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325. The prognostic value of serum levels of CCL2 and CCL5 in colorectal cancer
S148 Results: The fractal analysis correctly differentiated healthy rectal mucosa and any pathological changes- neoplasia, polyps, colitis (p < 0.0001). The sensitivity of fractal analysis to diagnose rectal neoplasia was 92.8e96.4%, while the specificity was 91.9e98.5% depending on the fractal parameter. The sensitivity of fractal analysis to diagnose rectal colitis was 84.2e92.1%, while the specificity was 95.0e96.0%, depending on the fractal parameter. Conclusions: The sensitivity and specificity of fractal analysis parameters found in this study demonstrate the strong utility of fractal analysis as a clinical tool that should be considered to supplement colonoscopic examination used in diagnosis of neoplasia or colitis. Conflict of interest: No conflict of interest. Ownership: Andrzej Gryglewski, Marian Mrozek and Marcin _ Zelawski are the creators and owners of COLON software. However, fractal analysis, such as described and used in this study, can also be performed using software programs other than COLON. http://dx.doi.org/10.1016/j.ejso.2016.06.220
325. The prognostic value of serum levels of CCL2 and CCL5 in colorectal cancer K. Brzuszkiewicz, S. Pietruszka, A. Paszko, A. Szczepanik, M. Ga˛dek, A. Nowak, J. Kulig 1st Department of General Oncological and Gastrointestinal Surgery, Jagiellonian University Medical College, General Surgery, Krakow, Poland Chemokines are the chemotactic cytokines. They play an important role in induction and maintenance of immune reactions by regulation of migration of immunocompetent cells, angiogenesis and migration of stem cells. They have also been shown to regulate other processes such as cancer progression and cancer cell migration. The aim of the study was to determine the prognostic role of serum levels of CCL2 (chemokine (C-C motif) ligand 2) and CCL5 (chemokine (CeC motif) ligand 5) in case of patients with colorectal cancer. The study involved 45 patients with colorectal cancer. The serum concentration of CCL2 and CCL5 was measured before the surgery. Calculated optimal cut ff points based on ROC curve were 103.6 pg/ml for CCL2 and 11933.2 pg/ml for CCL5. An analysis of survival and multivariate analysis of prognostic factors were performed. The five-years survival for a group with low levels of CCL 2 was 57.5% and was significantly higher compared to the group with high levels of CCL2 23.8% (p ¼ 0.028). In the case of CCL five-year survival for group with low levels of CCL5 was 18.3% and for a group with a high level of CCL 5 was 49.3%, which was not a statistically significant difference. In the Cox proportional hazard model, radicality of resection (p ¼ 0.001) and serum level of CCL2 (p ¼ 0.029) were independent prognostic factors. In the analysed group of patients serum level of CCL2 was a prognostic factor. This observation may indicate that inflamation associated with colorectal cancer is a negative prognostic factor. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.221
326. Malignant tumors of the small bowel e A 10 year cohort N. Tenreiro, R. Marques, C. Gomes, S. Silva, H. Moreira, A. Oliveira 1 CHTMAD, Cirurgia Geral, Vila Real, Portugal Background: Small bowel malignancies are rare, histologically diverse tumors that comprise 3e5% of gastrointestinal cancers with an increasing incidence. Although its relative proportions are changing, the most frequent histologic types are adenocarcinoma, carcinoid and sarcoma. Diagnosis is usually late mostly due to its vague and sparse symptoms. Our aim was to review all cases of small bowel malignant tumors. Material and methods: Retrospective analysis of patients admitted in our institution with small bowel primary malignancy in the last 10 years.
ABSTRACTS Demographic data, tumor characteristics, surgery information, neo-adjuvant or adjuvant therapy, recurrence, morbidity and mortality were reviewed. Results/Discussion: 14 patients were included (11 males, 3 females) with a median age of 65 (SD 13.8). Most common symptoms were abdominal pain, vomiting and gastrointestinal bleeding. The most frequent histologic subtype was adenocarcinoma (50%, n ¼ 7), followed by gastrointestinal stromal tumors (42.9%, n ¼ 6) and carcinoid (7.1%, n ¼ 1). According to location, 57.1% were located in the duodenum (5 adenocarcinomas, 2 GISTs e 1 carcinoid); 28.9% in the jejunum (2 adenocarcinomas, 2 GISTs) and 14.3% in the ileum (2 GISTs). Distribution of stage at diagnosis was: Stage I e 2; Stage II e 8, Stage III e 3, Stage IV e 1. Most of the patients (n ¼ 12) underwent curative surgery. In regard to adjuvant therapy, 50% GIST (n ¼ 3) were treated with imatinib and 43% of adenocarcinomas (n ¼ 3) were treated with chemotherapy. Disease recurrence was identified in 3 patients with adenocarcinoma and in 1 with GIST. Overall survival was better in the GIST group in comparison with adenocarcinoma (28 vs 36 months). Conclusions: As expected, duodenal adenocarcinomas were the most common tumors. However we found a higher incidence than expected of small bowel GISTs. Overall early stage at diagnosis allowed curative surgery in most patients. However, our findings are extremely biased due to the small sample. Hopefully, multicenter studies will provide some consensus, particularly in the adenocarcinoma group. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.222
327. Sleep apnea is prevalent among patients scheduled for surgery of colorectal cancer M. Claesson1, M. Jonsson Fagerlund2, M. Haapamaki1, M. Sund1, A. Blomberg3, C. Sahlin3, K. Franklin1 1 Ume a University, Dept of Surgery, Ume a, Sweden 2 Karolinska Institute, Dept of Anesthesiology, Stockholm, Sweden 3 Ume a University, Dept of Medicine, Ume a, Sweden Background: Age and obesity are risk factors for both colorectal cancer and sleep apnea, but the prevalence of sleep apnea is unknown in patients with colorectal cancer. Aim: To investigate the prevalence of sleep apnea among patients scheduled for surgery of colorectal cancer. Methods: 68 patients with colorectal cancer mean age 70 11 years, 22 women, BMI 26 4 were investigated with polysomnography (Embla) including continuous recordings of respiration, breathing movements, oxygen saturation, EEG, EOG, chin EMG, ECG and body position sensor at hospital during the night before surgery. They were also investigated with STOPBANG, Epworth sleepiness scale, height, weight and Mallampati score. Results: Eight-one percent had sleep apnea with 5 or more apneas and hypopneas per hour of sleep i.e. AHI > 5.38% had mild sleep apnea with AHI 5e15 sleep, 28% had moderate sleep apnea and 15% severe sleep apnea with AHI > 30. Patients slept on average 43% of the time in the supine position. In the supine position, they had an AHI of 28 24 versus 8 9 in the lateral position. Mallampati score and age were related to sleep apnea, while gender, body mass index, Epworth sleepiness scale, STOPBANG and a history of snoring was not. Conclusions: Sleep apnea is prevalent among patients who undergo surgery for colorectal cancer. Age, sleeping in the supine position and a high tongue according to Mallampati score were risk factors for sleep apnea. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.223
328. Emergency surgery for colorectal cancer S. Vaccari, B. Pirrera, M. Brighi, E. Picariello, F. Monari, M. Cervellera, V. Tonini Chirurgia d’Urgenza e Cervellera, Policlinico S.Orsola-Malpighi, Universita degli Studi di Bologna, DIMEC, Bologna, Italy
325. The prognostic value of serum levels of CCL2 and CCL5 in colorectal cancer K. Brzuszkiewicz, S. Pietruszka, A. Paszko, A. Szczepanik, M. Ga˛dek, A. Nowak, J. Kulig 1st Department of General Oncological and Gastrointestinal Surgery, Jagiellonian University Medical College, General Surgery, Krakow, Poland Chemokines are the chemotactic cytokines. They play an important role in induction and maintenance of immune reactions by regulation of migration of immunocompetent cells, angiogenesis and migration of stem cells. They have also been shown to regulate other processes such as cancer progression and cancer cell migration. The aim of the study was to determine the prognostic role of serum levels of CCL2 (chemokine (C-C motif) ligand 2) and CCL5 (chemokine (CeC motif) ligand 5) in case of patients with colorectal cancer. The study involved 45 patients with colorectal cancer. The serum concentration of CCL2 and CCL5 was measured before the surgery. Calculated optimal cut ff points based on ROC curve were 103.6 pg/ml for CCL2 and 11933.2 pg/ml for CCL5. An analysis of survival and multivariate analysis of prognostic factors were performed. The five-years survival for a group with low levels of CCL 2 was 57.5% and was significantly higher compared to the group with high levels of CCL2 23.8% (p ¼ 0.028). In the case of CCL five-year survival for group with low levels of CCL5 was 18.3% and for a group with a high level of CCL 5 was 49.3%, which was not a statistically significant difference. In the Cox proportional hazard model, radicality of resection (p ¼ 0.001) and serum level of CCL2 (p ¼ 0.029) were independent prognostic factors. In the analysed group of patients serum level of CCL2 was a prognostic factor. This observation may indicate that inflamation associated with colorectal cancer is a negative prognostic factor. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.221
326. Malignant tumors of the small bowel e A 10 year cohort N. Tenreiro, R. Marques, C. Gomes, S. Silva, H. Moreira, A. Oliveira 1 CHTMAD, Cirurgia Geral, Vila Real, Portugal Background: Small bowel malignancies are rare, histologically diverse tumors that comprise 3e5% of gastrointestinal cancers with an increasing incidence. Although its relative proportions are changing, the most frequent histologic types are adenocarcinoma, carcinoid and sarcoma. Diagnosis is usually late mostly due to its vague and sparse symptoms. Our aim was to review all cases of small bowel malignant tumors. Material and methods: Retrospective analysis of patients admitted in our institution with small bowel primary malignancy in the last 10 years.
ABSTRACTS Demographic data, tumor characteristics, surgery information, neo-adjuvant or adjuvant therapy, recurrence, morbidity and mortality were reviewed. Results/Discussion: 14 patients were included (11 males, 3 females) with a median age of 65 (SD 13.8). Most common symptoms were abdominal pain, vomiting and gastrointestinal bleeding. The most frequent histologic subtype was adenocarcinoma (50%, n ¼ 7), followed by gastrointestinal stromal tumors (42.9%, n ¼ 6) and carcinoid (7.1%, n ¼ 1). According to location, 57.1% were located in the duodenum (5 adenocarcinomas, 2 GISTs e 1 carcinoid); 28.9% in the jejunum (2 adenocarcinomas, 2 GISTs) and 14.3% in the ileum (2 GISTs). Distribution of stage at diagnosis was: Stage I e 2; Stage II e 8, Stage III e 3, Stage IV e 1. Most of the patients (n ¼ 12) underwent curative surgery. In regard to adjuvant therapy, 50% GIST (n ¼ 3) were treated with imatinib and 43% of adenocarcinomas (n ¼ 3) were treated with chemotherapy. Disease recurrence was identified in 3 patients with adenocarcinoma and in 1 with GIST. Overall survival was better in the GIST group in comparison with adenocarcinoma (28 vs 36 months). Conclusions: As expected, duodenal adenocarcinomas were the most common tumors. However we found a higher incidence than expected of small bowel GISTs. Overall early stage at diagnosis allowed curative surgery in most patients. However, our findings are extremely biased due to the small sample. Hopefully, multicenter studies will provide some consensus, particularly in the adenocarcinoma group. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.222
327. Sleep apnea is prevalent among patients scheduled for surgery of colorectal cancer M. Claesson1, M. Jonsson Fagerlund2, M. Haapamaki1, M. Sund1, A. Blomberg3, C. Sahlin3, K. Franklin1 1 Ume a University, Dept of Surgery, Ume a, Sweden 2 Karolinska Institute, Dept of Anesthesiology, Stockholm, Sweden 3 Ume a University, Dept of Medicine, Ume a, Sweden Background: Age and obesity are risk factors for both colorectal cancer and sleep apnea, but the prevalence of sleep apnea is unknown in patients with colorectal cancer. Aim: To investigate the prevalence of sleep apnea among patients scheduled for surgery of colorectal cancer. Methods: 68 patients with colorectal cancer mean age 70 11 years, 22 women, BMI 26 4 were investigated with polysomnography (Embla) including continuous recordings of respiration, breathing movements, oxygen saturation, EEG, EOG, chin EMG, ECG and body position sensor at hospital during the night before surgery. They were also investigated with STOPBANG, Epworth sleepiness scale, height, weight and Mallampati score. Results: Eight-one percent had sleep apnea with 5 or more apneas and hypopneas per hour of sleep i.e. AHI > 5.38% had mild sleep apnea with AHI 5e15 sleep, 28% had moderate sleep apnea and 15% severe sleep apnea with AHI > 30. Patients slept on average 43% of the time in the supine position. In the supine position, they had an AHI of 28 24 versus 8 9 in the lateral position. Mallampati score and age were related to sleep apnea, while gender, body mass index, Epworth sleepiness scale, STOPBANG and a history of snoring was not. Conclusions: Sleep apnea is prevalent among patients who undergo surgery for colorectal cancer. Age, sleeping in the supine position and a high tongue according to Mallampati score were risk factors for sleep apnea. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.223
328. Emergency surgery for colorectal cancer S. Vaccari, B. Pirrera, M. Brighi, E. Picariello, F. Monari, M. Cervellera, V. Tonini Chirurgia d’Urgenza e Cervellera, Policlinico S.Orsola-Malpighi, Universita degli Studi di Bologna, DIMEC, Bologna, Italy