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339. Results of Multivisceral Resection as a Treatment Option for Locally Advanced Rectal Cancer
ABSTRACTS was categorized into ’responders’ (TRG 3-4) and ’nonresponders’ (TRG 01-2). Chi square and Spearman correlation tests were used to evaluate correlation between TN change, TRG and lymph node status. Results: Tumor response (TRG) were: TRG 0: 12 (12.6%); TRG 1: 25 (26.3%); TRG 2: 28 (29.5%); TRG 3: 14 (14.7%); TRG 4: 16 (16.8%). The mean number of retrieved lymph nodes was 9.3. Preoperative staging showed N0 42%, N1 56% and N2 3%. Postoperative pathological evaluation of lymph node status showed no involvement in 67%, N1 23% and N2 10%. Responders were N0 92.6% and N positive 7.4%. Nonresponders were N0 58.8% and N positive 41.2% (p<0,001) Conclusion: Response to neoadyuvant therapy according to TRG was significantly associated with node stage; patients with node involvement had less response to chemoratiation than those N negative. 339. Results of Multivisceral Resection as a Treatment Option for Locally Advanced Rectal Cancer I. Shchepotin1, O. Kolesnik1, A. Beznosenko1, D. Mahmudov1 1 National Cancer Institute in Ukraine, Abdominal Oncology, Kyiv, Ukraine Background: Review a single-center experience of multivisceral resections for primary rectal cancer to determine the accuracy of intraoperative prediction of potential curability, to identify prognostic factors, and to examine the effect of surgical experience on short-term outcome and longterm results. Matherials and Methods: A retrospective study was performed to analyze the data collected 278 patients who underwent a curative resection for T4 primary rectal cancer from January 2000 to December 2009. Patients with distant metastases were excluded from the study. We evaluated the short-term and the long-term outcomes of a multiviceral resection relative to that of standard surgery. Results: In 136 cases of 278, the patients had macroscopically direct invasion of adjacent organs and underwent a multivisceral resection (main group), stage T4N0M0 - 86 (63.2%), T4N1-2M0 * 50 (36.8%). A control group consisted of 142 patients with T4 rectal cancer without either macro- or microscopic invasion into adjacent organs, who underwent standard surgery required, stage T4N0M0 * 99 (70%), T4N1-2M0 * 43 (30%). Adenocarcinoma was the most common type of tumors (96%). In the main group primary malignancies were predominantly distributed in lower rectum (57%) and upper rectum in a control group (67%). Among the combined resected organs, common organs were the uterus (45%), vagina (25%), prostate and bladder (23%), small bowel (15%). In the multivisceral resection group, tumor infiltration was confirmed histologically in 38% of the cases while in the remaining patients (62%), a peritumorous adhesion had mimicked tumor invasion. Postoperative complications (class III Clavien * Dindo) occurred in 6% of the patients who underwent standard surgery vs. 12% of those who underwent a multivisceral resection (P < 0.0001). The survival rate of patients after a multivisceral resection was similar to that of patients after standard surgery (5-year survival rates: 44.4% vs. 52,8%; P ¼ 0.36), thus a recurrence * free survival rate in both groups showed no statistical significance (30% vs. 36%; P¼0.59). Conclusion: For locally advanced rectal cancer multivisceral resection was associated with higher postoperative morbidity, but the long-term survival and disease * free survival is similar to that after a standard resection. A multivisceral resection is safe and can be recommended for most patients with locally advanced rectal cancer. 342. Quality of Care in Abdominoperineal Resections for Rectal Cancer G. B€ okkerink1, E.F.M. Buijs2, W. de Ruijter3, C. Geven2, C. Rosman4, H.C. Kuypers5, R. Strobel6, J. Heisterkamp7, A.J.A. Bremers8, H.D.W. Wilt8 1 Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands 2 Radboud University Nijmegen Medical Centre, Surgey, Nijmegen, The Netherlands
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St. Elisabeth Hospital, Surgey, Tilburg, The Netherlands Canisius Wilhelmina Hospital, Surgey, Nijmegen, The Netherlands 5 Gelderse Vallei Hospital, Surgey, Ede, The Netherlands 6 Bernhoven Hospital, Surgey, Oss, The Netherlands 7 St. Elisabeth Hospital, Surgey, Oss, The Netherlands 8 Radboud University Medical Centre, Surgey, Nijmegen, The Netherlands 4
Background: Quality of care for patients with rectal cancer has been improved significantly the last decades. The most importantly factor is the introduction of TME surgery, but also improved imaging techniques and neo-adjuvant treatment modalities such as (chemo)radiation have contributed to these improvements. Despite these efforts, patients with distal rectal cancer who need to undergo an abdominoperineal resection (APR) have an increased risk on involved margins, which is the most important predictor for local recurrence. To evaluate the results in care for patients undergoing an APR and to identify factors in current care, we performed a population based multicentre study. Methods: All patients who underwent an APR in five Dutch hospitals between December 1996 and December 2010 were extracted from the Netherlands Cancer Registry and Cancer registry of Comprehensive Cancer Center South. Patient, tumor and treatment characteristics were extracted from the medical records. Patients were divided into 3 cohorts, based on important changes in neoadjuvant treatment strategy. Results: A total number of 477 patients was included, cohorts consisted of 126, 109 and 147 patients, respectively. Mean age at time of surgery was 66 years (range:27-89) 62% of all patient was male. There were no significant differences between the three cohorts on baseline. There was a significant increase of the use of preoperative MRI in the consecutive cohorts (5, 53 and 95%, respectively). Neoadjuvant treatment changed from no treatment (65, 11 and 7%), to short course radiotherapy (23, 67 and 35%) and chemoradiation therapy (4, 12 and 56%). Reporting circumferential resection margin (CRM) in the pathology reports increased after the first cohort, but was still lacking in a significant number of patients (31, 65, en 50%). Improvement of surgery resulted in significant decrease in positive circumferential resection margins (19, 17 and 11%) and accidental bowel perforation (29, 22 and 9%). There were no significant difference between hospitals. Conclusions: Significant improvements have been made in preoperative work up and pathological assessment in patients who underwent an abdominoperineal resection. Although the number of tumor perforations decreased in the different time periods, the number of incomplete resections is still approximately 20%. Further improvement in surgical technique is necessary to improve results in patients who undergo an APR. 345. Oncologic Analysis of Mesorectal Excision with Lateral Pelvic Lymph Node Dissection for Lower Rectal Cancer T. Yatsuoka1, Y. Nishimura1, H. Sakamoto1, Y. Tanaka1 1 Saitama Cancer Center, Division of Gastroenterological surgery, Saitama, Japan Background: In spite of the anatomical knowledge of lateral lymphatic drainage, the clinical importance of it has not yet been fully investigated. The aim of this study was to review the oncological outcome of patients who underwent curative surgery for lower rectal cancer with mesorectal excision (ME) + lateral pelvic lymph node dissection (LPLD). Material and methods: A retrospective analysis was made of 100 patients who underwent curative surgery with ME+LPLD for clinical stage II-III lower rectal cancer (lower tumor margin below the peritoneal reflection) between 2000 and 2007. Low anterior resection was performed in 87 patients and the others were Miles operation or pelvic excentration. Bilateral lateral pelvic lymph node dissection was performed in 86 patients and unilateral lateral pelvic lymph node dissection in 14 patients. Operating time, postoperative complications and several clinicopathological features were reviewed from clinical charts. Long-term outcome including survival status was analyzed by univariate survival analyses performed using the
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St. Elisabeth Hospital, Surgey, Tilburg, The Netherlands Canisius Wilhelmina Hospital, Surgey, Nijmegen, The Netherlands 5 Gelderse Vallei Hospital, Surgey, Ede, The Netherlands 6 Bernhoven Hospital, Surgey, Oss, The Netherlands 7 St. Elisabeth Hospital, Surgey, Oss, The Netherlands 8 Radboud University Medical Centre, Surgey, Nijmegen, The Netherlands 4
Background: Quality of care for patients with rectal cancer has been improved significantly the last decades. The most importantly factor is the introduction of TME surgery, but also improved imaging techniques and neo-adjuvant treatment modalities such as (chemo)radiation have contributed to these improvements. Despite these efforts, patients with distal rectal cancer who need to undergo an abdominoperineal resection (APR) have an increased risk on involved margins, which is the most important predictor for local recurrence. To evaluate the results in care for patients undergoing an APR and to identify factors in current care, we performed a population based multicentre study. Methods: All patients who underwent an APR in five Dutch hospitals between December 1996 and December 2010 were extracted from the Netherlands Cancer Registry and Cancer registry of Comprehensive Cancer Center South. Patient, tumor and treatment characteristics were extracted from the medical records. Patients were divided into 3 cohorts, based on important changes in neoadjuvant treatment strategy. Results: A total number of 477 patients was included, cohorts consisted of 126, 109 and 147 patients, respectively. Mean age at time of surgery was 66 years (range:27-89) 62% of all patient was male. There were no significant differences between the three cohorts on baseline. There was a significant increase of the use of preoperative MRI in the consecutive cohorts (5, 53 and 95%, respectively). Neoadjuvant treatment changed from no treatment (65, 11 and 7%), to short course radiotherapy (23, 67 and 35%) and chemoradiation therapy (4, 12 and 56%). Reporting circumferential resection margin (CRM) in the pathology reports increased after the first cohort, but was still lacking in a significant number of patients (31, 65, en 50%). Improvement of surgery resulted in significant decrease in positive circumferential resection margins (19, 17 and 11%) and accidental bowel perforation (29, 22 and 9%). There were no significant difference between hospitals. Conclusions: Significant improvements have been made in preoperative work up and pathological assessment in patients who underwent an abdominoperineal resection. Although the number of tumor perforations decreased in the different time periods, the number of incomplete resections is still approximately 20%. Further improvement in surgical technique is necessary to improve results in patients who undergo an APR. 345. Oncologic Analysis of Mesorectal Excision with Lateral Pelvic Lymph Node Dissection for Lower Rectal Cancer T. Yatsuoka1, Y. Nishimura1, H. Sakamoto1, Y. Tanaka1 1 Saitama Cancer Center, Division of Gastroenterological surgery, Saitama, Japan Background: In spite of the anatomical knowledge of lateral lymphatic drainage, the clinical importance of it has not yet been fully investigated. The aim of this study was to review the oncological outcome of patients who underwent curative surgery for lower rectal cancer with mesorectal excision (ME) + lateral pelvic lymph node dissection (LPLD). Material and methods: A retrospective analysis was made of 100 patients who underwent curative surgery with ME+LPLD for clinical stage II-III lower rectal cancer (lower tumor margin below the peritoneal reflection) between 2000 and 2007. Low anterior resection was performed in 87 patients and the others were Miles operation or pelvic excentration. Bilateral lateral pelvic lymph node dissection was performed in 86 patients and unilateral lateral pelvic lymph node dissection in 14 patients. Operating time, postoperative complications and several clinicopathological features were reviewed from clinical charts. Long-term outcome including survival status was analyzed by univariate survival analyses performed using the