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− rectal cancer
S106 and organs. Current data on treatment results of MVR for LACC with bladder involvement is studied insufficiently. Materials and methods: Three hundred and three patients, who underwent curative surgery for LACC since 2008 until 2013 were included. Study group (SG) (85 patients) e radical MVR with full-thickness bladder resection for grade IIB e IIIC (pT4bN0-1M0) LACC. Control group (CG) e 218 patients with grade IIB e IIIC (pT4bN0-1M0) colorectal cancer, who underwent standard surgery for sigmoid and rectal cancer. Class III e V Clavien-Dindo complications, tumor invasion rate, overall and disease-free 5-year survival were assessed. Results: MVR with full-thickness bladder resection were performed in 17 patients with rectal and in 54 e with sigmoid cancer, among them ureterocystoneostomy took part in 14 cases. Postoperative class III e IV Clavien-Dindo complications were observed in 12 cases (14%). Most frequent of them were vesical fistulas (external and colovaginal) e 5 (6%) and anastomotic leakage e 4 (5%). Reoperation was considered as a treatment option in 6 cases (7%). There were no cases of postoperative mortality in both groups. Among CG patients anastomotic leakage was observed in 15 cases (7%), leading to diffuse peritonitis in 9 (4%) cases. There was no significant difference between rates of anastomotic leakage in both groups (p>0.05). in SG patients rate of tumor invasion was 53%, overall and disease-free 5-year survival was 6212,7% and 398%. In CG patients overall and disease-free 5-year survival was 72,39,5% and 46,810% respectively (p>0,05). Conclusions: En-bloc MVR in cases of LACC with urinary bladder involvement represents an optimal treatment strategy, resulting in satisfying short- and long-term outcomes with no significant difference in complications, overall and disease-free survival rates. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.254
263. Long-term outcomes of surgical treatment of colorectal neuroendocrine tumours I. Shchepotin1, O. Kolesnik1, A. Lukashenko1, D. Mahmudov1, A. Beznosenko1, V. Prymak1, A. Burlaka1 1 National Cancer Institute, Abdominal Oncology, Kyiv, Ukraine Background: Gastro-entero-pancreatic neuroendocrine tumors (GEPNETs) represent a rare subtype of malignancies, derived from diffuse gut endocrine system. GEP-NETs represent 3-4% of all colorectal tumors. Clinical and morphological characteristics, patterns of their progression dynamics and results of surgical treatment for colorectal GEP-NETs remain underestimated, regarding an emphasized analysis. Materials and methods: A retrospective analysis of 56 patients, who underwent surgical treatment for colorectal GEP-NETs (according to National cancer registry and case history data) was conducted. Mean age, primary tumor site, malignancy grade (WHO 2010 classification), frequency of local and advanced disease, overall 5-year survival and disease-free survival were assessed. Results: Mean age of patients was 5813 years, males and females distribution was eligible. No patient among the selected study population manifested with carcinoid syndrome e all had general symptoms. NETG1 (Ki-67 2%) were observed in 23 patients (40%), NET-G2 (Ki-67 e 3-20%) e in 13 (24%) and NEC-G3 (neuroendocrine carcinomas Ki-67 20%) were present in 20 patients (36%). Primary tumor site in the colon was observed in 36 patients (64%), in the rectum e 20 (36%). Colon NETs were mostly observed in the appendix and caecum e 15 (26%), rectal NETs e in the lower rectum e 9 (16%). Primary metastatic disease was in 12 patients (22%) e 10 (18%) had hepatic metastases, 2 (4%) e extrahepatic disease. By January 2013 17 patients (31%) died e 11 (20%) developed tumor progression, 6 (11%) e from non-tumor related causes. Tumor recurrence was observed in 7 patients (13%) e predominantly after anterior rectal resections. Overall 5-year survival rate for patients with NETs was 41,76,4% with median survival of 22 months. Overall 5-year disease-free survival was 32,47,8%. Rates of overall
ABSTRACTS and disease-free 5-year survival for patients with local disease was 7211,4% and 537,8% and for patients with advanced disease 286.7% and 1912.7%. Conclusions: Colorectal GEP-NETs represent a rare group of malignant tumors, demonstrating major distinguishment from adenocarcinoma clinically and biologically. Radical surgery results as a perspective treatment option. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.255
264. Neoadjuvant chemoradiotherapy for distal T2-3N+/L rectal cancer I. Shchepotin1, O. Kolesnik1, V. Ivankova1, O. Stolyarova1, A. Beznosenko1, D. Mahmudov1 1 National Cancer Institute, Abdominal Oncology, Kyiv, Ukraine Background: The two broad approaches to neoadjuvant therapy for distal rectal cancer - short-course and long-course radiation. The outcomes of these approaches reported in nonrandomized trials are not comparable because patients selected for treatment with short-course radiotherapy included those with T1e3 disease. The aim of this study was to compare survival, local control, postoperative complications and anal sphincter preservation in the two treatment groups: short-course (sRT) versus long-course radiotherapy (lRT) as a neoadjuvant modality for the management of lower rectal cancer. Materials and Methods: The study randomized 172 patients with T23N+/-M0 distal rectal cancer. Patients receive either neoadjuvant shortcourse radiotherapy (5 x 5 Gy ) and surgery within 1-2 days (Groupe 1) or long-course radiotherapy (30 Gy in 15 fractions of 2 Gy) and surgery 4 weeks later (Groupe 2). The median follow-up of living patients was 48 (range 38e64) months. Results: Complete response - 8,8%, partial response - 42,3% in Groupe 2. The actuarial 5-year overall survival was 77.6 % in the Groupe 1 and 90,2 % in the Groupe 2 (P ¼ 0,01). Disease-free survival was 62,7% versus 86,4 per cent (P ¼ 0,001), crude incidence of local recurrence was 8,8% versus 6,9% (P ¼ 0.170) respectively. Anal sphincter preservation in Group 2 was 91,1%, compared with 55,4% in the 1st group. Number of sphincter saving surgery for patients in Group 2 with initially planned abdominoperineal resection of the rectum increased by 2.7 times (p <0,005). Postoperative complications such as anastomotic leak comparable in both groups (8.8 and 7.5%). Conclusion: Combined treatment of patients with distal rectal cancer (T2-3N+/-M0) using neoadjuvant long-course radiotherapy of 30 Gy is safe and effective. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.256
265. Condition of the anal sphincter after neoadjuvant radiotherapy in patients with rectal cancer I. Shchepotin1, O. Kolesnik1, A. Grabovoy1, V. Ivankova1, M. Krotevich1, A. Beznosenko1, D. Mahmudov1, V. Zvirych1 1 National Cancer Institute, Abdominal Oncology, Kyiv, Ukraine Background: Vast majority of evidence suggest negative impact of radiation therapy on anal sphincter function. Morphologic changes, which lead to anal incontinence after applying different programs of neoadjuvant radiation therapy (NRT), remain unrevealed. The aim of this study was to assess histologic changes in the anal sphincter, occurring after applying different regimens of NRT in combined treatment of rectal malignancies. Materials and Methods: Histologic changes in anal sphincter tissues were analyzed in 49 patients with T2-4N0-2M0-1 low rectal cancer after NRT and abdomino-perineal resection. Twelve patients had
263. Long-term outcomes of surgical treatment of colorectal neuroendocrine tumours I. Shchepotin1, O. Kolesnik1, A. Lukashenko1, D. Mahmudov1, A. Beznosenko1, V. Prymak1, A. Burlaka1 1 National Cancer Institute, Abdominal Oncology, Kyiv, Ukraine Background: Gastro-entero-pancreatic neuroendocrine tumors (GEPNETs) represent a rare subtype of malignancies, derived from diffuse gut endocrine system. GEP-NETs represent 3-4% of all colorectal tumors. Clinical and morphological characteristics, patterns of their progression dynamics and results of surgical treatment for colorectal GEP-NETs remain underestimated, regarding an emphasized analysis. Materials and methods: A retrospective analysis of 56 patients, who underwent surgical treatment for colorectal GEP-NETs (according to National cancer registry and case history data) was conducted. Mean age, primary tumor site, malignancy grade (WHO 2010 classification), frequency of local and advanced disease, overall 5-year survival and disease-free survival were assessed. Results: Mean age of patients was 5813 years, males and females distribution was eligible. No patient among the selected study population manifested with carcinoid syndrome e all had general symptoms. NETG1 (Ki-67 2%) were observed in 23 patients (40%), NET-G2 (Ki-67 e 3-20%) e in 13 (24%) and NEC-G3 (neuroendocrine carcinomas Ki-67 20%) were present in 20 patients (36%). Primary tumor site in the colon was observed in 36 patients (64%), in the rectum e 20 (36%). Colon NETs were mostly observed in the appendix and caecum e 15 (26%), rectal NETs e in the lower rectum e 9 (16%). Primary metastatic disease was in 12 patients (22%) e 10 (18%) had hepatic metastases, 2 (4%) e extrahepatic disease. By January 2013 17 patients (31%) died e 11 (20%) developed tumor progression, 6 (11%) e from non-tumor related causes. Tumor recurrence was observed in 7 patients (13%) e predominantly after anterior rectal resections. Overall 5-year survival rate for patients with NETs was 41,76,4% with median survival of 22 months. Overall 5-year disease-free survival was 32,47,8%. Rates of overall
ABSTRACTS and disease-free 5-year survival for patients with local disease was 7211,4% and 537,8% and for patients with advanced disease 286.7% and 1912.7%. Conclusions: Colorectal GEP-NETs represent a rare group of malignant tumors, demonstrating major distinguishment from adenocarcinoma clinically and biologically. Radical surgery results as a perspective treatment option. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.255
264. Neoadjuvant chemoradiotherapy for distal T2-3N+/L rectal cancer I. Shchepotin1, O. Kolesnik1, V. Ivankova1, O. Stolyarova1, A. Beznosenko1, D. Mahmudov1 1 National Cancer Institute, Abdominal Oncology, Kyiv, Ukraine Background: The two broad approaches to neoadjuvant therapy for distal rectal cancer - short-course and long-course radiation. The outcomes of these approaches reported in nonrandomized trials are not comparable because patients selected for treatment with short-course radiotherapy included those with T1e3 disease. The aim of this study was to compare survival, local control, postoperative complications and anal sphincter preservation in the two treatment groups: short-course (sRT) versus long-course radiotherapy (lRT) as a neoadjuvant modality for the management of lower rectal cancer. Materials and Methods: The study randomized 172 patients with T23N+/-M0 distal rectal cancer. Patients receive either neoadjuvant shortcourse radiotherapy (5 x 5 Gy ) and surgery within 1-2 days (Groupe 1) or long-course radiotherapy (30 Gy in 15 fractions of 2 Gy) and surgery 4 weeks later (Groupe 2). The median follow-up of living patients was 48 (range 38e64) months. Results: Complete response - 8,8%, partial response - 42,3% in Groupe 2. The actuarial 5-year overall survival was 77.6 % in the Groupe 1 and 90,2 % in the Groupe 2 (P ¼ 0,01). Disease-free survival was 62,7% versus 86,4 per cent (P ¼ 0,001), crude incidence of local recurrence was 8,8% versus 6,9% (P ¼ 0.170) respectively. Anal sphincter preservation in Group 2 was 91,1%, compared with 55,4% in the 1st group. Number of sphincter saving surgery for patients in Group 2 with initially planned abdominoperineal resection of the rectum increased by 2.7 times (p <0,005). Postoperative complications such as anastomotic leak comparable in both groups (8.8 and 7.5%). Conclusion: Combined treatment of patients with distal rectal cancer (T2-3N+/-M0) using neoadjuvant long-course radiotherapy of 30 Gy is safe and effective. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.256
265. Condition of the anal sphincter after neoadjuvant radiotherapy in patients with rectal cancer I. Shchepotin1, O. Kolesnik1, A. Grabovoy1, V. Ivankova1, M. Krotevich1, A. Beznosenko1, D. Mahmudov1, V. Zvirych1 1 National Cancer Institute, Abdominal Oncology, Kyiv, Ukraine Background: Vast majority of evidence suggest negative impact of radiation therapy on anal sphincter function. Morphologic changes, which lead to anal incontinence after applying different programs of neoadjuvant radiation therapy (NRT), remain unrevealed. The aim of this study was to assess histologic changes in the anal sphincter, occurring after applying different regimens of NRT in combined treatment of rectal malignancies. Materials and Methods: Histologic changes in anal sphincter tissues were analyzed in 49 patients with T2-4N0-2M0-1 low rectal cancer after NRT and abdomino-perineal resection. Twelve patients had