- Email: [email protected]
14. The EURECCA Pancreatic Cancer Project: An overview of the first data
S70 to LPD (32% and 38%, respectively), matching a significantly higher rate of vascular resection/reconstruction and a higher median number of retrieved lymphnodes among patients undergoing OPD (50% and 53 (from 27 to 71)), compared to LPD (0% and 23 (from 12 to 46); p < .05 for both comparisons). R0 resection was achieved in 38 (95%) patients. Conclusions: this initial experience suggests that the SMA-first approach is safe, feasible, and oncologically sound both during OPD and during LPD, though larger series are needed to confirm these results. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.016
11. Intraoperative ultrasonography in pancreatic surgery: Staging and resection guidance A. Lukashenko, O. Kolesnik, A. Shudrak, V. Zvirych, C. Maliarchuk National Cancer Institute, Tumors of Abdominal Cavity, Kiev, Ukraine Background: Intraoperative ultrasound examination (IOUS) is indispensable part of modern surgical interventions in tumors of hepatopancreatobiliary zone. In this study retrospective analysis of IOUS efficiency in surgical treatment of pancreatic tumors was provided. Materials and methods: In the period from January 2013 till November 2015 in the National Cancer Institute IOUS was applied during 76 surgical interventions: for pancreatic head tumors e in 46 (60.5%) patients, for body/tail pancreatic tumors e in 20 (26.3%) patients, in 10 (13.2%) patients e for periampullary zone neoplasms. In IOUS we performed primary tumor assessment (localization, degree of tumor spreading to superior mesenteric vessels, hepatoduodenal ligament vessels, additional foci occurrence in pancreas), and liver metastases detection. Surgical interventions were performed: pancreatoduodenectomy in 52 (68.4%) patients, radical antegrade modal pancreatosplenectomy e in 14 (18.4%) patients. Results: IOUS allowed determining additional tumor foci in pancreas in 2 (2.6%) patients, in 8 (10.5%) observations tumor invasion into portal or superior mesenteric vein was determined. In 21 (27.6%) patient additional hepatic neoplasms were detected (in half of cases e 11.8%, metastases). These findings resulted in change of surgical intervention extent in 23 (30.3%) patients: expansion to combined resections in 14 (18.4%) patients, reduction to symptomatic operations in 5 (6.6%) cases, organ-preserving operations were performed in 4 (5.3%) patients. Variant anatomy of hepatic arterial blood supply was determined in 41 (53.9%) patients that necessitated performance correction of resection stages for preservation of adequate hepatic blood supply. Conclusions: IOUS is a highly-precise diagnostic method substantively influencing operation course in pancreatic tumors, enabling surgeon to provide adequate staging and permanent correction of operation course. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.017
12. The prognostic value of the lymph node ratio for resected pancreatic ductal carcinoma S. Aosasa, H. Abe, M. Nishikawa, M. Hoshikawa, T. Noro, S. Hiraki, Y. Kajiwara, T. Moriya, T. Yamasaki, E. Shinto, H. Tsujimoto, T. Tanimizu, H. Ueno, K. Hase, J. Yamamoto National Defense Medical College, Department of Surgery, Tokorozawa, Japan Background: Aim of this study was to evaluate the prognostic significance of the ratio of number of positive lymph nodes to total number of examined lymph nodes (lymph node ratio, LNR) for resected pancreatic ductal adenocarcinoma.
ABSTRACTS Material and methods: A total of 102 patients with pancreatic ductal carcinoma, who underwent R0 or R1 pancreatectomy from 2008 to 2014 were reviewed retrospectively. Clinicopathologic factors including number of positive lymph nodes (NP), number of examined lymph nodes (NE), LNR, and survival were analyzed by univariate and multivariate analyses. Furthermore, analyses using Akaike information criterion (AIC) and Harrell’s concordance index (c-index) were performed to evaluate the prognostic value. Results: Tumors were located mainly in the pancreatic head (68 patients, 67%). The median size of tumor was 3.3 cm (range 1.7e9.6) and 91 patients (89%) had lymph node metastasis. The median of NP, NE, and LNR was 4 (range 0e19), 32.5 (range 10e67), and 0.11 (range 0e0.69), respectively. Resection margin was negative (R0 resection) for 76 patients (75%) and postoperative chemotherapy was administered to 81 (79%) patients. Overall survival rates were 75%, 33%, and 20% at 1, 3, and 5 years, respectively. Univariate analysis revealed that NP (3), LNR (>0.11), CA19-9 level (>370), tumor size (>3 cm), R0 resection, postoperative chemotherapy significantly correlated (p < 0.01) with increased survival and a positive correlation was seen between NP and LNR (r ¼ 0.37, p < 0.01). Multivariate analysis with LNR, CA19-9 level, tumor size, R0 resection and postoperative chemotherapy revealed that LNR (HR 2.47) and postoperative chemotherapy (HR 2.05) were independent factors for overall survival. Otherwise, multivariate analysis with NP, CA19-9 level, tumor size, R0 resection and postoperative chemotherapy revealed that NP (HR 2.26) and R0 resection (HR 1.96) were independent factors for overall survival. Both AIC and the c-index showed that the prognostic value of LNR (AIC: 534.62, c-index: 0.646) was higher than that of NP (AIC: 537.12, c-index: 0.634). LNR also had an independent impact on recurrence-free survival after surgery. Conclusions: LNR is the most powerful tumor-related factor predicting overall and recurrence-free survival for resected pancreatic ductal carcinoma. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.018
14. The EURECCA Pancreatic Cancer Project: An overview of the first data 2 B.G. Sibinga Mulder1, E. Bastiaannet1, M. Primic-Zakelj , Z. Valerianova3, A. Ryzhov4, J.M. Borras5, G.J. Poston6, K. Sahora7, E. Van Eycken8, M.B. Mortensen9, D. Henning10, T. Gasslander11, V.E. Lemmens12, P.G. Boelens1, J.S.D. Mieog1, C.J.H. Van de Velde1, B.A. Bonsing1 1 Leiden University Medical Center, Surgery, Leiden, Netherlands 2 Epidemiology and Cancer Registry/Institute of Oncology, Oncology, Ljubljana, Slovenia 3 Bulgarian National Cancer Registry/National Oncological Hospital, Oncology, Sofia, Bulgaria 4 National Cancer Registry of Ukraine/National Institute of Cancer, Oncology, Kiev, Ukraine 5 Department of Clinical Sciences, University of Barcelona, Oncology, Barcelona, Spain 6 University Hospital Aintree, Surgery, Liverpool, United Kingdom 7 Medical University of Vienna/ABCSG Pancreatic Cancer Registry, Surgery and Comprehensive Cancer Centre, Vienna, Austria 8 Belgian Cancer Registry, Oncology, Brussels, Belgium 9 Odense University Hospital/Danish Pancreas Cancer Group, Surgery, Odense, Denmark 10 University of Halle-Wittenberg/Pancreatic Cancer Register, Surgery, Halle, Germany 11 Link€oping University/Swedish Registry for Pancreatic Tumors, Surgery, Link€oping, Sweden 12 Netherlands Cancer Registry/Comprehensive Cancer Centre The Netherlands, Research, Eindhoven, Netherlands
ABSTRACTS
S71
Background: International comparisons of hospital performances could provide clues to the most optimal and tailored treatment in cancer patients. EURECCA, acronym for European Registration of Cancer Care, is a platform aiming to (among others) improve cancer care by comparing European data. The aim of the present EURECCA study is to compare characteristics of patients with pancreatic cancer who underwent surgery. Material and methods: National cancer registries, as well as specific pancreatic cancer audits/registries, were invited to participate in the EURECCA Pancreatic cancer project. The participating countries were requested to provide data on patients diagnosed in the year 2012 or 2013, on the following variables: pathological TNM stage, patient characteristics (age, gender), surgery (yes/no) and vital status. Bulgaria, Ukraine, Slovenia, Leiden (the Netherlands) and Catalonia (Spain) are currently participating in this project. More countries have been invited and agreed to participate in the project; additional data will be analysed for the conference. For the present analysis, only patients who underwent surgery were selected. Results: Overall, 1551 patients are included: 79 from Leiden, 207 from Catalonia, 401 from Bulgaria, 48 from Slovenia and 816 from Ukraine. Median age and gender per registry, are presented in Table 1. Stage distribution of patients who received surgery was considerably different between the countries, which are also demonstrated in Table 1. Remarkably, Bulgaria and Ukraine performed more surgery in patient with stage III or IV than Catalonia and Leiden. At a median follow-up of 2 years, 40% of the patients from Leiden were still alive. At a median follow-up of 1 year, 8.5% of the patients in Bulgaria, 31% of the patients in Slovenia and 31% in Ukraine were still alive. There is no information available about follow-up from Catalonia.
Table 1 Median age and distribution of gender and stage of patients undergoing surgery for pancreatic cancer in 2013 by country. Bulgaria Catalonia Leiden Slovenia Ukraine (n ¼ 401) (n ¼ 207) (n ¼ 79) (n ¼ 48) (n ¼ 816) Age (median) Gender male/female Stage I Stage II Stage III Stage IV Stage unknown
65
70
66
61
54%/46%
56%/44%
47%/53% 58%/42% 54%/46%
40 [10%] 102 [25%] 80 [20%] 163 [41%] 16 [4%]
14 [7%] 130 [63%] 5 [2%] 2 [1%] 56 [27%]
9 [11%] 44 [56%] 4 [5%] 8 [10%] 14 [18%]
7 [15%] 25 [52%] 2 [4%] 9 [19%] 5 [10%]
64
97 [12%] 235 [30%] 134 [17%] 190 [23%] 60 [8%]
Conclusions: Data from these five international registries show a large variation in characteristics of surgically treated pancreatic cancer patients. Importantly, tumor stage distribution of patients undergoing surgical treatment differed among countries. Additional data of all participating countries is currently collected aiming to compare treatment strategies and outcome of pancreatic cancer patients in European countries. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.020
14 September 2016 11:30e12:40 Proffered Paper: Minimally Invasive and Robotic Surgery 15. TAMIS for rectal tumors: Advancements of a new approach D. Rega, D. Scala, U. Pace, A. Niglio, F. Ruffolo, M. Pannullo, C. Sassaroli, P. Delrio Istituto Nazionale Tumori Fondazione “G. Pascale”, Colorectal Surgical Oncology, Napoli, Italy Background: Transanal minimally invasive surgery (TAMIS) allows transanal excision of rectal lesions by the means of a single access port and traditional laparoscopic instruments. This technique represents a promising treatment for rectal neoplasms since it guarantees precise dissection and reproducible approaches. Materials and methods: From May 2010 to January 2016, we performed TAMIS excisions of rectal lesions in 58 patients using a SILS port. The pre-operative diagnosis was 29 tumours, 26 low and high grade displasias and 3 benign neoplasms. Fourteen patients had a neoadjuvant treatment. Pneumorectum was established at a pressure of 15e20 mmHg with continuous insufflation, and full thickness resections of rectal neoplasm with ordinary laparoscopic instruments were performed with a conventional 5-mm 30 laparoscopic camera. Results: The average operative time was 78 min. Five serious intraoperative complications occurred: one bleeding, 3 intraperitoneal perforation, 1 rectovaginal fistula (for a lesion in the anterior wall). The peritoneal infraction was closed by combined transanal and laparoscopic sutures in 1 patient; in 2 other patients transanal sutures only were used. In 1 patient a subsequent open laparotomy was necessary at postoperative day 2 and a Hartmann procedure was performed; a diverting colostomy was required in the patient with the rectovaginal fistula. Bleeding was successfully treated by cautery and sutures. Postoperative pathology confirmed benign rectal adenoma in 23 patients (15 low grade, 8 high grade) and 1 GIST, 1 lipoma and 1 mucinous adenoma. In 8 patients, no tumour (T0) could be detected: this occurred because of a
previous endoscopic resection in 4 cases and a complete response to neoadjuvant therapy in other 4 patients. This was diagnosed in 14 cases, a T1 cancer in 3 cases, a T2 cancer in 6 and a T3 cancer in 1 case. Unclear resection margins were detected in 6 pts: thereafter 5 patients underwent radical surgery. One patient was unfit for radical surgery and at follow up she is alive and well. Patients were discharged after a median of 3 days. At a median follow-up of 40 (2e70) months, local recurrences occurred in 6 patients (5 cancer and one low grade dysplasia). Conclusions: TAMIS shows several advantages compared to other transanal surgical procedures. Radical excision of rectal cancer can be safely performed, also for lesions downstaged by neoadjuvant treatment. Adequate treatment of benign lesions as well as perirectal tumor can be achieved. Standard instrumentations for laparoscopic surgery can be used and shorten learning curve and operating room set up. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.021
16. Robot-assisted Ivor Lewis esophagectomies with hand sewn anastomosis: Short-term outcome M. Lubbers, M. Van Det, E. Kouwenhoven ZGT Almelo, Surgery, Almelo, Netherlands Background: For a few years ago, open esophagectomy was the preferred surgical approach in patients with esophageal cancer. In recent years, minimally invasive esophagectomy is becoming popular with less pulmonary complications and a shorter hospital stay. Nonetheless, thoracoscopically creating the intrathoracic anastomosis is very challenging. Use of robot could help this technical demanding part of the esophagectomy.
11. Intraoperative ultrasonography in pancreatic surgery: Staging and resection guidance A. Lukashenko, O. Kolesnik, A. Shudrak, V. Zvirych, C. Maliarchuk National Cancer Institute, Tumors of Abdominal Cavity, Kiev, Ukraine Background: Intraoperative ultrasound examination (IOUS) is indispensable part of modern surgical interventions in tumors of hepatopancreatobiliary zone. In this study retrospective analysis of IOUS efficiency in surgical treatment of pancreatic tumors was provided. Materials and methods: In the period from January 2013 till November 2015 in the National Cancer Institute IOUS was applied during 76 surgical interventions: for pancreatic head tumors e in 46 (60.5%) patients, for body/tail pancreatic tumors e in 20 (26.3%) patients, in 10 (13.2%) patients e for periampullary zone neoplasms. In IOUS we performed primary tumor assessment (localization, degree of tumor spreading to superior mesenteric vessels, hepatoduodenal ligament vessels, additional foci occurrence in pancreas), and liver metastases detection. Surgical interventions were performed: pancreatoduodenectomy in 52 (68.4%) patients, radical antegrade modal pancreatosplenectomy e in 14 (18.4%) patients. Results: IOUS allowed determining additional tumor foci in pancreas in 2 (2.6%) patients, in 8 (10.5%) observations tumor invasion into portal or superior mesenteric vein was determined. In 21 (27.6%) patient additional hepatic neoplasms were detected (in half of cases e 11.8%, metastases). These findings resulted in change of surgical intervention extent in 23 (30.3%) patients: expansion to combined resections in 14 (18.4%) patients, reduction to symptomatic operations in 5 (6.6%) cases, organ-preserving operations were performed in 4 (5.3%) patients. Variant anatomy of hepatic arterial blood supply was determined in 41 (53.9%) patients that necessitated performance correction of resection stages for preservation of adequate hepatic blood supply. Conclusions: IOUS is a highly-precise diagnostic method substantively influencing operation course in pancreatic tumors, enabling surgeon to provide adequate staging and permanent correction of operation course. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.017
12. The prognostic value of the lymph node ratio for resected pancreatic ductal carcinoma S. Aosasa, H. Abe, M. Nishikawa, M. Hoshikawa, T. Noro, S. Hiraki, Y. Kajiwara, T. Moriya, T. Yamasaki, E. Shinto, H. Tsujimoto, T. Tanimizu, H. Ueno, K. Hase, J. Yamamoto National Defense Medical College, Department of Surgery, Tokorozawa, Japan Background: Aim of this study was to evaluate the prognostic significance of the ratio of number of positive lymph nodes to total number of examined lymph nodes (lymph node ratio, LNR) for resected pancreatic ductal adenocarcinoma.
ABSTRACTS Material and methods: A total of 102 patients with pancreatic ductal carcinoma, who underwent R0 or R1 pancreatectomy from 2008 to 2014 were reviewed retrospectively. Clinicopathologic factors including number of positive lymph nodes (NP), number of examined lymph nodes (NE), LNR, and survival were analyzed by univariate and multivariate analyses. Furthermore, analyses using Akaike information criterion (AIC) and Harrell’s concordance index (c-index) were performed to evaluate the prognostic value. Results: Tumors were located mainly in the pancreatic head (68 patients, 67%). The median size of tumor was 3.3 cm (range 1.7e9.6) and 91 patients (89%) had lymph node metastasis. The median of NP, NE, and LNR was 4 (range 0e19), 32.5 (range 10e67), and 0.11 (range 0e0.69), respectively. Resection margin was negative (R0 resection) for 76 patients (75%) and postoperative chemotherapy was administered to 81 (79%) patients. Overall survival rates were 75%, 33%, and 20% at 1, 3, and 5 years, respectively. Univariate analysis revealed that NP (3), LNR (>0.11), CA19-9 level (>370), tumor size (>3 cm), R0 resection, postoperative chemotherapy significantly correlated (p < 0.01) with increased survival and a positive correlation was seen between NP and LNR (r ¼ 0.37, p < 0.01). Multivariate analysis with LNR, CA19-9 level, tumor size, R0 resection and postoperative chemotherapy revealed that LNR (HR 2.47) and postoperative chemotherapy (HR 2.05) were independent factors for overall survival. Otherwise, multivariate analysis with NP, CA19-9 level, tumor size, R0 resection and postoperative chemotherapy revealed that NP (HR 2.26) and R0 resection (HR 1.96) were independent factors for overall survival. Both AIC and the c-index showed that the prognostic value of LNR (AIC: 534.62, c-index: 0.646) was higher than that of NP (AIC: 537.12, c-index: 0.634). LNR also had an independent impact on recurrence-free survival after surgery. Conclusions: LNR is the most powerful tumor-related factor predicting overall and recurrence-free survival for resected pancreatic ductal carcinoma. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.018
14. The EURECCA Pancreatic Cancer Project: An overview of the first data 2 B.G. Sibinga Mulder1, E. Bastiaannet1, M. Primic-Zakelj , Z. Valerianova3, A. Ryzhov4, J.M. Borras5, G.J. Poston6, K. Sahora7, E. Van Eycken8, M.B. Mortensen9, D. Henning10, T. Gasslander11, V.E. Lemmens12, P.G. Boelens1, J.S.D. Mieog1, C.J.H. Van de Velde1, B.A. Bonsing1 1 Leiden University Medical Center, Surgery, Leiden, Netherlands 2 Epidemiology and Cancer Registry/Institute of Oncology, Oncology, Ljubljana, Slovenia 3 Bulgarian National Cancer Registry/National Oncological Hospital, Oncology, Sofia, Bulgaria 4 National Cancer Registry of Ukraine/National Institute of Cancer, Oncology, Kiev, Ukraine 5 Department of Clinical Sciences, University of Barcelona, Oncology, Barcelona, Spain 6 University Hospital Aintree, Surgery, Liverpool, United Kingdom 7 Medical University of Vienna/ABCSG Pancreatic Cancer Registry, Surgery and Comprehensive Cancer Centre, Vienna, Austria 8 Belgian Cancer Registry, Oncology, Brussels, Belgium 9 Odense University Hospital/Danish Pancreas Cancer Group, Surgery, Odense, Denmark 10 University of Halle-Wittenberg/Pancreatic Cancer Register, Surgery, Halle, Germany 11 Link€oping University/Swedish Registry for Pancreatic Tumors, Surgery, Link€oping, Sweden 12 Netherlands Cancer Registry/Comprehensive Cancer Centre The Netherlands, Research, Eindhoven, Netherlands
ABSTRACTS
S71
Background: International comparisons of hospital performances could provide clues to the most optimal and tailored treatment in cancer patients. EURECCA, acronym for European Registration of Cancer Care, is a platform aiming to (among others) improve cancer care by comparing European data. The aim of the present EURECCA study is to compare characteristics of patients with pancreatic cancer who underwent surgery. Material and methods: National cancer registries, as well as specific pancreatic cancer audits/registries, were invited to participate in the EURECCA Pancreatic cancer project. The participating countries were requested to provide data on patients diagnosed in the year 2012 or 2013, on the following variables: pathological TNM stage, patient characteristics (age, gender), surgery (yes/no) and vital status. Bulgaria, Ukraine, Slovenia, Leiden (the Netherlands) and Catalonia (Spain) are currently participating in this project. More countries have been invited and agreed to participate in the project; additional data will be analysed for the conference. For the present analysis, only patients who underwent surgery were selected. Results: Overall, 1551 patients are included: 79 from Leiden, 207 from Catalonia, 401 from Bulgaria, 48 from Slovenia and 816 from Ukraine. Median age and gender per registry, are presented in Table 1. Stage distribution of patients who received surgery was considerably different between the countries, which are also demonstrated in Table 1. Remarkably, Bulgaria and Ukraine performed more surgery in patient with stage III or IV than Catalonia and Leiden. At a median follow-up of 2 years, 40% of the patients from Leiden were still alive. At a median follow-up of 1 year, 8.5% of the patients in Bulgaria, 31% of the patients in Slovenia and 31% in Ukraine were still alive. There is no information available about follow-up from Catalonia.
Table 1 Median age and distribution of gender and stage of patients undergoing surgery for pancreatic cancer in 2013 by country. Bulgaria Catalonia Leiden Slovenia Ukraine (n ¼ 401) (n ¼ 207) (n ¼ 79) (n ¼ 48) (n ¼ 816) Age (median) Gender male/female Stage I Stage II Stage III Stage IV Stage unknown
65
70
66
61
54%/46%
56%/44%
47%/53% 58%/42% 54%/46%
40 [10%] 102 [25%] 80 [20%] 163 [41%] 16 [4%]
14 [7%] 130 [63%] 5 [2%] 2 [1%] 56 [27%]
9 [11%] 44 [56%] 4 [5%] 8 [10%] 14 [18%]
7 [15%] 25 [52%] 2 [4%] 9 [19%] 5 [10%]
64
97 [12%] 235 [30%] 134 [17%] 190 [23%] 60 [8%]
Conclusions: Data from these five international registries show a large variation in characteristics of surgically treated pancreatic cancer patients. Importantly, tumor stage distribution of patients undergoing surgical treatment differed among countries. Additional data of all participating countries is currently collected aiming to compare treatment strategies and outcome of pancreatic cancer patients in European countries. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.020
14 September 2016 11:30e12:40 Proffered Paper: Minimally Invasive and Robotic Surgery 15. TAMIS for rectal tumors: Advancements of a new approach D. Rega, D. Scala, U. Pace, A. Niglio, F. Ruffolo, M. Pannullo, C. Sassaroli, P. Delrio Istituto Nazionale Tumori Fondazione “G. Pascale”, Colorectal Surgical Oncology, Napoli, Italy Background: Transanal minimally invasive surgery (TAMIS) allows transanal excision of rectal lesions by the means of a single access port and traditional laparoscopic instruments. This technique represents a promising treatment for rectal neoplasms since it guarantees precise dissection and reproducible approaches. Materials and methods: From May 2010 to January 2016, we performed TAMIS excisions of rectal lesions in 58 patients using a SILS port. The pre-operative diagnosis was 29 tumours, 26 low and high grade displasias and 3 benign neoplasms. Fourteen patients had a neoadjuvant treatment. Pneumorectum was established at a pressure of 15e20 mmHg with continuous insufflation, and full thickness resections of rectal neoplasm with ordinary laparoscopic instruments were performed with a conventional 5-mm 30 laparoscopic camera. Results: The average operative time was 78 min. Five serious intraoperative complications occurred: one bleeding, 3 intraperitoneal perforation, 1 rectovaginal fistula (for a lesion in the anterior wall). The peritoneal infraction was closed by combined transanal and laparoscopic sutures in 1 patient; in 2 other patients transanal sutures only were used. In 1 patient a subsequent open laparotomy was necessary at postoperative day 2 and a Hartmann procedure was performed; a diverting colostomy was required in the patient with the rectovaginal fistula. Bleeding was successfully treated by cautery and sutures. Postoperative pathology confirmed benign rectal adenoma in 23 patients (15 low grade, 8 high grade) and 1 GIST, 1 lipoma and 1 mucinous adenoma. In 8 patients, no tumour (T0) could be detected: this occurred because of a
previous endoscopic resection in 4 cases and a complete response to neoadjuvant therapy in other 4 patients. This was diagnosed in 14 cases, a T1 cancer in 3 cases, a T2 cancer in 6 and a T3 cancer in 1 case. Unclear resection margins were detected in 6 pts: thereafter 5 patients underwent radical surgery. One patient was unfit for radical surgery and at follow up she is alive and well. Patients were discharged after a median of 3 days. At a median follow-up of 40 (2e70) months, local recurrences occurred in 6 patients (5 cancer and one low grade dysplasia). Conclusions: TAMIS shows several advantages compared to other transanal surgical procedures. Radical excision of rectal cancer can be safely performed, also for lesions downstaged by neoadjuvant treatment. Adequate treatment of benign lesions as well as perirectal tumor can be achieved. Standard instrumentations for laparoscopic surgery can be used and shorten learning curve and operating room set up. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.021
16. Robot-assisted Ivor Lewis esophagectomies with hand sewn anastomosis: Short-term outcome M. Lubbers, M. Van Det, E. Kouwenhoven ZGT Almelo, Surgery, Almelo, Netherlands Background: For a few years ago, open esophagectomy was the preferred surgical approach in patients with esophageal cancer. In recent years, minimally invasive esophagectomy is becoming popular with less pulmonary complications and a shorter hospital stay. Nonetheless, thoracoscopically creating the intrathoracic anastomosis is very challenging. Use of robot could help this technical demanding part of the esophagectomy.