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400 POSTER Sentinel lymphatic mapping in rectal cancer
Poster session: Colorectal and anal cancer Fistula between prostate and pouch 2 (1.2%). Rectovaginal fistula 1 (0.6%). The two prostato-colonic pouch fistula’s occurred one and three years postrectal surgery following endoscopic prostatic surgery for benign adenoma’s, causing one death: the only complication with a possible relationship to radiotherapy. 127 patients were observed for a minimum period of five years, of them 92 survived. Conclusions: Resection and subsequent reconstruction of the rectum after short regimen preoperative radiotherapy shows only limited morbidity and low mortality. Caution however must be drawn to TUR of the prostate subsequent to a previous colo-anal reconstruction in an irradiated region.
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patients were not found with the use of mDF, there was a trend in that direction. With more patients staged as node positive, adjuvant chemotherapy can be offered to these patients which might lead to survival benefit in the future. 400
POSTER
Sentinel lymphatic mapping in rectal cancer W. Gawad 1 , I. Gouda 2 . 1 National Cancer Institute, Surgical Oncology, Cairo, Egypt; 2 National Cancer Institute, Pathology, Cairo, Egypt
About 50% of patients with colorectal cancer develop liver metastases at some point in their illness. Surgical resection, which offers the only chance of long-term survival, is an option in only 15% of cases.Those patients initially deemed inoperable may undergo neoadjuvant chemotherapy to be down-staged to a point where surgery becomes an option. The purpose of this study was to analyze a consecutive series of 16 patients referred for staged resection of colorectal liver metastases. From December 1995 and December 2003, 68 colorectal-cancer patients with liver metastases underwent hepatic resection with curative intent. Sixteen of these patients, were treated with neoadjuvant chemotherapy. A 7year survival analysis was performed. Eleven patients (69%) were affected by synchronous and five (31%) by metachronous metastases. Six out of 11 synchronous (55%) and 4 out of 5 metachronous (80%) metastases did not progress while receiving chemotherapy. Among all 68 resected patients there was no perioperative mortality (within 30 days following surgery), and the complication rate was 25%. The 5-year survival rates for the entire group was 47%, and 86% for patients whose disease did not progress during chemotherapy. The 5-year disease-free survival rates were 30% overall and 50% for chemotherapy responders. The response to chemotherapy is likely to be a prognostic factor related to survival; however larger studies and longer follow-up are required to confirm this impression. The hope for the future is the development of more effective chemotherapeutic regimens, which may allow a larger number of previously-unresectable patients to benefit from curative surgery.
Background and Objectives: Nearly 30% of patients with stage I, II rectal cancer with no evidence of nodal deposits develop systemic disease despite radical curative surgery. It is postulated that a subset group of patients do harbor nodal micrometastases not detected by the classic Hematoxylin and Eosin (H& E) staining. This prospective study aimed to assess the feasibility of in vivo sentinel lymphatic node (SLN) mapping and biopsy in accurate nodal staging and decision making. This might offer a reasonable clue to whether lateral lymph node metastases can be diagnosed by SLN mapping and so provide benefit to patients with advanced rectal cancer regarding consideration of more extensive resection. Material and Methods: The study included 25 patients with mid and low rectal tumours. In mid rectal tumours blue dye was injected circumferentially in the peritumoral area in the subserosal plane. Similarly in low rectal tumours submucosal injection around the tumour through proctoscopy was performed. Immediate labeling and prompt dissection of blue stained nodes were followed by the standard radical resection. The sentinel nodes were separately sent for focused histopathological examination, the surgical specimen including other nodes for routine examination. H&E negative SLN were tested Immunohistochemically (IHC) Results: Sentinel Lymph Node (SLN) mapping was feasible in 24 out of 25 patients (96%) with a mean number of SLN 2.8/ patient (0-3).Positive SLN were found in 9 patients (38%) while negative SLN were found in 15 patients (62%).The incidence of metastasis in SLN was 26%.Lateral positive nodes were found in 3 patients (13%).Upstaging of T2-3N0 to T2-3N1 was done in 15% of cases. Skip lesions were present in one patient. Conclusion: Sentinel Lymph Node (SLN) In vivo mapping using blue dye is a promising and feasible technique with a short learning curve. Lateral node dissection was excluded in 87% of patients. Proper nodal Staging by SLN focused analysis leads to identification of a subset group of patients that could benefit from adjuvant therapy.
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Response to neo-adjuvant chemotherapy in colorectal-cancer patients with liver metastases A.C. Chiappa, E. Bertani, R. Biffi, U. Pace, C. Grassi, F. Biella, D. Poldi, D. Papis, S. Cenciarelli, B. Andreoni. European Institute of Oncology/University of Milan, General Surgery, Milano, Italy
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Effect of re-fixation in modified Davidson’s Fixative on number of lymph nodes and TNM-stage in colon cancer B. Inberg 1 , W. Kelder 1 , J.T.M. Plukker 2 , H. Groen 3 , P.C. Baas 1 , A.T.M.G. Tiebosch 4 . 1 Martini Ziekenhuis Groningen, Surgery, Groningen, The Netherlands; 2 University Medical Center, Surgery, Groningen, The Netherlands; 3 University Medical Center, Medical Technology Assessment, Groningen, The Netherlands; 4 Martini Ziekenhuis Groningen, Pathology, Groningen, The Netherlands Aim: To investigate the effect of modified Davidson’s Fixative (mDF) on the number of lymph nodes found in a specimen after colon resection and TNM-staging. Patients and methods: Specimens of 242 patients were available for analysis. Of these 242 specimens 117 were examined using traditional dissection with manual examination of all nodes. 125 specimens were treated with formalin fixation for 42-72 hours, serially sectioned and re-fixed in mDF containing ethanol, glacial acetid acid, formaldehyde and water. Results: In the specimens treated without the mDF the median number of nodes found was 5 (range 0-17), with use of the mDF the median number of nodes examined increased to 13 (0-35, p=0,000). Also type of resection and T-stadium were of significance influence on the number of lymph nodes found. The percentage of node positive cases increased from 30% to 41% after the use of mDF. This difference is almost significant (p=0,077) Conclusion: More lymph nodes are recovered with the use of mDF by the pathologist in a colon resection specimen. Although more node positive
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Intraperitoneal hypertermic chemotherapy is real method of improvement results of treatment of the widespread forms of a colorectal cancer A. Kitaev, S. Leonov, V. Petrov, G. Lasarev, E. Mikhaylova. The Central Military Clinical A.A. Vishnevsky Hospital, Coloproctological center, Krasnogorsk, Russian Federation Introduction: Colorectal cancer is a serious medical problem. In the developed countries on prevalence it stands on the second place among malignant diseases. Annually in the world 700 000 new cases of a cancer of this localization and 400 000 - 500 000 lethal outcomes caused by it are recorded. As a component of researches we used the method of the Intraperitoneal Hypertermic Chemotherapy (IHCT) based on ability of a heat to cause a denaturation of proteins, enzymatic and genetic structures of a tumour cells, to change microcirculation blood and lymphs in a tumour zone, to provide a penetration and deposition of the cytotoxic agent inside of the cancer cell. Methods: This research include 222 persons was treatmented in the coloproctological center of hospital since April 1996 till July 2005. Men was – 60.0%, women – 40.0%. About 56% patients were more 60 years old. The investigated patients has been distributed on 4 groups by kinds of operative interventions and using IHCT: I group are 42 persons (18,9%) - radical operations with (IHCT); II group are 46 persons (20.8%) - cytoreductive operations with IHCT; III group are 68 persons (30.6%) - radical operations without IHCT and IY group are66 persons (29.7%) - cytoreductive operations without IHCT.
S119
patients were not found with the use of mDF, there was a trend in that direction. With more patients staged as node positive, adjuvant chemotherapy can be offered to these patients which might lead to survival benefit in the future. 400
POSTER
Sentinel lymphatic mapping in rectal cancer W. Gawad 1 , I. Gouda 2 . 1 National Cancer Institute, Surgical Oncology, Cairo, Egypt; 2 National Cancer Institute, Pathology, Cairo, Egypt
About 50% of patients with colorectal cancer develop liver metastases at some point in their illness. Surgical resection, which offers the only chance of long-term survival, is an option in only 15% of cases.Those patients initially deemed inoperable may undergo neoadjuvant chemotherapy to be down-staged to a point where surgery becomes an option. The purpose of this study was to analyze a consecutive series of 16 patients referred for staged resection of colorectal liver metastases. From December 1995 and December 2003, 68 colorectal-cancer patients with liver metastases underwent hepatic resection with curative intent. Sixteen of these patients, were treated with neoadjuvant chemotherapy. A 7year survival analysis was performed. Eleven patients (69%) were affected by synchronous and five (31%) by metachronous metastases. Six out of 11 synchronous (55%) and 4 out of 5 metachronous (80%) metastases did not progress while receiving chemotherapy. Among all 68 resected patients there was no perioperative mortality (within 30 days following surgery), and the complication rate was 25%. The 5-year survival rates for the entire group was 47%, and 86% for patients whose disease did not progress during chemotherapy. The 5-year disease-free survival rates were 30% overall and 50% for chemotherapy responders. The response to chemotherapy is likely to be a prognostic factor related to survival; however larger studies and longer follow-up are required to confirm this impression. The hope for the future is the development of more effective chemotherapeutic regimens, which may allow a larger number of previously-unresectable patients to benefit from curative surgery.
Background and Objectives: Nearly 30% of patients with stage I, II rectal cancer with no evidence of nodal deposits develop systemic disease despite radical curative surgery. It is postulated that a subset group of patients do harbor nodal micrometastases not detected by the classic Hematoxylin and Eosin (H& E) staining. This prospective study aimed to assess the feasibility of in vivo sentinel lymphatic node (SLN) mapping and biopsy in accurate nodal staging and decision making. This might offer a reasonable clue to whether lateral lymph node metastases can be diagnosed by SLN mapping and so provide benefit to patients with advanced rectal cancer regarding consideration of more extensive resection. Material and Methods: The study included 25 patients with mid and low rectal tumours. In mid rectal tumours blue dye was injected circumferentially in the peritumoral area in the subserosal plane. Similarly in low rectal tumours submucosal injection around the tumour through proctoscopy was performed. Immediate labeling and prompt dissection of blue stained nodes were followed by the standard radical resection. The sentinel nodes were separately sent for focused histopathological examination, the surgical specimen including other nodes for routine examination. H&E negative SLN were tested Immunohistochemically (IHC) Results: Sentinel Lymph Node (SLN) mapping was feasible in 24 out of 25 patients (96%) with a mean number of SLN 2.8/ patient (0-3).Positive SLN were found in 9 patients (38%) while negative SLN were found in 15 patients (62%).The incidence of metastasis in SLN was 26%.Lateral positive nodes were found in 3 patients (13%).Upstaging of T2-3N0 to T2-3N1 was done in 15% of cases. Skip lesions were present in one patient. Conclusion: Sentinel Lymph Node (SLN) In vivo mapping using blue dye is a promising and feasible technique with a short learning curve. Lateral node dissection was excluded in 87% of patients. Proper nodal Staging by SLN focused analysis leads to identification of a subset group of patients that could benefit from adjuvant therapy.
399
401
398
POSTER
Response to neo-adjuvant chemotherapy in colorectal-cancer patients with liver metastases A.C. Chiappa, E. Bertani, R. Biffi, U. Pace, C. Grassi, F. Biella, D. Poldi, D. Papis, S. Cenciarelli, B. Andreoni. European Institute of Oncology/University of Milan, General Surgery, Milano, Italy
POSTER
Effect of re-fixation in modified Davidson’s Fixative on number of lymph nodes and TNM-stage in colon cancer B. Inberg 1 , W. Kelder 1 , J.T.M. Plukker 2 , H. Groen 3 , P.C. Baas 1 , A.T.M.G. Tiebosch 4 . 1 Martini Ziekenhuis Groningen, Surgery, Groningen, The Netherlands; 2 University Medical Center, Surgery, Groningen, The Netherlands; 3 University Medical Center, Medical Technology Assessment, Groningen, The Netherlands; 4 Martini Ziekenhuis Groningen, Pathology, Groningen, The Netherlands Aim: To investigate the effect of modified Davidson’s Fixative (mDF) on the number of lymph nodes found in a specimen after colon resection and TNM-staging. Patients and methods: Specimens of 242 patients were available for analysis. Of these 242 specimens 117 were examined using traditional dissection with manual examination of all nodes. 125 specimens were treated with formalin fixation for 42-72 hours, serially sectioned and re-fixed in mDF containing ethanol, glacial acetid acid, formaldehyde and water. Results: In the specimens treated without the mDF the median number of nodes found was 5 (range 0-17), with use of the mDF the median number of nodes examined increased to 13 (0-35, p=0,000). Also type of resection and T-stadium were of significance influence on the number of lymph nodes found. The percentage of node positive cases increased from 30% to 41% after the use of mDF. This difference is almost significant (p=0,077) Conclusion: More lymph nodes are recovered with the use of mDF by the pathologist in a colon resection specimen. Although more node positive
POSTER
Intraperitoneal hypertermic chemotherapy is real method of improvement results of treatment of the widespread forms of a colorectal cancer A. Kitaev, S. Leonov, V. Petrov, G. Lasarev, E. Mikhaylova. The Central Military Clinical A.A. Vishnevsky Hospital, Coloproctological center, Krasnogorsk, Russian Federation Introduction: Colorectal cancer is a serious medical problem. In the developed countries on prevalence it stands on the second place among malignant diseases. Annually in the world 700 000 new cases of a cancer of this localization and 400 000 - 500 000 lethal outcomes caused by it are recorded. As a component of researches we used the method of the Intraperitoneal Hypertermic Chemotherapy (IHCT) based on ability of a heat to cause a denaturation of proteins, enzymatic and genetic structures of a tumour cells, to change microcirculation blood and lymphs in a tumour zone, to provide a penetration and deposition of the cytotoxic agent inside of the cancer cell. Methods: This research include 222 persons was treatmented in the coloproctological center of hospital since April 1996 till July 2005. Men was – 60.0%, women – 40.0%. About 56% patients were more 60 years old. The investigated patients has been distributed on 4 groups by kinds of operative interventions and using IHCT: I group are 42 persons (18,9%) - radical operations with (IHCT); II group are 46 persons (20.8%) - cytoreductive operations with IHCT; III group are 68 persons (30.6%) - radical operations without IHCT and IY group are66 persons (29.7%) - cytoreductive operations without IHCT.