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417. Perioperative chemotherapy in locally advanced gastric cancer
S160 No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.405
416. A rare cause of acute abdomen e Case report R. Bra´sio1, A.R. Malaquias2, I. Gil2, P.F. Alves2, N.J. Rama2 1 Centro Hospitalar de Leiria, Leiria, Portugal 2 Centro Hospitalar de Leiria, Cirurgia 1, Leiria, Portugal Background: Gastrointestinal stroma tumours (GISTs) are the most frequent mesenchymal tumours of the gastrointestinal tract. However only 10% occurs in the jejunum. These tumours could be silent, or may have unspecific symptoms, as abdominal pain, weight loss, bleeding or anaemia. Materials and methods: The authors present a rare case of acute abdomen, of a 73-year-old man who was admitted in the emergency department with acute abdominal pain and vomiting. Physical examination revealed a painful abdomen, with epigastric guarding, and no others important findings. Complementary evaluation showed not only a rise in inflammatory parameters but also a small pneumoperitoneum, an ischemic jejunal loop and free fluid in the abdominal cavity, in abdomino-pelvic computed tomography scan. Results: An urgent laparotomy was performed revealing a perforated jejunal tumour with invasion of the mesentery. For removing the tumour, a segmental enterectomy was performed. The pathological report identified a perforated GIST (pT4). The patient underwent therapy with imatinib and nowadays, after 19 months, is asymptomatic without signs of recurrence. Conclusions: Spontaneous perforation of jejunal GIST is extremely rare, with less than 20 cases described in the literature. These cases, as well as all perforated GISTs, have a poor prognosis and complete, R0 resection of the tumour and intensive and careful follow-up are highly recommended. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.406
417. Perioperative chemotherapy in locally advanced gastric cancer J. Pereira1, D. Brito1, A. Ferreira1, C. Fernandes2, C. Ribeiro1, A. Sousa1, F. Videira1, L. Lara Santos1, D. Pereira3, J. Abreu de Sousa3 1 Instituto Portugu^es de Oncologia do Porto Francisco Gentil, Oncologia Cir urgica, Porto, Portugal 2 Hospital Santo Espırito da Ilha Terceira, Cirurgia Geral, Angra do Heroısmo, Portugal 3 Instituto Portugu^es de Oncologia do Porto Francisco Gentil, Oncologia Medica, Porto, Portugal Background: About two thirds of patients with gastric cancer have locally advanced disease at diagnosis. Recent studies have demonstrated that these patients benefit from perioperative chemotherapy, resulting in an improvement of the T- and N-categories and of the R0 resection rate. The aim of this study is to analyse the results of our institution in this population. Material and methods: Retrospective study, analysing all patients with locally advanced gastric cancer who have been treated with preoperative chemotherapy before surgery in a single institution, between 2008 and 2013. Medical records were reviewed and the data analysis was performed with SPSS. Results: In this period, 50 patients with locally advanced gastric cancer were initially treated with preoperative chemotherapy. The majority of the patients were male e 76% (38) e with a median age of 64 (31e78) years old and an ECOG performance status of 0 (37) or 1 (13). The tumors were cT3 and cT4 (a/b) with clinically positive lymph nodes in 92% (46) of the cases and they were from the gastroesophageal junction (n ¼ 18), gastric fundus (n ¼ 2), gastric body (n ¼ 18), gastric antrum (n ¼ 5), lesser curvature (n ¼ 6) and greater curvature (n ¼ 1). Almost all patients
ABSTRACTS (48) were treated with 5-Fluorouracil and Cisplatin, performed along a median of 3 treatments. A re-evaluation CT-scan was performed in 46 (92%) patients, showing a partial response in 33 (66%) and progression of the disease in 5 patients (10%). A surgery with a curative intent was performed in 74% (37) of the patients, with a R0 resection rate of 92% (34). A D2-lymphadenectomy was performed in all cases, with more than 15 lymph nodes isolated in all patients and more than 25 in 76.3% of them (29). Occult metastases were found in 10 patients (20%). The surgical morbidity rate was 12.5% (6) and one patient have died. All tumors were adenocarcinoma on the histological analysis, 56% (28) of them staged ypN+, 10.4% (5) staged ypT1-2 and one patient have had complete pathologic response. Thirty four patients (74%) received postoperative chemotherapy. The median OS was 30.8 months (M) and the median Disease-free Survival (DFS) was 27 M, with a median time of follow-up of 17.6 M. Conclusions: In patients with resectable locally advanced gastric adenocarcinomas, a perioperative chemotherapy regimen induces a downstaging of the tumor, with excellent rates of R0 resection, OS and DFS, in our case series. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.407
418. Indication of the operative treatment in gastric carcinoma e Is the pathological diagnosis necessary? M. Stasek1, R. Aujesky2, R. Vrba2, L. Hrdina3, P. Janda2, C. Neoral2 1 FN Olomouc, Olomouc, Czech Republic 2 FN Olomouc, Department of Surgery I, Olomouc, Czech Republic 3 FN Olomouc, Department of Radiology, Olomouc, Czech Republic Background: The carcinoma of the stomach is a condition with standardised diagnostic algorithm and a multimodal therapeutic strategy. The diagnosis is made in clinical stage IV in 45%. The cause of the diagnostic and therapeutic delay may be in the perseveration on preoperative histological diagnosis in some cases. Methods: The retrospective analysis of the patients with gastric carcinoma in the years 2011e2014 was provided. We have included patients with preoperatively negative pathological examination and definitive diagnosis of the gastric cancer. The symptoms, endoscopical, CT and PET CT findings, operative treatment, definitive stage of the disease, postoperative complication and further therapy were evaluated. Results: 5 patients with negative histology and suspected gastric cancer were treated in our surgical facility in the years 2011e2014. The symptoms included bleeding (1), pseudoachalasia (1) and dyspepsia with vomiting, weight loss and gastric outlet obstruction (3). Endoscopy proved evident tumor with bleeding (1), distal esophageal stenosis with intact mucosa (1) and infiltrative process of the gastric wall with rigidity and stenosis of the pyloroantral region. The PET CT underlined the suspection for the tumor in 4 cases and failed in 1 case. Total gastrectomy, splenectomy, omentectomy and D2 lymphadenectomy (4) or proximal gastric resection with D2 lymphadenectomy (1) were provided. The stage of the disease at the time of operation was IIB (1), IIIA (1) and IIIC (3) respectively. The postoperative course was complicated by anastomotic leak with sepsis and death the 37th postoperative day, in others cases, postoperative chemoradiotherapy following DeGramont protocol was indicated. Conclusion: The histologic diagnosis is not necessary for indication of the operative treatment in suspected gastric carcinoma in selected patients with the standard diagnostic work-up (gastroscopy, CT and/or PET CT and in selected cases EUS). Every uncertain case should undergo critical evaluation including a multidisciplinary consultation. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.408
416. A rare cause of acute abdomen e Case report R. Bra´sio1, A.R. Malaquias2, I. Gil2, P.F. Alves2, N.J. Rama2 1 Centro Hospitalar de Leiria, Leiria, Portugal 2 Centro Hospitalar de Leiria, Cirurgia 1, Leiria, Portugal Background: Gastrointestinal stroma tumours (GISTs) are the most frequent mesenchymal tumours of the gastrointestinal tract. However only 10% occurs in the jejunum. These tumours could be silent, or may have unspecific symptoms, as abdominal pain, weight loss, bleeding or anaemia. Materials and methods: The authors present a rare case of acute abdomen, of a 73-year-old man who was admitted in the emergency department with acute abdominal pain and vomiting. Physical examination revealed a painful abdomen, with epigastric guarding, and no others important findings. Complementary evaluation showed not only a rise in inflammatory parameters but also a small pneumoperitoneum, an ischemic jejunal loop and free fluid in the abdominal cavity, in abdomino-pelvic computed tomography scan. Results: An urgent laparotomy was performed revealing a perforated jejunal tumour with invasion of the mesentery. For removing the tumour, a segmental enterectomy was performed. The pathological report identified a perforated GIST (pT4). The patient underwent therapy with imatinib and nowadays, after 19 months, is asymptomatic without signs of recurrence. Conclusions: Spontaneous perforation of jejunal GIST is extremely rare, with less than 20 cases described in the literature. These cases, as well as all perforated GISTs, have a poor prognosis and complete, R0 resection of the tumour and intensive and careful follow-up are highly recommended. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.406
417. Perioperative chemotherapy in locally advanced gastric cancer J. Pereira1, D. Brito1, A. Ferreira1, C. Fernandes2, C. Ribeiro1, A. Sousa1, F. Videira1, L. Lara Santos1, D. Pereira3, J. Abreu de Sousa3 1 Instituto Portugu^es de Oncologia do Porto Francisco Gentil, Oncologia Cir urgica, Porto, Portugal 2 Hospital Santo Espırito da Ilha Terceira, Cirurgia Geral, Angra do Heroısmo, Portugal 3 Instituto Portugu^es de Oncologia do Porto Francisco Gentil, Oncologia Medica, Porto, Portugal Background: About two thirds of patients with gastric cancer have locally advanced disease at diagnosis. Recent studies have demonstrated that these patients benefit from perioperative chemotherapy, resulting in an improvement of the T- and N-categories and of the R0 resection rate. The aim of this study is to analyse the results of our institution in this population. Material and methods: Retrospective study, analysing all patients with locally advanced gastric cancer who have been treated with preoperative chemotherapy before surgery in a single institution, between 2008 and 2013. Medical records were reviewed and the data analysis was performed with SPSS. Results: In this period, 50 patients with locally advanced gastric cancer were initially treated with preoperative chemotherapy. The majority of the patients were male e 76% (38) e with a median age of 64 (31e78) years old and an ECOG performance status of 0 (37) or 1 (13). The tumors were cT3 and cT4 (a/b) with clinically positive lymph nodes in 92% (46) of the cases and they were from the gastroesophageal junction (n ¼ 18), gastric fundus (n ¼ 2), gastric body (n ¼ 18), gastric antrum (n ¼ 5), lesser curvature (n ¼ 6) and greater curvature (n ¼ 1). Almost all patients
ABSTRACTS (48) were treated with 5-Fluorouracil and Cisplatin, performed along a median of 3 treatments. A re-evaluation CT-scan was performed in 46 (92%) patients, showing a partial response in 33 (66%) and progression of the disease in 5 patients (10%). A surgery with a curative intent was performed in 74% (37) of the patients, with a R0 resection rate of 92% (34). A D2-lymphadenectomy was performed in all cases, with more than 15 lymph nodes isolated in all patients and more than 25 in 76.3% of them (29). Occult metastases were found in 10 patients (20%). The surgical morbidity rate was 12.5% (6) and one patient have died. All tumors were adenocarcinoma on the histological analysis, 56% (28) of them staged ypN+, 10.4% (5) staged ypT1-2 and one patient have had complete pathologic response. Thirty four patients (74%) received postoperative chemotherapy. The median OS was 30.8 months (M) and the median Disease-free Survival (DFS) was 27 M, with a median time of follow-up of 17.6 M. Conclusions: In patients with resectable locally advanced gastric adenocarcinomas, a perioperative chemotherapy regimen induces a downstaging of the tumor, with excellent rates of R0 resection, OS and DFS, in our case series. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.407
418. Indication of the operative treatment in gastric carcinoma e Is the pathological diagnosis necessary? M. Stasek1, R. Aujesky2, R. Vrba2, L. Hrdina3, P. Janda2, C. Neoral2 1 FN Olomouc, Olomouc, Czech Republic 2 FN Olomouc, Department of Surgery I, Olomouc, Czech Republic 3 FN Olomouc, Department of Radiology, Olomouc, Czech Republic Background: The carcinoma of the stomach is a condition with standardised diagnostic algorithm and a multimodal therapeutic strategy. The diagnosis is made in clinical stage IV in 45%. The cause of the diagnostic and therapeutic delay may be in the perseveration on preoperative histological diagnosis in some cases. Methods: The retrospective analysis of the patients with gastric carcinoma in the years 2011e2014 was provided. We have included patients with preoperatively negative pathological examination and definitive diagnosis of the gastric cancer. The symptoms, endoscopical, CT and PET CT findings, operative treatment, definitive stage of the disease, postoperative complication and further therapy were evaluated. Results: 5 patients with negative histology and suspected gastric cancer were treated in our surgical facility in the years 2011e2014. The symptoms included bleeding (1), pseudoachalasia (1) and dyspepsia with vomiting, weight loss and gastric outlet obstruction (3). Endoscopy proved evident tumor with bleeding (1), distal esophageal stenosis with intact mucosa (1) and infiltrative process of the gastric wall with rigidity and stenosis of the pyloroantral region. The PET CT underlined the suspection for the tumor in 4 cases and failed in 1 case. Total gastrectomy, splenectomy, omentectomy and D2 lymphadenectomy (4) or proximal gastric resection with D2 lymphadenectomy (1) were provided. The stage of the disease at the time of operation was IIB (1), IIIA (1) and IIIC (3) respectively. The postoperative course was complicated by anastomotic leak with sepsis and death the 37th postoperative day, in others cases, postoperative chemoradiotherapy following DeGramont protocol was indicated. Conclusion: The histologic diagnosis is not necessary for indication of the operative treatment in suspected gastric carcinoma in selected patients with the standard diagnostic work-up (gastroscopy, CT and/or PET CT and in selected cases EUS). Every uncertain case should undergo critical evaluation including a multidisciplinary consultation. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.408