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25. The impact of postoperative enteral immunonutrition on postoperative complications and survival in gastric cancer patients
ABSTRACTS (6e9 mm). 2 cases of malignancy were discovered in polyps <5 mm (0.07%) while malignancy was found in 68 patients with polyps altogether. 26 patients (0.6%) with polyps had high grade dysplasia (most commonly tubular adenoma with HGD), among them 16 cases of HGD were found in small polyps (6 in <5 mm polyps (0.2%) and 10 in 6e9 mm polyps (0.8%)). Conclusions: Management of small colorectal polyps is still not standardized and there is no size-based strategy of treatment. Although malignancy is more often found in large polyps, small polyps require attentive approach and adequate removing technique. The cases of high grade dysplasia and malignancy found in polyps smaller than 5 mm can be of great importance to emphasize the necessity to develop a management strategy for small polyps. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.029
24. Prospective study of robotic assisted rectal surgery for carcinoma rectum R.K. Chandrashekara, S. Somashekhar, S.S. Zaveri, R.C. Jaka, K. Ashwin, G. Prasanna, R.N. Natraj, E. Ramya Manipal Comprehensive Cancer Centre, Surgical Oncology, Banglore, India Background: Robotic surgical systems have dramatically changed minimally invasive surgery as they could potentially address limitations of laparoscopic rectal surgery. Inspite of many evidences that are being published it is still in its infancy when it comes to its acceptancy in terms of safety, feasibility and oncological outcomes. This prospective observational study is conducted to evaluate the safety, feasibility, technique, and outcomes (operative, oncological short-term and post-operative) of robotic-assisted rectal surgery for carcinoma rectum in the Indian set up. Materials and methods: This was a prospective observational study conducted between February 2014 and February 2016, including 35 patients, diagnosed of rectal carcinoma. All patients who were diagnosed of rectal carcinoma where evaluated and worked up for staging and metastatic survey. Patients underwent robotic rectal cancer surgery in form of either low anterior resection or abdominoperineal resection. Patients who were T3 and above or N+ received neo-adjuvant chemoradiation as protocol, reassesed after 6e8 weeks and then taken up for surgery. Results: Out of 35 patients, 25 were male and 10 were female, aged between 34e80 years. All patients had adenocarcinoma rectum, with 11 having carcinoma in upper rectum, 4 in mid rectum and 20 in lower rectum. 28 patients had T3 lesion, 4 had T2 and 3 had T4 lesion. 26 out of 35 patients received neo-adjuvant chemoradiation before surgery. 28 patients had low anterior resection and 7 patients underwent abdomino-perineal resection. Average operative time including docking time and surgery time was 226.32 min (170e300 min), mean blood loss was 146.76 ml (120e200 ml), there was no conversion to open surgery in any case. Bowel sounds appeared on average on 3rd day, with patients requiring iv analgesics on a average for 3.7 days (2e5 days ) and oral analgesics for 3.6 days (2e5 days ). All margins were negative (proximal, distal, circumferential ) in all patients, mesorectal grade was complete in 33 patients and near complete in 2. Mean number of lymph nodes harvested is 9.5 (2e32). 2 patients had anastomotic dehiscence after 1 month. Minor complications were noticed in 5 patients. Conclusion: In conclusion, robotic rectal surgery has several benefits in the treatment of rectal cancer and should be part of the armamentarium of the experienced surgeon dealing with this disease. We conclude that the robotic-assisted rectal cancer surgery is safe and an oncologically feasible technique. However, large study group and long-term follow-up data are required to evaluate the recurrence and survival rates. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.030
S75 25. The impact of postoperative enteral immunonutrition on postoperative complications and survival in gastric cancer patients A. Szczepanik1, L. Scisło2, R. Pach1, J. Kulig1, P. Brandt3, E. Walewska2, A. Nowak1, M. Ga˛dek1, G. Puto2 1 Jagiellonian University Medical College, 1st Department of General Oncological and Gastrointestinal Surgery, Krakow, Poland 2 Jagiellonian University Medical College, 1Clinical Nursing Unit Nursing and Obstetrics Institute e Faculty of Health Sciences, Krakow, Poland 3 Baystate Medical Centre, Baystate Medical Centre, Springfield, USA Immunomodulating enteral nutrition in the perioperative period may reduce postoperative complications in cancer patients. Little is known if this effect translates to the better survival. The aim of study was to assess the impact of postoperative immunomodulating enteral nutrition on postoperative complications and survival of gastric cancer patients. The group of 98 gastric cancer patients were randomly assigned for postoperative immunomodulating enteral nutrition n ¼ 44 (Reconvan, Fresenius Kabi), or standard enteral nutrition n ¼ 54 (Peptisorb, Nutricia). Postoperative complications, mortality, 6-months and 1-year survival were analyzed. The overall postoperative morbidity did not differ between groups. The rate of pulmonary complications (excluding pneumonia) was significantly lower in immunomodulation group (0% vs 9.3%, p ¼ 0.044), as well as 60day mortality (0% vs 11.1%, p ¼ 0.037). There was no difference in 6months and 1 year survival between groups. This confirmed that postoperative immunomodulating enteral nutrition may reduce respiratory complications and postoperative mortality in comparison to standard enteral nutrition. Despite this effect, it did not improve 6 months and 1-year survival in immunomodulation group. Probably the beneficial effect of immunomodulating enteral nutrition is too weak to be significant in such a number of patients. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.031
26. Hyperthermic intraperitoneal chemoperfusion in combined treatment of locally advanced and disseminated gastric cancer: Results of a single-centre study R. Yarema1, M. Ohorchak2, Y. Oliynyk1, M. Matusak2, M. Zubarev1, P. Gyrya2, Y. Kovalchuk2, V. Safiyan2, I. Karelin2, T. Semotuk3, T. Novicka3, L. Laba3, M. Yarysh3, T. Fetsych1 1 Danylo Halytsky Lviv National Medical University, Oncology, Lviv, Ukraine 2 Lviv Regional Cancer Center, Abdominal Surgery, Lviv, Ukraine 3 Lviv Regional Cancer Center, Intensive Care, Lviv, Ukraine Background: Patients with locally advanced gastric cancer (GC) and/ or peritoneal metastases have a poor prognosis despite systemic chemotherapy or palliative surgery. The aim of this retrospective comparative non-randomized study was to evaluate aggressive cytoreduction in combination with hyperthermic intraperitoneal chemoperfusion (HIPEC) as a novel treatment strategy for patients with intraperitoneal disseminated and locally advanced GC. Material and methods: 59 GC patients with serosal invasion (n ¼ 24), limited peritoneal metastases (n ¼ 25), or disseminated peritoneal metastases and tense ascites (n ¼ 10) underwent combination therapy with HIPEC. Three matched control groups undergoing standard therapies were retrospectively identified. Results: Combination therapy for serosa-invasive GC reduced the level of metachronous peritoneal carcinomatosis from 75% in the surgical control subgroup to 33.3% (p ¼ 0.004) and increased median survival from 13.3 months to 32.5 months (r ¼ 0.0006). The median and 1-year survival rates for intraperitoneal disseminated GC patients undergoing therapy with the use of HIPEC were 12 months and 54.2% compared with 8.4 months and 20%, respectively (p ¼ 0.004) for control subgroup patients (palliative chemotherapy). For patients with complete cytoreduction median survival
24. Prospective study of robotic assisted rectal surgery for carcinoma rectum R.K. Chandrashekara, S. Somashekhar, S.S. Zaveri, R.C. Jaka, K. Ashwin, G. Prasanna, R.N. Natraj, E. Ramya Manipal Comprehensive Cancer Centre, Surgical Oncology, Banglore, India Background: Robotic surgical systems have dramatically changed minimally invasive surgery as they could potentially address limitations of laparoscopic rectal surgery. Inspite of many evidences that are being published it is still in its infancy when it comes to its acceptancy in terms of safety, feasibility and oncological outcomes. This prospective observational study is conducted to evaluate the safety, feasibility, technique, and outcomes (operative, oncological short-term and post-operative) of robotic-assisted rectal surgery for carcinoma rectum in the Indian set up. Materials and methods: This was a prospective observational study conducted between February 2014 and February 2016, including 35 patients, diagnosed of rectal carcinoma. All patients who were diagnosed of rectal carcinoma where evaluated and worked up for staging and metastatic survey. Patients underwent robotic rectal cancer surgery in form of either low anterior resection or abdominoperineal resection. Patients who were T3 and above or N+ received neo-adjuvant chemoradiation as protocol, reassesed after 6e8 weeks and then taken up for surgery. Results: Out of 35 patients, 25 were male and 10 were female, aged between 34e80 years. All patients had adenocarcinoma rectum, with 11 having carcinoma in upper rectum, 4 in mid rectum and 20 in lower rectum. 28 patients had T3 lesion, 4 had T2 and 3 had T4 lesion. 26 out of 35 patients received neo-adjuvant chemoradiation before surgery. 28 patients had low anterior resection and 7 patients underwent abdomino-perineal resection. Average operative time including docking time and surgery time was 226.32 min (170e300 min), mean blood loss was 146.76 ml (120e200 ml), there was no conversion to open surgery in any case. Bowel sounds appeared on average on 3rd day, with patients requiring iv analgesics on a average for 3.7 days (2e5 days ) and oral analgesics for 3.6 days (2e5 days ). All margins were negative (proximal, distal, circumferential ) in all patients, mesorectal grade was complete in 33 patients and near complete in 2. Mean number of lymph nodes harvested is 9.5 (2e32). 2 patients had anastomotic dehiscence after 1 month. Minor complications were noticed in 5 patients. Conclusion: In conclusion, robotic rectal surgery has several benefits in the treatment of rectal cancer and should be part of the armamentarium of the experienced surgeon dealing with this disease. We conclude that the robotic-assisted rectal cancer surgery is safe and an oncologically feasible technique. However, large study group and long-term follow-up data are required to evaluate the recurrence and survival rates. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.030
S75 25. The impact of postoperative enteral immunonutrition on postoperative complications and survival in gastric cancer patients A. Szczepanik1, L. Scisło2, R. Pach1, J. Kulig1, P. Brandt3, E. Walewska2, A. Nowak1, M. Ga˛dek1, G. Puto2 1 Jagiellonian University Medical College, 1st Department of General Oncological and Gastrointestinal Surgery, Krakow, Poland 2 Jagiellonian University Medical College, 1Clinical Nursing Unit Nursing and Obstetrics Institute e Faculty of Health Sciences, Krakow, Poland 3 Baystate Medical Centre, Baystate Medical Centre, Springfield, USA Immunomodulating enteral nutrition in the perioperative period may reduce postoperative complications in cancer patients. Little is known if this effect translates to the better survival. The aim of study was to assess the impact of postoperative immunomodulating enteral nutrition on postoperative complications and survival of gastric cancer patients. The group of 98 gastric cancer patients were randomly assigned for postoperative immunomodulating enteral nutrition n ¼ 44 (Reconvan, Fresenius Kabi), or standard enteral nutrition n ¼ 54 (Peptisorb, Nutricia). Postoperative complications, mortality, 6-months and 1-year survival were analyzed. The overall postoperative morbidity did not differ between groups. The rate of pulmonary complications (excluding pneumonia) was significantly lower in immunomodulation group (0% vs 9.3%, p ¼ 0.044), as well as 60day mortality (0% vs 11.1%, p ¼ 0.037). There was no difference in 6months and 1 year survival between groups. This confirmed that postoperative immunomodulating enteral nutrition may reduce respiratory complications and postoperative mortality in comparison to standard enteral nutrition. Despite this effect, it did not improve 6 months and 1-year survival in immunomodulation group. Probably the beneficial effect of immunomodulating enteral nutrition is too weak to be significant in such a number of patients. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.031
26. Hyperthermic intraperitoneal chemoperfusion in combined treatment of locally advanced and disseminated gastric cancer: Results of a single-centre study R. Yarema1, M. Ohorchak2, Y. Oliynyk1, M. Matusak2, M. Zubarev1, P. Gyrya2, Y. Kovalchuk2, V. Safiyan2, I. Karelin2, T. Semotuk3, T. Novicka3, L. Laba3, M. Yarysh3, T. Fetsych1 1 Danylo Halytsky Lviv National Medical University, Oncology, Lviv, Ukraine 2 Lviv Regional Cancer Center, Abdominal Surgery, Lviv, Ukraine 3 Lviv Regional Cancer Center, Intensive Care, Lviv, Ukraine Background: Patients with locally advanced gastric cancer (GC) and/ or peritoneal metastases have a poor prognosis despite systemic chemotherapy or palliative surgery. The aim of this retrospective comparative non-randomized study was to evaluate aggressive cytoreduction in combination with hyperthermic intraperitoneal chemoperfusion (HIPEC) as a novel treatment strategy for patients with intraperitoneal disseminated and locally advanced GC. Material and methods: 59 GC patients with serosal invasion (n ¼ 24), limited peritoneal metastases (n ¼ 25), or disseminated peritoneal metastases and tense ascites (n ¼ 10) underwent combination therapy with HIPEC. Three matched control groups undergoing standard therapies were retrospectively identified. Results: Combination therapy for serosa-invasive GC reduced the level of metachronous peritoneal carcinomatosis from 75% in the surgical control subgroup to 33.3% (p ¼ 0.004) and increased median survival from 13.3 months to 32.5 months (r ¼ 0.0006). The median and 1-year survival rates for intraperitoneal disseminated GC patients undergoing therapy with the use of HIPEC were 12 months and 54.2% compared with 8.4 months and 20%, respectively (p ¼ 0.004) for control subgroup patients (palliative chemotherapy). For patients with complete cytoreduction median survival