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377. Liver colorectal metastases surgical treatment outcomes: Oncological coloproctological unit experience
ABSTRACTS metastases and 38 with metachronous ones. Preoperative, intraoperative and postoperative data results were retrospectively reviewed. Patients were divided into three time periods: a first period from January 1997 to December 2008 (n ¼ 29), a second period from January 2004 to December 2008 (n ¼ 68), a third period from January 209 to September 2013 (n ¼ 85). The following parameters were analyzed and related to overall survival: timing of metastases (metachronous versus synchronous); neoadjuvant chemotherapy; number, diameter and site (unilobar versus bilobar) of CLM before and after neoadjuvant treatment; RECIST; levels of preoperative carcinoembryogenic antigen (CEA); presence of extrahepatic disease; type of hepatic resection (minor, major, extended); involvement of hepatic pedicle lymph node; eventual riresection. The following parameters were analyzed and not related to overall survival: findings at the intraoperative ultrasound; hepatic pedicle clamping; intraoperative blood loss; perioperative complications; hospital length of stay. Kaplan-Meier survival and Cox regression analysis were used. A p value <0.05 was considered significant. Results: Median overall survival was 44.8 months in patients undergoing hepatic resection and 14 months in the non resected group. The presence of preoperative extrahepatic disease, elevated CEA levels, multiple and bilateral pattern of CLM and >5 cm in size were negative prognostic factors. No difference in terms of complications were observed among the three time periods. No benefit in terms of overall survival was shown in the neoadjuvant chemotherapy group. Conclusion: Surgery is the mainstay of treatment of CLM, with a mortality <1% and a morbidity at around 31%. Although negative prognostic factors can be identified preoperatively, the chance of surgical cure has not to be denied to any patients as surgery is the only factor that has a significant impact on overall survival. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.365
376. Radiofrequency ablation of colorectal liver metastases after effective downstaging by chemotherapy provides good survival rates and should therefore always be considered K. Nielsen1, H.J. Scheffer2, J.H. Volders3, A.A.J.M. Van Tilborg2, E.F.I. Comans2, E.S.M. De Lange-de Klerk4, M.J.D.L. Van der Vorst5, S. Meijer1, M.R. Meijerink2, M.P. Van den Tol1 1 VU Medical Center, Surgery, Amsterdam, Netherlands 2 VU Medical Center, Radiology and Nuclear Medicine, Amsterdam, Netherlands 3 Gelderse Vallei, Surgery, Ede, Netherlands 4 VU Medical Center, Epidemiology and Biostatistics, Amsterdam, Netherlands 5 VU Medical Center, Medical Oncology, Amsterdam, Netherlands Background: Systemic chemotherapy is able to downstage colorectal liver metastases (CRLM), initially unsuitable for local treatment, to locally treatable disease. Surgical resection has proven to add to survival in these patients. The aim of our study was to evaluate the outcome of patients with CRLM, treated with RFA after effective downstaging by chemotherapy, and to identify factors associated with recurrences and survival. Material and methods: Patients with liver dominant CRLM, initially unsuitable for local treatment but candidates for RFA after downstaging by systemic chemotherapy were analysed. Chemotherapeutic regime consisted predominantly of Xelox with or without bevacizumab. Pre-operative work-up consisted of PET-CT, CT and/or MRI. Follow-up was conducted with PET-CT or CT thorax and abdomen. Results: Fifty-one patients with a median of 7 lesions were included. After chemotherapy, the median number of lesions seen on CT and intra-operative ultrasound were 3 and 5 respectively. Median survival was 49 months and was associated with the presence of extrahepatic disease at time of presentation and recurrences after treatment (p ¼ 0.00), with a trend towards lesion size (p ¼ 0.06). Estimate cumulative survival at 1- 3- and 4 years
S145 was 90% (CI 82.8e97.2%), 63% (CI 47.7e78.3%) and 45% (95% CI 26e64) respectively. Median disease free survival was 6 months and was increased when not all lesions were recovered on IOUS (p ¼ 0.03) and decreased when extrahepatic disease was present (p ¼ 0.01). Conclusion: RFA for CRLM effectively downstaged by chemotherapy provides potential local control and survival-benefit. Follow-up imaging and assessment of local treatment possibilities after palliative chemotherapy for liver dominant CRLM by a multidisciplinary team should therefore always be considered. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.366
377. Liver colorectal metastases surgical treatment outcomes: Oncological coloproctological unit experience I. Rebeko1, D. Hapanovich1, I. Veyalkin2, D. Michnuk3, A. Udzin3, G. Kolyadich3, V. Tatarinovich3, I. Anufreenok1, A. Ospischev3, J. Jelobkovich1 1 N.N. Alexandrov National Cancer Centre of Belarus, Abdominal Oncological Department, Minsk, Belarus 2 N.N. Alexandrov National Cancer Centre of Belarus, Epidemiological Department, Minsk, Belarus 3 N.N. Alexandrov National Cancer Centre of Belarus, Oncological Coloproctological Unit, Minsk, Belarus Background: Surgical treatment of resectable colorectal liver metastases (CRLM) can achieve 5-year survival rates at the level of 30e50%. However, most publications affecting this topic contain the results of collaborative management of coloproctological and hepatopancreatobilliary or specialized hepatopancreatobilliary units. The purpose of our study is to evaluate CRLM surgical treatment outcomes in oncological coloproctological unit. Material and methods: CRLM surgical treatment in N.N.Alexandrov National Cancer Centre started only in 2002. The prospective analysis of retrospective data of 426 (236 men, 190 women) CRLM patients undergoing complete cytoreduction from 2002 to 2013 in oncological coloproctological unit is submitted in this paper. Synchronous and metachronous metastases have been identified in 253 and 173 patients, respectively, with average age of 58,410,2 (22e83) years. No adjuvant therapy was performed to our patients until 2007. From the whole amount of patients, 121 had no previous to surgery treatment modalities, 35 had transarterial chemoembolization, 82 had mono- and polychemotherapy. The primary tumor surgeries were performed to 182 persons. The study was based on the next resectability criteria: removal of all metastases with clearance more than 0,1 cm and preservation of more than 30% liver tissue or two and more segments with saved biliary and vascular pedicle and one or more hepatic vein, the absence of unresectable extrahepatic metastases, ECOG status 0e1. In total, 468 operations were performed to 426 patients. From this amount, second resection was performed in 30 cases, 2-stage procedure was performed in 12 cases. Intraoperative radiofrequency ablation has been added to surgery in 46 cases. Survival analysis was conducted for persons, whose treatment had been completed until 2012. Results: There were 13 patients who died after operations. Thirty days postoperative mortality rate has amounted to 2,8%, morbidity rate of 3e5 by Dindo-Clavien classification has amounted to 12% (56 patients). Median and event-free 5-year survival have amounted to 39,9 (34,6; 45,3) months and 0,34 [95% CI: 0,26e0,42]. Median and 5-year recurrence free survival have amounted to 22,1 (18,5; 25,7) months and 0,19 [95% CI: 0,13e0,25], respectively. Conclusions: The use of modern criteria of resectability and surgeon’s qualification makes it possible to reach acceptable short- and long-term CRLM treatment results regardless to the unit status. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.367
376. Radiofrequency ablation of colorectal liver metastases after effective downstaging by chemotherapy provides good survival rates and should therefore always be considered K. Nielsen1, H.J. Scheffer2, J.H. Volders3, A.A.J.M. Van Tilborg2, E.F.I. Comans2, E.S.M. De Lange-de Klerk4, M.J.D.L. Van der Vorst5, S. Meijer1, M.R. Meijerink2, M.P. Van den Tol1 1 VU Medical Center, Surgery, Amsterdam, Netherlands 2 VU Medical Center, Radiology and Nuclear Medicine, Amsterdam, Netherlands 3 Gelderse Vallei, Surgery, Ede, Netherlands 4 VU Medical Center, Epidemiology and Biostatistics, Amsterdam, Netherlands 5 VU Medical Center, Medical Oncology, Amsterdam, Netherlands Background: Systemic chemotherapy is able to downstage colorectal liver metastases (CRLM), initially unsuitable for local treatment, to locally treatable disease. Surgical resection has proven to add to survival in these patients. The aim of our study was to evaluate the outcome of patients with CRLM, treated with RFA after effective downstaging by chemotherapy, and to identify factors associated with recurrences and survival. Material and methods: Patients with liver dominant CRLM, initially unsuitable for local treatment but candidates for RFA after downstaging by systemic chemotherapy were analysed. Chemotherapeutic regime consisted predominantly of Xelox with or without bevacizumab. Pre-operative work-up consisted of PET-CT, CT and/or MRI. Follow-up was conducted with PET-CT or CT thorax and abdomen. Results: Fifty-one patients with a median of 7 lesions were included. After chemotherapy, the median number of lesions seen on CT and intra-operative ultrasound were 3 and 5 respectively. Median survival was 49 months and was associated with the presence of extrahepatic disease at time of presentation and recurrences after treatment (p ¼ 0.00), with a trend towards lesion size (p ¼ 0.06). Estimate cumulative survival at 1- 3- and 4 years
S145 was 90% (CI 82.8e97.2%), 63% (CI 47.7e78.3%) and 45% (95% CI 26e64) respectively. Median disease free survival was 6 months and was increased when not all lesions were recovered on IOUS (p ¼ 0.03) and decreased when extrahepatic disease was present (p ¼ 0.01). Conclusion: RFA for CRLM effectively downstaged by chemotherapy provides potential local control and survival-benefit. Follow-up imaging and assessment of local treatment possibilities after palliative chemotherapy for liver dominant CRLM by a multidisciplinary team should therefore always be considered. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.366
377. Liver colorectal metastases surgical treatment outcomes: Oncological coloproctological unit experience I. Rebeko1, D. Hapanovich1, I. Veyalkin2, D. Michnuk3, A. Udzin3, G. Kolyadich3, V. Tatarinovich3, I. Anufreenok1, A. Ospischev3, J. Jelobkovich1 1 N.N. Alexandrov National Cancer Centre of Belarus, Abdominal Oncological Department, Minsk, Belarus 2 N.N. Alexandrov National Cancer Centre of Belarus, Epidemiological Department, Minsk, Belarus 3 N.N. Alexandrov National Cancer Centre of Belarus, Oncological Coloproctological Unit, Minsk, Belarus Background: Surgical treatment of resectable colorectal liver metastases (CRLM) can achieve 5-year survival rates at the level of 30e50%. However, most publications affecting this topic contain the results of collaborative management of coloproctological and hepatopancreatobilliary or specialized hepatopancreatobilliary units. The purpose of our study is to evaluate CRLM surgical treatment outcomes in oncological coloproctological unit. Material and methods: CRLM surgical treatment in N.N.Alexandrov National Cancer Centre started only in 2002. The prospective analysis of retrospective data of 426 (236 men, 190 women) CRLM patients undergoing complete cytoreduction from 2002 to 2013 in oncological coloproctological unit is submitted in this paper. Synchronous and metachronous metastases have been identified in 253 and 173 patients, respectively, with average age of 58,410,2 (22e83) years. No adjuvant therapy was performed to our patients until 2007. From the whole amount of patients, 121 had no previous to surgery treatment modalities, 35 had transarterial chemoembolization, 82 had mono- and polychemotherapy. The primary tumor surgeries were performed to 182 persons. The study was based on the next resectability criteria: removal of all metastases with clearance more than 0,1 cm and preservation of more than 30% liver tissue or two and more segments with saved biliary and vascular pedicle and one or more hepatic vein, the absence of unresectable extrahepatic metastases, ECOG status 0e1. In total, 468 operations were performed to 426 patients. From this amount, second resection was performed in 30 cases, 2-stage procedure was performed in 12 cases. Intraoperative radiofrequency ablation has been added to surgery in 46 cases. Survival analysis was conducted for persons, whose treatment had been completed until 2012. Results: There were 13 patients who died after operations. Thirty days postoperative mortality rate has amounted to 2,8%, morbidity rate of 3e5 by Dindo-Clavien classification has amounted to 12% (56 patients). Median and event-free 5-year survival have amounted to 39,9 (34,6; 45,3) months and 0,34 [95% CI: 0,26e0,42]. Median and 5-year recurrence free survival have amounted to 22,1 (18,5; 25,7) months and 0,19 [95% CI: 0,13e0,25], respectively. Conclusions: The use of modern criteria of resectability and surgeon’s qualification makes it possible to reach acceptable short- and long-term CRLM treatment results regardless to the unit status. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.367