- Email: [email protected]
302. The Impact of Overweight and Obesity on Complications After Rectal Cancer Surgery
ABSTRACTS pretreatment MRI and rigid sigmoidoscopy and were included. There was a moderately strong agreement of tumour height, between MRI and sigmoidoscopy (weighted Kappa ¼ 0.455), and a strong positive correlation (Spearman r ¼ 0.72, p¼<0.05). Three outliers (>95% CI) were identified, in which treatment options would have differed based on MRI measurement alone. Conclusions: Tumour height was reliably determined on MRI by an ^ O ~ radiologist when compared with measurement by rigid experienced OGI sigmoidoscopy. However based on the significant variation in a small number of patients we would continue to recommend direct measurement of all rectal tumours with rigid sigmoidoscopy prior to MDT discussion to ensure correct treatment decisions. 298. Posteoperative Outcomes Following Colorectal Cancer Surgery in the Elderly - a Comparison of Laparoscopic and Open Surgery R.L. Harries1, K.B. Bowling1, A. Lala1 1 Ysbyty Gwynedd, General Surgery, Bangor, United Kingdom Background: Elderly patients have a high incidence of colorectal cancer, and with our ageing population the number of elderly patients undergoing colorectal cancer (CRC) procedures will significantly increase. Although laparoscopic surgery has international acceptance for CRC, there has been little evidence focusing on its use in patients aged over 75 years. The aim of this study was to assess the post-operative outcomes comparing laparoscopic with open surgery in elderly patients undergoing CRC surgery. Methods: We performed a retrospective review of our prospectively maintained database, from 2008-2011, of all patients aged over 75 who had underwent either laparoscopic or open CRC surgery. Anal cancers and emergency surgery were excluded from our analysis. Demographic data, post-operative length of stay, complications and 30 day mortality were recorded. Results: There were a total of 164 patients aged over 75 who underwent elective CRC surgery between April 2008- April 2011. 83 males and 81 Females. 62 underwent laparoscopic surgery and 102 had open surgery. The laparoscopic group had a median age of 80 years (range 75-96) compared to the open group with a median age of 82 years (range 75-96). Median post-operative length of stay was 8 days (range 2-49) in the laparoscopic group and 13 days (range 3-376) in the open group (p¼0.0013). 30 day mortality was 4.8% in the laparoscopic group compared to 5.9% in open group (p¼1.0000). Rate of anastomotic leak was 1.6% in the laparoscopic group and 4.9% in the open group (p¼0.4102); and rate of wound infection was 6.4% in the laparoscopic group and 0.9% in the open group (p¼0.0682). Conclusions: Our study showed that laparoscopic surgery has a statistically significantly shorter post-operative length of stay compared to open surgery, with no difference in 30 day mortality and complication rate. Laparoscopic CRC surgery has been shown to be safe and have significant benefits within the elderly population. 299. A Five-year Follow-up Study of Dukes’ B Colonic Cancer - Does Adjuvant Chemotherapy Alter Survival? R.L. Harries1, W. Al-Khyatt1, A.E. Brewster1, K.J. Swarnkar1, E.S. Mckain1, B.M. Stephenson1, G.L. Williams1 1 Royal Gwent Hospital, Colorectal Unit, Newport, United Kingdom ~ Background: Adjuvant chemotherapy benefits patients with DukesO ~ B cancer remains controversial, yet may C disease; its use for DukesO be considered for patients with adverse tumour prognostic factors. The aim of this study was to assess the disease specific survival for patients ~ B colonic cancer with and without adjuvant chemotherapy with DukeOs at our colorectal unit. Methods: A retrospective review of consecutive patients having a po~ B colonic tentially curative resection for histologically confirmed DukesO cancer at a single institution. All rectal cancers were excluded from the study. All data, including mortality, was obtained from the prospectively
827 maintained databases of the colorectal department and histology department. Results: From January 2000* December 2003 a total of 109 patients ~ B colonic underwent a curative resection for histologically proven DukesO cancer. Their median age was 71 (range 44-91) years and 63 were males. The minimum follow up was 5 years. Of the 109 patients, 24 were deemed ^ ~ and had no chemotherapy. 80 patients were deemed to to be Ogood BO have a poorer prognosis due to tumour size >5cm, T stage 4, extramural vascular invasion or evidence of perforation or obstruction; these were ^ ~ Data was unavailable for 5 patients. Of these 80 deemed as Obad BO. ^ ~ patients, 21 underwent 5-FU based chemotherapy. The mean disObad BO ^ ~ group was 52.9 months, compared ease-specific survival for the Ogood BO ^ ~ group who didnOt ~ undergo chemotherapy to 50.8 months for the Obad BO ^ ~ group who did have chemotherapy and 49.3 months for the Obad BO (p¼0.108). Conclusion: Our study has shown that adjuvant chemotherapy for ^ ~ DukesO ~ B colon cancer achieved a 5-year survival rate that was Obad O ~ B colon cancer. The selective use of adjucomparable to ’good’ DukeOs ~ B cancer. A further vant chemotherapy is of benefit in high risk DukeOs study is recommended to assess other therapies which might be more tolerable and effective in a wider patients range. 300. Extracapsular Extension of Nodal Metastases for Prognosis in Patients with Colorectal Cancer - Ours Experience S. Maksimovic1, B. Jakovljevic2 1 General Hospital Sveti Vracevi, Surgical Oncology, Bijeljina, BosniaHerzegovina 2 Clinical Centar Banja Luka, Oncology, Banja Luka, Bosnia-Herzegovina Background: Extracapsular extension (ECE) of nodal metastases from colorectal cancer is a frequent histological finding, but its significance for prognosis and treatment is unclear. We evaluate the prognostic value of lymph node metastasis with extracapsular extension for local control and metastasis-free survival in colorectal cancer. Methods: From January 2000 to January 2012 of 236 rectal cancer patients were treated with surgery and postoperative radiochemotherapy. Patients were grouped according to nodal status (node negative, n ¼ 82 (34,7%); node positive without ECE, n ¼ 115, (48,7%) node positive with ECE, n ¼ 39 (16,5%). Well-known prognostic factors such as International Union against Cancer (UICC) stage, T and N stage, presence of lymphangiosis, and grade were assessed. The end points were analyzed by the Kaplan-Meier method, and prognostic factors were compared in a Cox regression model. Results: We analyzed the patients with node positive without ECE n ¼ 115, (48, 7%) and patients with node positive with ECE, n ¼ 39 (16,5%), the actuarial 10-year local control and distant metastasis-free survival rate was 63% and 35%, respectively. Patients with ECE of lymph node metastasis had an impaired 10-year local control rate (30%) compared with node positive without ECE, (p ¼ 0.033). Metastasis-free survival also differed for the two groups, with a rate of 21% for those with extracapsular involvement, 42% for those without ECE, p <0.0001). The impact of ECE on local control was confirmed in the regression model (risk ratio [RR] 1.6, 95% confidence interval [CI] 1.1*2.9, p ¼ 0.033). Conclusions: Prognosis was significantly worse in patients with node positive with ECE compared to the patients with node positive without ECE. ECE of node metastasis is connected with a substantial decline in local control. 302. The Impact of Overweight and Obesity on Complications After Rectal Cancer Surgery K. Mrak1, J. Tschmelitsch1 1 Barmherzige Br€uder, Surgical Department, St. Veit / Glan, Austria Background: The influence of obesity on postoperative complications after various surgical interventions remains controversial. The aim of this study is to evaluate the impact of overweight and obesity on the occurrence
828
ABSTRACTS
of postoperative complications for patients undergoing elective resection for rectal carcinoma. Material and Methods: A retrospective data analysis of 676 patients undergoing surgical treatment for rectal carcinoma at our department was conducted. Depending on their body mass index (BMI) patients were grouped as follows: group I included patients up to BMI 24.9 kg/m2, group II patients with a BMI between 25 and 29.9 kg/m2 and group III all patients with a BMI higher than 30 kg/m2. Complications were classified as minor and major complications with regard to severity grades (1 to 5). Statistical analysis was performed to evaluate the difference of complication rates between the different BMI groups. Results: Some 444 patients were included for analysis. Overall 300 (67.6%) of the 444 patients did not develop postoperative complications, 82 (18.4%) patients suffered from minor (grade 1+2) and 56 (12.6%) from major (grade 3+4) complications. Six (1.4%) patients died (grade 5). Fisher«s exact test indicated no statistically significant difference of complication rates between the different BMI groups (p¼0.3716). Conclusion: Compared with nonobese or normal-weight patients, obese patients do not have a statistically significant higher risk to develop postoperative complications after rectal resection for carcinoma.
Background: The aim of this study is to evaluate whether depth of infiltration within T3 colorectal tumors influences long term oncologic outcome. Material and Methods: Patients with stage pT3 colon and rectal tumors were divided into four subgroups according to the depth of infiltration. The influence on overall and disease-free survival was tested for each subgroup and compared in an univariate and multivariate analysis. Results: A total of 368 patients were evaluated with a median followup time of 92.5 months. In 181 patients with colon cancer 5- and 10 years overall survival was 82.7% and 65.0%, 5- and 10 years disease free survival was 80.9% and 64.4%. For 187 rectal cancer 5 * and 10 years overall survival was 69.0% and 50.5% and disease free survival was 61.3% and 47.5%. Neither in colon nor in rectal cancer different pT3-categories showed a statistical significant influence on survival or the ocurrence of local or distant recurrence in uni * and multivariate analysis. However there was a significant influence of higher pT3 subgroups on lymph node involvement and vessel invasion in rectal cancer patients. Conclusion: Subdivision of pT3 tumors in colon cancer, based on depth of infiltration does not provide us with additional information about prognosis. In rectal cancer T3 * substages were associated with lymph node involvement, however we could not show an impact on recurrence or survival.
303. Quality of Life After Surgery for Low Rectal Cancer - Pouch Anastomosis Vs Stoma K. Mrak1, J. Tschmelitsch1 1 Barmherzige Br€ uder, Surgical Department, St. Veit / Glan, Austria
305. Clinical Study of Low Rectal Carcinoma with Isolated Lateral Node Spread H. Sato1, K. Maeda1, T. Hanai1, K. Masumori1, Y. Koide1, K. Honda1, M. Shiota1, S. Matsuoka1, M. Mizuno1 1 Fujita Health University, Department of Surgery, Toyoake, Japan
Background: Low and ultralow anterior resections for rectal cancer with colorectal or coloanal anastomoses do not compromise oncologic results compared to an abdominoperineal excision. Although avoidance of a permanent colostomy is regarded as beneficial for a patient«s quality of life by most surgeons, patients undergoing sphincter sparing surgery may develop a number of functional problems. A colonic pouch significantly improves functional outcome after rectal resection and low anastomosis and may positively influence quality of life. The aim of this study was to compare quality of life in long term survivors who underwent ultralow anterior resection with total mesorectal excision and colonic j-pouch anastomosis (CPA) to patients with abdominoperineal excision and end colostomy (APE) for rectal cancer. Materials and Methods: The medical records of 151 patients who underwent surgery for ultralow rectal cancer from 2001 to 2007 from our prospectively maintained rectal cancer database were analysed. Quality of life in 59 eligible patients was assessed using the EORTC QLQ C 30 and EORTC QLQ CR29. Results were compared for patients with CPA vs. APE. Results: The median follow up in the 59 patients was 6.3 years (3 years-10 years). Quality of life was good in all patients, however CPA patients had better quality of life scores than APE patients. Global health status (p¼0.009), physical functioning (p¼0.0002), role functioning (p¼0.03), cognitive functioning (p¼0.046), social functioning (p¼0.002), body image (p¼0.053), embarrassment (0.002) and urinary frequency (p¼0.003) were significantly better for patients with CPA. Conclusion: The quality of life after rectal resection and colon pouch anastomosis is better than after APE in several domains . However, QoL should not be regarded as an isolated concept but rather as one of several possible clinical outcomes of interest. 304. The Significance of Histological Substaging in Curative Resected T3 Colorectal Cancer K. Mrak1, M. Jagoditsch1, S. Leibl2, A. Klingler3, J. Tschmelitsch1 1 Barmherzige Br€ uder, Surgical Department, St. Veit / Glan, Austria 2 University of Graz, Pathology, Graz, Austria 3 Assign Data Management and Biostatistics, Biostatistics, Innsbruck, Austria
Background: This study was performed to identify the clinicopathologic characteristics of low rectal carcinoma with isolated lateral spread and without accompanying metastases in the mesorectum (isolated LNM), and the significance of lateral lymph node dissection (LND) for low rectal carcinoma with isolated LNM. Patients and methods: The study comprised 292 patients with T3 or T4 low rectal carcinoma undergoing sharp LND in lateral pelvic area (the space between the autonomic nerve and the internal iliac artery, and the obturator space), with preservation of the pelvic autonomic nerve after TME. The patients were retrospectively divided into four groups; patients with node metastases in both TME area and lateral nodes (group B, n¼51), patients with node metastases in TME area but not in lateral nodes (group T, n¼94), patients with isolated LNM (group I, n¼14), and patients without node metastases in both the mesorectum and lateral nodes (group N, n¼133). Clinicopathologic characteristics and clinical outcomes of the patients with isolated LNM in terms of recurrence and prognosis were retrospectively studied. Results: The isolated LNM were found in 9.5% of the patients without node metastases in TME area. Recurrence was significantly less frequent in group I (35.7%) than in group B (70.6%), though the frequency of recurrence was equivalent between group I and group T (36.2%). There was no significant difference in the frequency of local recurrence between group I (21.4%) and group B (29.4%). Recurrence via blood was significantly more frequent in group B (43.1%) than in group I (14.2%), though the frequency of recurrence via blood was equivalent between group I and group T (15.9%). There was no significant difference in overall 5-year survival rate between group I (53.8%) and group T (71.3%). There was significantly more non-differentiated type tumor, tumor with venous invasion, T4 tumor, patients with high serum level of CEA or CA19-9 in group I than in group N. The number of dissected node in lateral pelvic area was significantly more in group I (15.1 8.8) than in group N (11.5 6.8), in spite of equivalent number of dissected lymph node in the mesorectum. Conclusion: LND was recommended to improve survival for low rectal carcinoma with T4 tumor, or non-differentiated type tumor, or high serum level of CEA or CA19-9, even if there was no involved lymph node in the mesorectum.
827 maintained databases of the colorectal department and histology department. Results: From January 2000* December 2003 a total of 109 patients ~ B colonic underwent a curative resection for histologically proven DukesO cancer. Their median age was 71 (range 44-91) years and 63 were males. The minimum follow up was 5 years. Of the 109 patients, 24 were deemed ^ ~ and had no chemotherapy. 80 patients were deemed to to be Ogood BO have a poorer prognosis due to tumour size >5cm, T stage 4, extramural vascular invasion or evidence of perforation or obstruction; these were ^ ~ Data was unavailable for 5 patients. Of these 80 deemed as Obad BO. ^ ~ patients, 21 underwent 5-FU based chemotherapy. The mean disObad BO ^ ~ group was 52.9 months, compared ease-specific survival for the Ogood BO ^ ~ group who didnOt ~ undergo chemotherapy to 50.8 months for the Obad BO ^ ~ group who did have chemotherapy and 49.3 months for the Obad BO (p¼0.108). Conclusion: Our study has shown that adjuvant chemotherapy for ^ ~ DukesO ~ B colon cancer achieved a 5-year survival rate that was Obad O ~ B colon cancer. The selective use of adjucomparable to ’good’ DukeOs ~ B cancer. A further vant chemotherapy is of benefit in high risk DukeOs study is recommended to assess other therapies which might be more tolerable and effective in a wider patients range. 300. Extracapsular Extension of Nodal Metastases for Prognosis in Patients with Colorectal Cancer - Ours Experience S. Maksimovic1, B. Jakovljevic2 1 General Hospital Sveti Vracevi, Surgical Oncology, Bijeljina, BosniaHerzegovina 2 Clinical Centar Banja Luka, Oncology, Banja Luka, Bosnia-Herzegovina Background: Extracapsular extension (ECE) of nodal metastases from colorectal cancer is a frequent histological finding, but its significance for prognosis and treatment is unclear. We evaluate the prognostic value of lymph node metastasis with extracapsular extension for local control and metastasis-free survival in colorectal cancer. Methods: From January 2000 to January 2012 of 236 rectal cancer patients were treated with surgery and postoperative radiochemotherapy. Patients were grouped according to nodal status (node negative, n ¼ 82 (34,7%); node positive without ECE, n ¼ 115, (48,7%) node positive with ECE, n ¼ 39 (16,5%). Well-known prognostic factors such as International Union against Cancer (UICC) stage, T and N stage, presence of lymphangiosis, and grade were assessed. The end points were analyzed by the Kaplan-Meier method, and prognostic factors were compared in a Cox regression model. Results: We analyzed the patients with node positive without ECE n ¼ 115, (48, 7%) and patients with node positive with ECE, n ¼ 39 (16,5%), the actuarial 10-year local control and distant metastasis-free survival rate was 63% and 35%, respectively. Patients with ECE of lymph node metastasis had an impaired 10-year local control rate (30%) compared with node positive without ECE, (p ¼ 0.033). Metastasis-free survival also differed for the two groups, with a rate of 21% for those with extracapsular involvement, 42% for those without ECE, p <0.0001). The impact of ECE on local control was confirmed in the regression model (risk ratio [RR] 1.6, 95% confidence interval [CI] 1.1*2.9, p ¼ 0.033). Conclusions: Prognosis was significantly worse in patients with node positive with ECE compared to the patients with node positive without ECE. ECE of node metastasis is connected with a substantial decline in local control. 302. The Impact of Overweight and Obesity on Complications After Rectal Cancer Surgery K. Mrak1, J. Tschmelitsch1 1 Barmherzige Br€uder, Surgical Department, St. Veit / Glan, Austria Background: The influence of obesity on postoperative complications after various surgical interventions remains controversial. The aim of this study is to evaluate the impact of overweight and obesity on the occurrence
828
ABSTRACTS
of postoperative complications for patients undergoing elective resection for rectal carcinoma. Material and Methods: A retrospective data analysis of 676 patients undergoing surgical treatment for rectal carcinoma at our department was conducted. Depending on their body mass index (BMI) patients were grouped as follows: group I included patients up to BMI 24.9 kg/m2, group II patients with a BMI between 25 and 29.9 kg/m2 and group III all patients with a BMI higher than 30 kg/m2. Complications were classified as minor and major complications with regard to severity grades (1 to 5). Statistical analysis was performed to evaluate the difference of complication rates between the different BMI groups. Results: Some 444 patients were included for analysis. Overall 300 (67.6%) of the 444 patients did not develop postoperative complications, 82 (18.4%) patients suffered from minor (grade 1+2) and 56 (12.6%) from major (grade 3+4) complications. Six (1.4%) patients died (grade 5). Fisher«s exact test indicated no statistically significant difference of complication rates between the different BMI groups (p¼0.3716). Conclusion: Compared with nonobese or normal-weight patients, obese patients do not have a statistically significant higher risk to develop postoperative complications after rectal resection for carcinoma.
Background: The aim of this study is to evaluate whether depth of infiltration within T3 colorectal tumors influences long term oncologic outcome. Material and Methods: Patients with stage pT3 colon and rectal tumors were divided into four subgroups according to the depth of infiltration. The influence on overall and disease-free survival was tested for each subgroup and compared in an univariate and multivariate analysis. Results: A total of 368 patients were evaluated with a median followup time of 92.5 months. In 181 patients with colon cancer 5- and 10 years overall survival was 82.7% and 65.0%, 5- and 10 years disease free survival was 80.9% and 64.4%. For 187 rectal cancer 5 * and 10 years overall survival was 69.0% and 50.5% and disease free survival was 61.3% and 47.5%. Neither in colon nor in rectal cancer different pT3-categories showed a statistical significant influence on survival or the ocurrence of local or distant recurrence in uni * and multivariate analysis. However there was a significant influence of higher pT3 subgroups on lymph node involvement and vessel invasion in rectal cancer patients. Conclusion: Subdivision of pT3 tumors in colon cancer, based on depth of infiltration does not provide us with additional information about prognosis. In rectal cancer T3 * substages were associated with lymph node involvement, however we could not show an impact on recurrence or survival.
303. Quality of Life After Surgery for Low Rectal Cancer - Pouch Anastomosis Vs Stoma K. Mrak1, J. Tschmelitsch1 1 Barmherzige Br€ uder, Surgical Department, St. Veit / Glan, Austria
305. Clinical Study of Low Rectal Carcinoma with Isolated Lateral Node Spread H. Sato1, K. Maeda1, T. Hanai1, K. Masumori1, Y. Koide1, K. Honda1, M. Shiota1, S. Matsuoka1, M. Mizuno1 1 Fujita Health University, Department of Surgery, Toyoake, Japan
Background: Low and ultralow anterior resections for rectal cancer with colorectal or coloanal anastomoses do not compromise oncologic results compared to an abdominoperineal excision. Although avoidance of a permanent colostomy is regarded as beneficial for a patient«s quality of life by most surgeons, patients undergoing sphincter sparing surgery may develop a number of functional problems. A colonic pouch significantly improves functional outcome after rectal resection and low anastomosis and may positively influence quality of life. The aim of this study was to compare quality of life in long term survivors who underwent ultralow anterior resection with total mesorectal excision and colonic j-pouch anastomosis (CPA) to patients with abdominoperineal excision and end colostomy (APE) for rectal cancer. Materials and Methods: The medical records of 151 patients who underwent surgery for ultralow rectal cancer from 2001 to 2007 from our prospectively maintained rectal cancer database were analysed. Quality of life in 59 eligible patients was assessed using the EORTC QLQ C 30 and EORTC QLQ CR29. Results were compared for patients with CPA vs. APE. Results: The median follow up in the 59 patients was 6.3 years (3 years-10 years). Quality of life was good in all patients, however CPA patients had better quality of life scores than APE patients. Global health status (p¼0.009), physical functioning (p¼0.0002), role functioning (p¼0.03), cognitive functioning (p¼0.046), social functioning (p¼0.002), body image (p¼0.053), embarrassment (0.002) and urinary frequency (p¼0.003) were significantly better for patients with CPA. Conclusion: The quality of life after rectal resection and colon pouch anastomosis is better than after APE in several domains . However, QoL should not be regarded as an isolated concept but rather as one of several possible clinical outcomes of interest. 304. The Significance of Histological Substaging in Curative Resected T3 Colorectal Cancer K. Mrak1, M. Jagoditsch1, S. Leibl2, A. Klingler3, J. Tschmelitsch1 1 Barmherzige Br€ uder, Surgical Department, St. Veit / Glan, Austria 2 University of Graz, Pathology, Graz, Austria 3 Assign Data Management and Biostatistics, Biostatistics, Innsbruck, Austria
Background: This study was performed to identify the clinicopathologic characteristics of low rectal carcinoma with isolated lateral spread and without accompanying metastases in the mesorectum (isolated LNM), and the significance of lateral lymph node dissection (LND) for low rectal carcinoma with isolated LNM. Patients and methods: The study comprised 292 patients with T3 or T4 low rectal carcinoma undergoing sharp LND in lateral pelvic area (the space between the autonomic nerve and the internal iliac artery, and the obturator space), with preservation of the pelvic autonomic nerve after TME. The patients were retrospectively divided into four groups; patients with node metastases in both TME area and lateral nodes (group B, n¼51), patients with node metastases in TME area but not in lateral nodes (group T, n¼94), patients with isolated LNM (group I, n¼14), and patients without node metastases in both the mesorectum and lateral nodes (group N, n¼133). Clinicopathologic characteristics and clinical outcomes of the patients with isolated LNM in terms of recurrence and prognosis were retrospectively studied. Results: The isolated LNM were found in 9.5% of the patients without node metastases in TME area. Recurrence was significantly less frequent in group I (35.7%) than in group B (70.6%), though the frequency of recurrence was equivalent between group I and group T (36.2%). There was no significant difference in the frequency of local recurrence between group I (21.4%) and group B (29.4%). Recurrence via blood was significantly more frequent in group B (43.1%) than in group I (14.2%), though the frequency of recurrence via blood was equivalent between group I and group T (15.9%). There was no significant difference in overall 5-year survival rate between group I (53.8%) and group T (71.3%). There was significantly more non-differentiated type tumor, tumor with venous invasion, T4 tumor, patients with high serum level of CEA or CA19-9 in group I than in group N. The number of dissected node in lateral pelvic area was significantly more in group I (15.1 8.8) than in group N (11.5 6.8), in spite of equivalent number of dissected lymph node in the mesorectum. Conclusion: LND was recommended to improve survival for low rectal carcinoma with T4 tumor, or non-differentiated type tumor, or high serum level of CEA or CA19-9, even if there was no involved lymph node in the mesorectum.