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463. The benefits of liver resection for isolated metachronous cervical cancer liver metastases
ABSTRACTS was not taken into account in the mentioned recommendations, we considered to describe here our experience. Presented surgical approach potentially would allow achieving a maximum of radicalism while maintaining adequate liver function in CRC patients with multiple and huge bilobar lesions with prevalence of metastatic process in right liver lobe, particular in cases with low possibility of chemotherapy response. The aim was to estimate the feasibility and safety of colon resection simultaneously with ALPPS (associating liver partition and portal vein ligation for staged hepatectomy), or right in situ split hepatectomy in 9 patients with multiply huge synchronous CRCLM. Material and methods: All patients included in the study characterized by symptomatic CRC and synchronous resectable huge bilobar CRCLM with low possibility of surgical intervention after chemotherapy. The average age of patients was 59 6.7 years. ALPPS was performed in 3 cases, in situ right hepatectomy e in 6. The 1st stage of surgery included colon resection and first step of hepatectomy (non anatomical resection of left liver with/without RFA liver partition and right portal vein branch ligation). The 2nd surgery stage followed by interval amounted of right lobectomy or hemihepatectomy. Results: The median number of metastases was 10 (from 4 to 28) with average maximum size e 12.8 6.7 cm. Duration of 1st surgical stage was 348.9 57.6 minutes and 197.8 50.6 minutes for 2nd. The average blood loss was 496.7 279.0 ml and 650.0 165.8 ml for 1st and 2nd stages respectively. The interval average between two stages was 37.2 13.7 days. Postoperative complications of 3e5 according to Dindo-Clavien was observed in 4 patients: biliary fistula, peritonitis, abscess, and one liver insufficiency after two-stage hemihepatectomy resulting in death within 60 days after 2nd surgery stage. Conclusions: Despite the great technical difficulty of simultaneously resections with in situ split hepatectomy, this strategy enable to reach R0 resection in huge multiple CRCLM with high probability of chemotherapy failure. Our experience demonstrated the approach with satisfactory mortality and postoperative complications rate. Moreover, the death could be prevented by prolongation of the interval between surgical stages. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.288
461. Prognostic value of stromal caveolin-1 expression in colorectal liver metastases K. Neofytou1, A. Petrou1, C. Petrides1, A. Angelou1, G. Agrogiannis2, I. Papakonstandinou3, A. Papalambros1, N. Kavatzas2, E. Pikoulis1, T. Liakakos1, E. Felekouras1 1 Laikon General Hospital, Athens Medical School, National and Kapodistrian University of Athens, 1st Department of Surgery, Athens, Greece 2 Laikon General Hospital, Athens Medical School, National and Kapodistrian University of Athens, First Department of Pathology, Athens, Greece 3 Aretaieion Hospital, Medical School, University of Athens, Second Department of Surgery, Athens, Greece Background: Loss of Stromal Caveolin-1 (CAV1) expression is associated with poor prognosis in various cancers. In this study, we evaluated the prognostic value of CAV1 expression of both tumour cells and stromal cells in colorectal liver metastases (CRLM) in patients undergoing hepatectomy for liver-only colorectal metastases. Materials and methods: In this retrospective study, 109 patients were enrolled. CAV1 expression was studied by immunohistochemistry. The staining was scored semiquantitatively as weak, or strong for both tumour cells and stromal cells. DFS and OS were calculated using both KaplanMeier and multivariate Cox-regression methods. Results: Weak stromal CAV1 expression was associated with decreased DFS (HR 1.90; 95% CI, 1.20e3.00; P ¼ 0.006) and OS (HR2.84; 95% CI, 1.48e5.42; P ¼ 0.002) in univariate analysis. This finding remained significant in multivariate analysis for both DFS and OS (HR 2.07; 95%CI, 1.29e3.33; P ¼ 0.002, and HR 1.86; 95%CI, 1.17e2.96; P ¼ 0.008 respectively). Tumour CAV1 expression was not
S169 associated with DFS and OS. Five-years DFS and OS rates were 27% and 43% respectively in patients with weak and 70% and 71% respectively in patients with strong stromal CAV1 expression. Conclusions: In this study, we indicate that weak stromal CAV1 expression in CRLM is an adverse prognostic factor in patients who undergo liver resection for liver-only colorectal metastases. We suggest validation of this finding in an independent cohort and consideration of risk stratification for post-hepatectomy adjuvant follow up and therapy. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.289
462. Prognostic value of monocarboxylate transporter 4 expression in patients with colorectal liver metastases C. Petrides1, K. Neofytou1, A. Petrou1, A. Angelou1, G. Agrogiannis2, N. Kavatzas2, A. Papalambros1, E. Felekouras1, T. Liakakos1, E. Pikoulis1 1 Laikon General Hospital, Athens Medical School, National and Kapodistrian University of Athens, 1st Department of Surgery, Athens, Greece 2 Laikon General Hospital, Athens Medical School, National and Kapodistrian University of Athens, First Department of Pathology, Athens, Greece Background: To validate the prognostic significance of the stromal expression of Monocarboxylate Transporter 4 (MCT4) in patients with colorectal liver metastases (CRLM) treated with liver resection following neoadjuvant chemotherapy. Materials and methods: This is a retrospective study, of 107 patients with colorectal liver metastases. MCT4 expression in stroma and in cancer cells was studied by immunohistochemistry. The staining was scored semiquantitatively as weak, or strong. DFS and OS were calculated using both Kaplan-Meier and multivariate Cox-regression methods. Results: Specimens from 57 patients (53.27%) showed weak levels of stromal MCT4 staining, whereas 50 patients (46.73%) showed strong levels of MCT4 staining. From the statistical analysis strong stromal MCT4 expression was associated with decreased DFS (HR 1.79; 95% CI, 1.12e2.85; P ¼ 0.014) and OS (HR 3.81 95% CI, 1.88e7.72; P < 0.001) in univariate analysis. This finding remained significant in multivariate analysis for both DFS and OS (HR 1.95; 95% CI, 1.19e3.17; P ¼ 0.007, and HR 4.38; 95% CI, 2.15e8.92; P < 0.001 respectively). Tumour MCT4 expression was not associated with DFS and OS. Five-years DFS and OS rates were 43% and 78% respectively in patients with weak and 15% and 37% respectively in patients with strong stromal MCT4 expression. Conclusions: Our results indicated that strong expression of stromal MCT4 in CRLM was associated with poor prognosis in patients who undergo liver resection for liver-only colorectal metastases. This finding could be further more validated in independed studies and MCT4 could be used as a new biomarker in CRLM and creates the possibility of new studies in targeted therapies. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.290
463. The benefits of liver resection for isolated metachronous cervical cancer liver metastases N. Bacalbasa1, I. Balescu2, S. Dima3, I. Popescu3 1 Carol Davila University of Medicine and Pharmacy, Obstetrics and Gynecology, Bucharest, Romania 2 Ponderas Hospital, Visceral Surgery, Bucharest, Romania 3 Dan Setlacec Center of Gatrointestinal Disease and Liver Transplantation, Fundeni Clinical Institute, Visceral Surgery, Bucharest, Romania
S170
ABSTRACTS
Background: Although the subject of liver resections originating from various malignancies has been widely debated, when it comes to liver metastases from cervical cancer the reported results are rather scarce due to the rarity of cases in which hepatic resections are feasible with curative intent. Material and methods: Between 2002 and 2014 13 patients were submitted to surgery for isolated cervical cancer liver metastases in Fundeni Clinical Institute, Bucharest, Romania. One patient presenting a synchronous pelvic recurrence which was also resected was excluded. The remnant 12 cases were included in the present study. Results: Liver resection was performed after a median interval of 22 months from the time of cervical cancer surgery and consisted of major resections in four cases and minor resections in eight cases. In all cases resection was performed with curative intent, no residual disease being found at the end of the surgical procedures. During the postoperative period two patients developed liver resection related complications which were successfully managed in a conservative manner. The median overall survival after hepatic resection for cervical cancer liver metastases was 18 months. Conclusions: liver resection for hepatic metastases with uterine cervix origin can provide a significant survival benefit in cases in which is performed with curative intent. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.291 464. Surgical rescue of unresectable liver metastases from colorectal origin after neoadjuvant treatment: Our experience P. Bretcha-Boix1, M. Duarte2, A. Paz2, C. Pino-Marin2, J. Farre-Alegre2 1 Hospital Quir on Torrevieja, Platform of Oncology, Alicante, Spain 2 Hospital Quiron Torrevieja, Platform of Oncology, Torrevieja, Spain Background: Surgery of liver metastases has increased in the last decade thanks to a multidisciplinary approach that has allowed greater therapeutic aggressiveness. Our objective is to evaluate the survival of these subset of patients (pts) treated in our hospital with a multidisciplinary approach. Material and methods: From February 2001 to September 2013, 240 pts were treated in our hospital of which 184 were considered initially unresectable. 38 pts (21%) could be operated after an average of 10 cycles of chemotherapy with 5-fluorouracil + leucovorin combined with oxaliplatin (82%) irinotecan (3%) both (10%) + cetuximab (5%). 205 metastases were treated, an average of 5 lesions per pt and a medium size of 3,4 cm (0.7 to 21 cm). The most frequently affected segment was the third (58%) and the least affected was the I (12%). Extrahepatic disease was present in 10 pts (26%). Multifocality and extrahepatic disease was the leading cause of unresectability. Results: Three pts underwent a left hepatectomy, 3 pts a right hepatectomy and 2 pts were performed an extended Left (1) and right (1). One pt received a central hepatectomy. 40 metastasectomies, 13 segmentectomies and 122 RFA were performed. In four cases a portal ligation and ablative treatment was performed at a first stage, and later an hepatectomy at a second stage. 8 pts (21%) an extrahepatic tumor resection was performed. Morbidity was 19% and mortality of 6% within 2 months
of postoperative follow up. After a mean follow-up of 109 months, tumor recurrence was identified in 11 pts (16%) of which 9 pts a surgical salvage was performed after chemotherapy treatment, one pt received systemic chemotherapy as a unique treatment and another pt received radiotherapy + stenting. The disease free survival has been of 13 months and the 5-year survival of 21%. Currently 9 pts are alive (7 without evidence of disease). Conclusions: A multidisciplinary approach with modern systemic chemotherapy administration has allowed surgical salvage of 21% of our patients with 5-year survival similar to those of the literature. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.292
465. Surgical aggressive treatment of primary and liver metastases of neuroendocrine tumors E. Rubio1, J. Nu~ no1, L. Brandariz2, I. Domınguez2, J. Bernal2, A. Vivas2, O. Alonso1, S. Gonza´lez1, P. Pelaez2, J. Perea2, J. Garcia Borda2, E. Ferrero2 1 MDAIE, Surgical Oncology, MADRID, Spain 2 Hospital Universitario 12 de Octubre, Surgery, Madrid, Spain Background: In contrast to other gastrointestinal endocrine tumors, tumors of the jejunum-ileum of comparable size can behave very aggressively. According to the literature, only 23% of patients having undergone apparently curative resection were free of disease after 25 years. Regional lymph node metastases are present at the time of diagnosis in 36e39% and non-localized disease is evident in 64.1% of the patients. For localized tumors of the small intestine, the 5-year survival rate is 65e75% for regional disease, whereas for non-localized tumors the 5year survival is 50% according to the SEER registry. The 5-year survival rate of patients with hepatic tumor spread is 18e32%. Objective: To describe two cases of surgical aggressive treatment for primary and metastatic neuroendocrine tumor (MNT). Case 1: Male 46 yo, diagnosticated of MNT with multiple affectation and heart disease (tricuspid regurgitation and severe dilatation of right cavities, he is operated: a right hepatectomy, hepatectomy subsegmentary (4b), cholecistectomy and ileal resection (primary) was made. Histopathology: Good differenced MNT. He was discharged 19 day after surgery without complications. Case 2: Male 52 yo, diagnosticated of cecal MNT with multiple affectation, he is operated: an open right colectomy, 9 metastasectomies, and vesicular implant was resected. Histopathology: Good differenced MNT. He was discharged 10 day after surgery without complications. Conclusions: Aggressive surgical resection for metastatic NETs with the goal of clearing all detectable disease. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.293
Poster Session: Lung Cancer 475. Leiomyosarcoma of the mediastinum: An extremely rare case S.H. Chou1,2, Y.L. Lee2, H.P. Li2, J.Y. Lee2, H.H. Chiang2 1 Kaohsiung Medical University Hospital, Department of Surgery, Kaohsiung City, Taiwan 2 Kaohsiung Medical University Hospital, Department of Respiratory Therapy, Kaohsiung City, Taiwan
Background: Malignant smooth muscle tumors usually develop in the organs with abundant smooth muscle such as intestine, esophagus and uterus. Sarcoma developed in the soft tissue of mediastinum has not been found in the literature. We herein report a case of leiomyosarcoma of mediastinum. Case presentation: A 44-year-old male who was diagnosed with neurofibromatosis type 1 20 year ago, was admitted to our ward because of chest
461. Prognostic value of stromal caveolin-1 expression in colorectal liver metastases K. Neofytou1, A. Petrou1, C. Petrides1, A. Angelou1, G. Agrogiannis2, I. Papakonstandinou3, A. Papalambros1, N. Kavatzas2, E. Pikoulis1, T. Liakakos1, E. Felekouras1 1 Laikon General Hospital, Athens Medical School, National and Kapodistrian University of Athens, 1st Department of Surgery, Athens, Greece 2 Laikon General Hospital, Athens Medical School, National and Kapodistrian University of Athens, First Department of Pathology, Athens, Greece 3 Aretaieion Hospital, Medical School, University of Athens, Second Department of Surgery, Athens, Greece Background: Loss of Stromal Caveolin-1 (CAV1) expression is associated with poor prognosis in various cancers. In this study, we evaluated the prognostic value of CAV1 expression of both tumour cells and stromal cells in colorectal liver metastases (CRLM) in patients undergoing hepatectomy for liver-only colorectal metastases. Materials and methods: In this retrospective study, 109 patients were enrolled. CAV1 expression was studied by immunohistochemistry. The staining was scored semiquantitatively as weak, or strong for both tumour cells and stromal cells. DFS and OS were calculated using both KaplanMeier and multivariate Cox-regression methods. Results: Weak stromal CAV1 expression was associated with decreased DFS (HR 1.90; 95% CI, 1.20e3.00; P ¼ 0.006) and OS (HR2.84; 95% CI, 1.48e5.42; P ¼ 0.002) in univariate analysis. This finding remained significant in multivariate analysis for both DFS and OS (HR 2.07; 95%CI, 1.29e3.33; P ¼ 0.002, and HR 1.86; 95%CI, 1.17e2.96; P ¼ 0.008 respectively). Tumour CAV1 expression was not
S169 associated with DFS and OS. Five-years DFS and OS rates were 27% and 43% respectively in patients with weak and 70% and 71% respectively in patients with strong stromal CAV1 expression. Conclusions: In this study, we indicate that weak stromal CAV1 expression in CRLM is an adverse prognostic factor in patients who undergo liver resection for liver-only colorectal metastases. We suggest validation of this finding in an independent cohort and consideration of risk stratification for post-hepatectomy adjuvant follow up and therapy. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.289
462. Prognostic value of monocarboxylate transporter 4 expression in patients with colorectal liver metastases C. Petrides1, K. Neofytou1, A. Petrou1, A. Angelou1, G. Agrogiannis2, N. Kavatzas2, A. Papalambros1, E. Felekouras1, T. Liakakos1, E. Pikoulis1 1 Laikon General Hospital, Athens Medical School, National and Kapodistrian University of Athens, 1st Department of Surgery, Athens, Greece 2 Laikon General Hospital, Athens Medical School, National and Kapodistrian University of Athens, First Department of Pathology, Athens, Greece Background: To validate the prognostic significance of the stromal expression of Monocarboxylate Transporter 4 (MCT4) in patients with colorectal liver metastases (CRLM) treated with liver resection following neoadjuvant chemotherapy. Materials and methods: This is a retrospective study, of 107 patients with colorectal liver metastases. MCT4 expression in stroma and in cancer cells was studied by immunohistochemistry. The staining was scored semiquantitatively as weak, or strong. DFS and OS were calculated using both Kaplan-Meier and multivariate Cox-regression methods. Results: Specimens from 57 patients (53.27%) showed weak levels of stromal MCT4 staining, whereas 50 patients (46.73%) showed strong levels of MCT4 staining. From the statistical analysis strong stromal MCT4 expression was associated with decreased DFS (HR 1.79; 95% CI, 1.12e2.85; P ¼ 0.014) and OS (HR 3.81 95% CI, 1.88e7.72; P < 0.001) in univariate analysis. This finding remained significant in multivariate analysis for both DFS and OS (HR 1.95; 95% CI, 1.19e3.17; P ¼ 0.007, and HR 4.38; 95% CI, 2.15e8.92; P < 0.001 respectively). Tumour MCT4 expression was not associated with DFS and OS. Five-years DFS and OS rates were 43% and 78% respectively in patients with weak and 15% and 37% respectively in patients with strong stromal MCT4 expression. Conclusions: Our results indicated that strong expression of stromal MCT4 in CRLM was associated with poor prognosis in patients who undergo liver resection for liver-only colorectal metastases. This finding could be further more validated in independed studies and MCT4 could be used as a new biomarker in CRLM and creates the possibility of new studies in targeted therapies. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.290
463. The benefits of liver resection for isolated metachronous cervical cancer liver metastases N. Bacalbasa1, I. Balescu2, S. Dima3, I. Popescu3 1 Carol Davila University of Medicine and Pharmacy, Obstetrics and Gynecology, Bucharest, Romania 2 Ponderas Hospital, Visceral Surgery, Bucharest, Romania 3 Dan Setlacec Center of Gatrointestinal Disease and Liver Transplantation, Fundeni Clinical Institute, Visceral Surgery, Bucharest, Romania
S170
ABSTRACTS
Background: Although the subject of liver resections originating from various malignancies has been widely debated, when it comes to liver metastases from cervical cancer the reported results are rather scarce due to the rarity of cases in which hepatic resections are feasible with curative intent. Material and methods: Between 2002 and 2014 13 patients were submitted to surgery for isolated cervical cancer liver metastases in Fundeni Clinical Institute, Bucharest, Romania. One patient presenting a synchronous pelvic recurrence which was also resected was excluded. The remnant 12 cases were included in the present study. Results: Liver resection was performed after a median interval of 22 months from the time of cervical cancer surgery and consisted of major resections in four cases and minor resections in eight cases. In all cases resection was performed with curative intent, no residual disease being found at the end of the surgical procedures. During the postoperative period two patients developed liver resection related complications which were successfully managed in a conservative manner. The median overall survival after hepatic resection for cervical cancer liver metastases was 18 months. Conclusions: liver resection for hepatic metastases with uterine cervix origin can provide a significant survival benefit in cases in which is performed with curative intent. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.291 464. Surgical rescue of unresectable liver metastases from colorectal origin after neoadjuvant treatment: Our experience P. Bretcha-Boix1, M. Duarte2, A. Paz2, C. Pino-Marin2, J. Farre-Alegre2 1 Hospital Quir on Torrevieja, Platform of Oncology, Alicante, Spain 2 Hospital Quiron Torrevieja, Platform of Oncology, Torrevieja, Spain Background: Surgery of liver metastases has increased in the last decade thanks to a multidisciplinary approach that has allowed greater therapeutic aggressiveness. Our objective is to evaluate the survival of these subset of patients (pts) treated in our hospital with a multidisciplinary approach. Material and methods: From February 2001 to September 2013, 240 pts were treated in our hospital of which 184 were considered initially unresectable. 38 pts (21%) could be operated after an average of 10 cycles of chemotherapy with 5-fluorouracil + leucovorin combined with oxaliplatin (82%) irinotecan (3%) both (10%) + cetuximab (5%). 205 metastases were treated, an average of 5 lesions per pt and a medium size of 3,4 cm (0.7 to 21 cm). The most frequently affected segment was the third (58%) and the least affected was the I (12%). Extrahepatic disease was present in 10 pts (26%). Multifocality and extrahepatic disease was the leading cause of unresectability. Results: Three pts underwent a left hepatectomy, 3 pts a right hepatectomy and 2 pts were performed an extended Left (1) and right (1). One pt received a central hepatectomy. 40 metastasectomies, 13 segmentectomies and 122 RFA were performed. In four cases a portal ligation and ablative treatment was performed at a first stage, and later an hepatectomy at a second stage. 8 pts (21%) an extrahepatic tumor resection was performed. Morbidity was 19% and mortality of 6% within 2 months
of postoperative follow up. After a mean follow-up of 109 months, tumor recurrence was identified in 11 pts (16%) of which 9 pts a surgical salvage was performed after chemotherapy treatment, one pt received systemic chemotherapy as a unique treatment and another pt received radiotherapy + stenting. The disease free survival has been of 13 months and the 5-year survival of 21%. Currently 9 pts are alive (7 without evidence of disease). Conclusions: A multidisciplinary approach with modern systemic chemotherapy administration has allowed surgical salvage of 21% of our patients with 5-year survival similar to those of the literature. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.292
465. Surgical aggressive treatment of primary and liver metastases of neuroendocrine tumors E. Rubio1, J. Nu~ no1, L. Brandariz2, I. Domınguez2, J. Bernal2, A. Vivas2, O. Alonso1, S. Gonza´lez1, P. Pelaez2, J. Perea2, J. Garcia Borda2, E. Ferrero2 1 MDAIE, Surgical Oncology, MADRID, Spain 2 Hospital Universitario 12 de Octubre, Surgery, Madrid, Spain Background: In contrast to other gastrointestinal endocrine tumors, tumors of the jejunum-ileum of comparable size can behave very aggressively. According to the literature, only 23% of patients having undergone apparently curative resection were free of disease after 25 years. Regional lymph node metastases are present at the time of diagnosis in 36e39% and non-localized disease is evident in 64.1% of the patients. For localized tumors of the small intestine, the 5-year survival rate is 65e75% for regional disease, whereas for non-localized tumors the 5year survival is 50% according to the SEER registry. The 5-year survival rate of patients with hepatic tumor spread is 18e32%. Objective: To describe two cases of surgical aggressive treatment for primary and metastatic neuroendocrine tumor (MNT). Case 1: Male 46 yo, diagnosticated of MNT with multiple affectation and heart disease (tricuspid regurgitation and severe dilatation of right cavities, he is operated: a right hepatectomy, hepatectomy subsegmentary (4b), cholecistectomy and ileal resection (primary) was made. Histopathology: Good differenced MNT. He was discharged 19 day after surgery without complications. Case 2: Male 52 yo, diagnosticated of cecal MNT with multiple affectation, he is operated: an open right colectomy, 9 metastasectomies, and vesicular implant was resected. Histopathology: Good differenced MNT. He was discharged 10 day after surgery without complications. Conclusions: Aggressive surgical resection for metastatic NETs with the goal of clearing all detectable disease. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.293
Poster Session: Lung Cancer 475. Leiomyosarcoma of the mediastinum: An extremely rare case S.H. Chou1,2, Y.L. Lee2, H.P. Li2, J.Y. Lee2, H.H. Chiang2 1 Kaohsiung Medical University Hospital, Department of Surgery, Kaohsiung City, Taiwan 2 Kaohsiung Medical University Hospital, Department of Respiratory Therapy, Kaohsiung City, Taiwan
Background: Malignant smooth muscle tumors usually develop in the organs with abundant smooth muscle such as intestine, esophagus and uterus. Sarcoma developed in the soft tissue of mediastinum has not been found in the literature. We herein report a case of leiomyosarcoma of mediastinum. Case presentation: A 44-year-old male who was diagnosed with neurofibromatosis type 1 20 year ago, was admitted to our ward because of chest