tbilisi, Georgia Background: The peritoneum is one of the most common site of recurrence in gastric cancer. Median survival for PC is only about fore months, if untreated and the benefit of palliative systemic chemotherapy is limited. Only a quarter of patients are eligible for curative treatment, consisting of CRS/HIPEC. These clinical problems underline the need for effective adjuvant therapy in high-risk patients to minimize the risk of outgrowth of peritoneal micro metastases. Adjuvant HIPEC seems to be suitable for this purpose. Without the need for CRS, adjuvant HIPEC can be performed with a low complication rate and short hospital stay. The aim of this study is to determine the effectiveness of adjuvant HIPEC in preventing the development of PC in patients with gastric cancer at high risk of peritoneal recurrence. Patients and Methods: This study was performed in the Georgian NCC, starting in February 2014. Eligible for inclusion are patients who underwent curative resection for T4, cM0 stage gastric cancer. After resection of the primary tumour, 46 patients will be randomized to adjuvant HIPEC comparing with routine systemic chemotherapy only in the control arm. Different cytostatic agents were used for 60−90 min at 42−43ºC. Postoperatively in both arms of the study in patients without evidence of disease based on routine follow-up using CT, CEA and CA 19-9. Results: Morbidity and mortality were 32.81% and 3.12%, respectively, with three cases (4.68%) of peritoneal recurrence, from total number 64

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patients 62% were male and 48% female. Mean age was 57.6 years, range 31 to 73 years. In the beginning of treatment, the KPS was over 80% for all patients. Median follow-up was 23 months, ranging from 7 to 52 months. 2 patients were diagnosed with a pancreatic fistulae through the identification of an abnormal discharge in the closed suction drain placed during surgery, and confirmed by a fluid amylase examination, no additional treatment was necessary. 2 patients had an intraabdominal abscess that required re-laparotomy. Conclusions: Adjuvant HIPEC is assumed to reduce the expected 42% absolute risk of PC in patients with T4 GC to a risk of 14%. This reduction is likely to translate into a prolonged overall survival. In light of our experience and supported by literature data, we can affirm that HIPEC has a potential role in the prevention of gastric carcinomatosis. Certainly further studies are required on a larger scale to validate this new but promising approach. No conflict of interest. 597 POSTER Inhibitory effect of (−)-epigallocatechin-3-gallate and bleomycin on human pancreatic cancer MIA Paca-2 cell growth S. Bimonte1 , M. Leongito1 , A. Barbieri2 , F. Izzo1 . 1 National Cancer Institute Fondazione G. Pascale, Division of Abdominal Surgical Oncology- Hepatobiliary Unit, Naples, Italy; 2 National Cancer Institute Fondazione G. Pascale, SSD Animal Sperimentation, Naples, Italy Background: Human pancreatic cancer is currently one of the deadliest cancers with high mortality rate. It has been previously shown that (−)-epigallocatechin-3-gallate (EGCG), the most abundant catechin found in green tea, has shown suppressive effects on human pancreatic cancer cells. Bleomycin (BLM), an anti-cancer chemotherapeutic drug that induces DNA damage, has antitumor effects by induction of apoptosis in several cancer cell lines and also in pancreatic cancer cells. The present study investigated for the first time, the inhibitory effect of EGCG and BLM on pancreatic cancer cell growth. Methods: Using the pancreatic cancer cell lines MIA PaCa-2 cells the efficacy and synergism of EGCG and BLM were evaluated by in vitro tests. Inhibition of cell proliferation was determined by MTT assay. Mitochondrial depolarization was performed with JC-1 probe. Viability and apoptosis were determined by Flow Cytometry with annexin V, propidium iodide staining and DNA fragmentation assay. Results: Cell proliferation assay revealed significant additive inhibitory effects with combination of EGCG and BLM at 72 h in a dose dependent manner. The combination of EGCG and BLM induced cell cycle S-phase arrest and mitochondrial depolarization. Viability, apoptosis and DNA fragmentation assay indicated that the combination of EGCG and bleomycin potentiated apoptosis. Conclusions: Our results indicate that EGCG and BLM have additive antiproliferative effects in vitro by induction of apoptosis of MIA PaCa-2 cells. This combination could represent a new strategy with potential advantages for treatment of pancreatic cancer. To date, this is the first report published of the inhibitory effect of EGCG and BLM on human pancreatic cancer MIA Paca-2 cell growth. No conflict of interest. 598 POSTER Incidence of gastric cancer in Sri Lanka: analysis of the cancer registry data and comparison with other South Asian populations D. Wickramasinghe1 , N. Wickramasinghe2 , N. Samarasekera1 . 1 Faculty of Medicine- University of Colombo, Department of Surgery, Coombo 8, Sri Lanka; 2 Ministry of health, Ministry of Health, Colombo, Sri Lanka Background: This study aims to report the incidence of gastric carcinoma (GCa) in Sri Lanka (SL) and to compare these findings with other cancer registry data of the region and with migrant populations. Materials and Methods: We compared the data published by the National Cancer Control Program of Sri Lanka over the last 2 decades with data from the National Cancer Registry Programme of the Indian Council of Medical Research and Karachi cancer registry. SEERstat was used to analyse the Surveillance, Epidemiology, and End Results database to analyse data on Indian migrant population. Results: Gastric CA was the 10th most common cancer in males. The incidence of Gastric CA rises with age in both sexes, with a peak in the 70−74 year age group. There was a disproportionately higher number of GCa in the tamil population (Chi square test, p = 0.0022). The commonest type of Gastric CA in Sri Lanka was Adenomas and Adenocarcinomas, NOS (n = 175, 61.6%), followed by Cystic/mucinous/serous neoplasms second. (n = 83, 7.0%). India, Pakistan and Sri Lanka had comparable Age Adjusted Incidence (AAI) and age distribution of Gastric CA. All migrant populations had lower