383. Can RECIST be considered a predictor of outcome in patients with liver metastases from colorectal cancer?

ABSTRACTS Background: Liver and/or lung metastasis is commonly encountered in patients with colorectal cancer. The efficacy of aggressive surgical resection for the hepatic metastasis is validated. However, the surgical approach for concomitant liver and lung metastasis in colorectal cancer patients is equivocal. Methods: Clinicopathologic data were retrospectively reviewed from 234 patients of colorectal cancer with concomitant liver and lung metastasis during 5-year period. Clinical outcome and survival data were analyzed. Results: From January 2008 through December 2012, 234 colorectal cancer patients with concomitant liver and lung metastasis were evaluated. After excluding combined other organ metastasis, 129 patients (55.1%) were revealed to synchronous concomitant liver and lung metastasis from colorectal cancer and 36 patients (15.4%) were metachronous metastasis. And surgical resection was performed in 33 patients (25.6%) in synchronous metastasis and 6 (16.7%) in metachronous metastasis. In metastatic pattern analysis on liver and lung, more number of lesion and bilateral distribution were observed in synchronous group than metachronous group (Liver, p ¼ 0.001 & p ¼ 0.003; Lung, p ¼ 0.001 & p ¼ 0.002). Patients undergone surgical resection showed better overall survival in both synchronous and metachronous group in survival analysis (p ¼ 0.001 & p ¼ 0.028). Especially, complete resection of both liver and lung metastatic lesion by simultaneous or staged operation revealed better survival outcome than single resection out of two metastatic lesion in synchronous metastatic group (p ¼ 0.037). Primary site of colorectal cancer and complete resection were significant prognostic factors by multivariate analysis for patients with surgically removed concomitant liver and lung metastasis (Rectal primary: p ¼ 0.006, HR 1.475; complete resection: p ¼ 0.003, HR 3.084). Conclusion: Surgical resection for hepatic and pulmonary metastasis in colorectal cancer can improve complete remission and survival rate in resectable case. Because colorectal cancer itself with concomitant liver and lung metastasis is not a poor prognostic factor as well as a contraindication for surgical treatments, the aggressive surgical approach may be recommended in well-selected resectable case. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.371

382. Thermographic monitoring of radiofrequency and microwave ablation in a perfused porcine liver model S. Swierczynski1, F. Primavesi1, E. Klieser2, T. Kiesslich3, T. Ja¨ger1, R. Illig2, D. Neureiter2, D. Ofner1, S. Sta¨ttner1 1 Paracelsus Medical University Salzburg, Department of Surgery, Salzburg, Austria 2 Paracelsus Medical University Salzburg, Institute of Pathology, Salzburg, Austria 3 Paracelsus Medical University Salzburg, Department of Internal Medicine I, Salzburg, Austria Background: Radiofrequency ablation (RFA) and microwave ablation (MWA) are currently the two dominant modalities for ablative treatment of unresectable liver tumours. Both are safe, effective and easy to use, but two particular clinically relevant issues arise due to technical specifications of either technique. Incorporation of vessels within the ablation zone can cause cooling in the nearby tumour target area (heat-sink effect) with risk of local recurrence. The ablation process is regularly monitored with b-mode sonography to ensure successful tumour ablation with appropriate safety margins, but tissue scarring or gas bubble formation may hamper interpretation of sonographic images. A number of other imaging modalities like contrast-enhanced ultrasound have been examined to monitor the ablation process. This study for the first time examines thermographic monitoring for RFA and MWA. Material and methods: Porcine livers (n ¼ 4) were connected with a closed perfusion system flushed with 37  C warmed phosphate buffered saline. RFA and MWA of healthy liver tissue were performed at peripheral

S147 sites as well as central locations nearby large vessels for additional evaluation of heat sink effects. Intervention was monitored with a thermographic camera (Model A35sc, FLIR). Liver surface infrared emission changes were recorded real-time during all ablative stages. Ablation zone was measured and evaluated by gross pathology and immunohistochemistry for the detection of residual vital tissue within the expected ablation site, especially near large vessels. Surface temperature was evaluated with FLIR Tools Plus software and statistically analyzed. Results: Average time to successful ablation was significantly longer in RFA compared to MWA (5.5 min. + preheat time 2.5 min. vs. 2 min.) The local surface temperature during central RFA near adjacent vascular structures was up to 30% lower compared to peripheral RFA, even though RFA was capable of reaching much higher peripheral surface temperatures than MWA (81 C vs. 63 C). Results of histopathologic examinations concerning vital tissue within the ablation zone and effects of RFA and MWA on vascular structures are still pending at time of submission but will be presented at the meeting. Conclusions: Thermographic imaging is a suitable tool to monitor correct ablation process and demonstrate a significant heat sink effect for RFA but not MWA near large vessels. MWA reaches consistent surface temperatures with successful ablation much faster than RFA, mainly due to technical reasons. With further validation for in-vivo ablation, infrared monitoring might be useful to ensure appropriate ablation especially near vascular structures. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.372

383. Can RECIST be considered a predictor of outcome in patients with liver metastases from colorectal cancer? A. Ferro1, P. Pilati1, D. Nitti1 1 Universita’ di Padova, Scienze Chirurgiche Oncologiche e Gastroenterologiche, Padova, Italy Background: To evaluate the impact on surgery and Overall Survival of Response Evaluation Criteria In Solid Tumors (RECIST) in patients receiving neoadjuvant chemotherapy for colorectal liver metastases (CLM). Materials and methods: From January 1997 to September 2013, 135 patients affected by CLM underwent neoadjuvant chemotherapy prior to surgery with curative intent. Patients were divided into three groups according to the RECIST, evaluated on the computed tomography scan: 74 patients (55%) showing Partial Response (PR), 33 patients (24%) showing Stable Disease (SD), 28 patients (21%) Progressive Disease (PD). No Complete Response was recorded. Percentage of resectability and radicality achieved in the PR, SD, PD resected patients were analysed. Overall Survival in the PD group and in the PR + SR group was compared. Results: The percentage of resectability achieved in the groups PR, SD, PD were respectively 81.1%, 81.8%, 35.7%. The percentage of resection R0 and R1 achieved in the PR group who underwent hepatic resection with curative intent were respectively 73.3% and 16.7%. The percentage of resection R0 and R1 achieved in the SD group who underwent hepatic resection with curative intent were respectively 55% and 11%. The percentage of resection R0 and R1 achieved in the PD group who underwent hepatic resection with curative intent were respectively 82% and 10%. There was no statistically significant difference in terms of Overall Survival in the patients who underwent hepatic resection between the PD and the PR + SD groups. Conclusion: Although the percentage of patients who underwent surgery with curative intent, in the PD group, is as low as 35.7%, in this group the radicality achieved (R0 and R1) was very high (82 and 10% respectively).

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ABSTRACTS

No significant difference in terms of Overall Survival was evidenced between the group of patients who underwent progression of disease after neoadjuvant chemotherapy (PD) and the group who showed a partial response or a stable disease(PR +SD), according to the RECIST. Therefore, RECIST are not reliable criteria for selecting candidates for surgery. The chance of surgery with curative intent should be given to all patients with CLM, irrespective of the type of response they show after the neoadjuvant chemotherapy administration.

The decision for surgery in these patients has to mainly rely on the technical feasibility at the appropriate preoperative and intraoperative imaging. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.373

Poster Session: Lung Cancer 384. Correlation of non-small cell lung carcinoma surgical treatment and local recurrence of the disease D. Stojiljkovic1, R. Dzodic1, D. Subotic2, T. Stojiljkovic3, N. Santrac1 1 Institute of Oncology and Radiology, Surgery, Belgrade, Serbia 2 Institute of Lung Diseases Clinical Center of Serbia, Thoracic Surgery, Belgrade, Serbia 3 Medical Center, Radiology, Smederevo, Serbia Background: For years, it is believed that, in patients with primary non-small cell lung carcinoma (NSCLC), lobectomy represents the minimal extent of resection, even in tumors that are small enough for wedge or segment resection to achieve completeness of resection. Materials and methods: This study followed 114 patients surgically treated for NSCLC in three medical institutions: Institute for Lung Diseases, Clinical Center of Serbia and Institute for Oncology and Radiology of Serbia, from year 2002 to 2010, who had a local recurrence of the disease. Due to great number of surgical procedures that are appropriate for specific disease stage and patients’ general condition, all operations were sorted in: type 1 e sparing surgery (atypical and segmental resection), type 2 e standard operations (lobectomy and bilobectomy), type 3 e extensive surgery (all types of operations larger than bilobectomy), type 4 e conserving surgery with thoracic wall resection, type 5 e standard operations with thoracic wall resection, type 6 e extensive surgery with thoracic wall resection. Time to local recurrence was observed depending on the operation type. Results: There was a statistically significant difference in time to local recurrence in relation to type of primary tumor resection (Log-rank test; c25 ¼ 16.103; p ¼ 6.56*103). Results of cross-analysis of local recurrence and operation types are shown in the Table. As shown, patients treated with lobectomy and bilobectomy have a significantly longer time to local recurrence than patients with these operations extended to thoracic wall resection, which is related to the initial disease stage. Conclusion: Results indicate that the extended surgery, as well as higher initial disease stage and the quality of surgical work, affect strongly earlier recurrence of NSCLC. Table: Results of cross-analysis of local recurrence and operation types. Op tip

Log Rank test; c21

p#

1 1 1 1 1 2 2 2 2 3 3 3 4 4 5

0.05 4.414 4.024 7.485 3.773 4.935 2.496 9.111 1.613 0.19 1.066 0.074 0.046 0 0.143

0.8235 0.0356 0.0448 0.0062 0.0520 0.0263 0.1141 0.0025 0.2040 0.6633 0.3018 0.7853 0.8295 0.9920 0.7057

vs vs vs vs vs vs vs vs vs vs vs vs vs vs vs

2 3 4 5 6 3 4 5 6 4 5 6 5 6 6

significant p-values are determined in relation to the Bonferroni correction (a1 ¼ 0.05/15 ¼ 0.0033). No conflict of interest. #

http://dx.doi.org/10.1016/j.ejso.2014.08.374

385. Radical operation of stage IIIB locally advanced non-small cell lung cancer with carina, pericardium, superior vena cava and pulmonary trunk invasion: Our center experience R.W. Liu1, S. Xu1, J.H. Liu1, Y. Wu1, Z.Q. Song1, G. Chen1, D.X. Zhu1, S. Wei1, Q.H. Zhou1, J. Chen1 1 Tianjin Medical University General Hospital, Lung Cancer Surgery Department, Tianjin, China Background: Due to the serious complications and high mortality during perioperative period, locally advanced non-small cell lung cancer (LANSCLC) is recommended to receive chemotherapy, radiotherapy or targeted therapy instead of surgical treatment. The operation required excellent ability for the surgeon and the treatment effect is still undefined. Here, we presented a highly complex surgical procedure of stage IIIB lung cancer patient and aimed to discuss on the surgical treatment of LANSCLC. Materials and methods: A 72-year-old male with heavy smoke was diagnosed as stage IIIB lung cancer according to the CT scan. His right superior and middle lobar bronchus, carina, trachea, pericardium, superior vena cava and right pulmonary trunk were invaded by the mass. The patient was underwent radical resection of the tumor with right superior and middle lobar, superior vena cava, part of the right pericardium and part of right pulmonary trunk. And reconstruction of trachea and carina (via anastomosis of right inferior lobar bronchus, trachea and left main bronchus), superior vena cava (through anastomosis of stump of the vein, artificial blood vessel and auricula dextra) and right pulmonary trunk were performed subsequently. We also executed systematic lymph node dissection and closed thoracic drainage before closure. Results: The operation lasted about 13 hours and accomplished smoothly. The patient was received intensive postoperative care including nutritional support therapy, application of antibacterial agents, sucking sputum by using bronchoscope. A CT scan indicated normal function of artery, artificial blood vessel and the rest of the lung tissue on the day 13 postoperatively. On day 17, the patient was discharged safely. Conclusions: It required ultra excellent ability for the surgeon to accomplish such operations. In our department, we performed about 4 similar operations per year and follow-up study was executed for each patient. However, the curative effect of surgical treatment for stage IIIB lung cancer patients is still controversial. Whether the surgical therapy can improve the progression-free survival and overall survival for these patients still requires further investigation. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.375