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700. Small bowel adenocarcinoma in a regional hospital - a series of cases
ABSTRACTS
S191
in Arab women, but no significant change in Arab men. Colon cancer showed a relative decrease in incidence in the Jewish population, but an increase in the Arab population. A decrease in incidence in rectal cancer was observed in the Jewish population, while an increase was observed in the Arab population. Conclusion: Gastric, colon, and rectal cancers exhibit differences in incidence and outcome between Jewish and Arab populations in Israel. These differences were not observed in the other five types of less common gastrointestinal cancers. Jews
Colon cancer Gastric cancer Rectal cancer Pancreatic cancer Liver cancer Gallbladder cancer Esophageal cancer Small bowel cancer
Arabs
Male
Female
Male
1980 2012
1980 2012
1980 2012 1980 2012
33.9 33.6 16.8 8.80* 16.5 10.6* 8.4 8.5 3.3 2.9 1.2 1.6 1.8 1.4 0.5 0.9
28.5 8.95 12.7 7.5 1.4 2.8 1.3 0.7
7.9 26* 9.78 9.37 2.2 7.1* 2.6 5.7 1.2 3.2 3.8 2.6 1.0 0.7 0.38 0.48
25.1 4.12* 7.3* 6.5 1.4 1.5 0.8 0.8
Female
6.1 22.1* 4.74 5.35* 2.6 6.9* 4.6 4.3 0.6 1.1 2.7 2.9 0.2 0.2 0.68 0.96
Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.357 683. Audit-based improvements in the management of patients with diseases of the breast in a newly founded breast clinic V. Kalles, G. Boutsikos, E. Fradelos, I. Papapanagiotou, I. Tsouknidas, E. Voulgaris, G. Xanthopoulou, N. Ivros, G. Pechlivanides Naval and Veterans Hospital, 2nd Department of Surgery, Athens, Greece Background: Our hospital’s breast clinic started admitting patients in 2013. By retrospectively investigating the management of the patients seen in clinic, we identified possible pitfalls and proposed a course of action to resolve these issues. After implementing most of the changes proposed, a retrospective analysis of the management of patients with breast problems that were seen in 2014 was done, in order to identify new possible problems, and measure the effect of the implemented changes.
Material and methods: The hospital records of patients seen or admitted in our Breast Clinic during the year 2014 were retrospectively reviewed. Compared to year 2013, the changes implemented were: 1) more clinic hours to accommodate the increased need for appointments, 2) a weekly breast surgery list to reduce patient waiting time between clinic visit and surgery, and 3) a faster referral of patients to the Breast MDT following their operation to reduce the time between surgery and administration of adjuvant therapy. Changes regarding the modernization of screening and diagnostic equipment (mammography, ultrasound, stereotactic biopsy table) were not implemented due to lack of appropriate funds. Results: During 2014, 419 women and 8 men with a mean age of 52,7 years (range 14e90 years) were seen in the outpatient clinic. The waiting time for an appointment was reduced to 7 days. 51% of the patients presented for screening mammography and exam, and 23% for further investigation of a breast symptom (most frequently a breast lump). 35 biopsies were performed (8 FNA, 27 core biopsies) with or without ultrasound guidance. 16/27 core biopsies had a malignant result, while 11/27 were negative for cancer (one false negative result). 6/8 FNAs were negative for cancer, 1/8 was suspicious for cancer and 1/8 positive. There were no false negative FNAs. 40 patients underwent a procedure in their breast(s). A total of 12 open biopsies, 18 wide local excisions (12 wireguided), and 10 mastectomies (1 bilateral, 3 with reconstruction, 3 MRMs) were performed. SNB was performed in 20 patients and was positive in 7. Re-excision rates for inadequate margins were 0%. In a total of 25 cancer patients treated, the waiting time between the clinic visit and surgery was reduced to 12,7 days (from 16,25 days in 2013), and the waiting time between surgery and MDT discussion was reduced to 33,1 days (from 37,8 days in 2013). Conclusions: The audit of the management of patients visiting our Breast Clinic during the first year of its operation revealed significant information on potentially useful actions in order to improve patient care. By implementing most of the proposed changes, we managed to significantly improve patient outcomes. However, the need for modern equipment remains obvious, as well as the need to remain alert and seek constant improvement in patient care. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.358
Poster Session: Regional Cancer Treatment and Peritoneal Malignancy 700. Small bowel adenocarcinoma in a regional hospital - a series of cases A.T. Bernardo Silva Hospital Divino Espirito Santo, General Surgery, Ponta Delgada Azores, Portugal Background: Primary small bowel adenocarcinoma (SBA) accounts for less than 2% of all gastrointestinal tumours and its clinicopathologic characteristics have not been well elucidated. The unspecific and vague symptoms lead to a difficult and usually late diagnosis and consequently to a worse prognosis. In this study we analyse the experience of a regional institution in the management of this rare condition. Material and methods: Retrospective study of the patients diagnosed with SBA between 1995 and 2014 at our institution. The variables analysed were clinical presentation, diagnostic methods, therapeutic approach, surgical procedures, adjuvant treatment and global survival. Results: The study included 8 patients (4 males, 4 females). Median age at presentation was 64,1 years. The most frequent initial symptoms
were abdominal pain, nausea and vomiting. Four patients presented within acute clinical settings. Tumours were located at duodenum (n ¼ 4), jejunum (n ¼ 3) and ileum (n ¼ 1). Six patients were submitted to surgery, five of them with curative intent. Surgical treatments performed were segmental resection (n ¼ 3), ileocolic resection (n ¼ 1), pancreatoduodenectomy (n ¼ 1), gastroenterostomy (n ¼ 1). Adjuvant treatment was chemotherapy in 4 patients and radiotherapy in only one patient. Global survival of 46,5 months. Four patients are still alive with survivals between 1,5 and 20 years, free of disease. Conclusions: The early diagnosis is crucial to allow a radical surgical resection, which is the only potentially curative treatment. Its rarity makes difficult to gather evidence in order to establish therapeutic approach guidelines. Sharing the experience of cases from each center is important to a better knowledge about this entity. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.359
S191
in Arab women, but no significant change in Arab men. Colon cancer showed a relative decrease in incidence in the Jewish population, but an increase in the Arab population. A decrease in incidence in rectal cancer was observed in the Jewish population, while an increase was observed in the Arab population. Conclusion: Gastric, colon, and rectal cancers exhibit differences in incidence and outcome between Jewish and Arab populations in Israel. These differences were not observed in the other five types of less common gastrointestinal cancers. Jews
Colon cancer Gastric cancer Rectal cancer Pancreatic cancer Liver cancer Gallbladder cancer Esophageal cancer Small bowel cancer
Arabs
Male
Female
Male
1980 2012
1980 2012
1980 2012 1980 2012
33.9 33.6 16.8 8.80* 16.5 10.6* 8.4 8.5 3.3 2.9 1.2 1.6 1.8 1.4 0.5 0.9
28.5 8.95 12.7 7.5 1.4 2.8 1.3 0.7
7.9 26* 9.78 9.37 2.2 7.1* 2.6 5.7 1.2 3.2 3.8 2.6 1.0 0.7 0.38 0.48
25.1 4.12* 7.3* 6.5 1.4 1.5 0.8 0.8
Female
6.1 22.1* 4.74 5.35* 2.6 6.9* 4.6 4.3 0.6 1.1 2.7 2.9 0.2 0.2 0.68 0.96
Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.357 683. Audit-based improvements in the management of patients with diseases of the breast in a newly founded breast clinic V. Kalles, G. Boutsikos, E. Fradelos, I. Papapanagiotou, I. Tsouknidas, E. Voulgaris, G. Xanthopoulou, N. Ivros, G. Pechlivanides Naval and Veterans Hospital, 2nd Department of Surgery, Athens, Greece Background: Our hospital’s breast clinic started admitting patients in 2013. By retrospectively investigating the management of the patients seen in clinic, we identified possible pitfalls and proposed a course of action to resolve these issues. After implementing most of the changes proposed, a retrospective analysis of the management of patients with breast problems that were seen in 2014 was done, in order to identify new possible problems, and measure the effect of the implemented changes.
Material and methods: The hospital records of patients seen or admitted in our Breast Clinic during the year 2014 were retrospectively reviewed. Compared to year 2013, the changes implemented were: 1) more clinic hours to accommodate the increased need for appointments, 2) a weekly breast surgery list to reduce patient waiting time between clinic visit and surgery, and 3) a faster referral of patients to the Breast MDT following their operation to reduce the time between surgery and administration of adjuvant therapy. Changes regarding the modernization of screening and diagnostic equipment (mammography, ultrasound, stereotactic biopsy table) were not implemented due to lack of appropriate funds. Results: During 2014, 419 women and 8 men with a mean age of 52,7 years (range 14e90 years) were seen in the outpatient clinic. The waiting time for an appointment was reduced to 7 days. 51% of the patients presented for screening mammography and exam, and 23% for further investigation of a breast symptom (most frequently a breast lump). 35 biopsies were performed (8 FNA, 27 core biopsies) with or without ultrasound guidance. 16/27 core biopsies had a malignant result, while 11/27 were negative for cancer (one false negative result). 6/8 FNAs were negative for cancer, 1/8 was suspicious for cancer and 1/8 positive. There were no false negative FNAs. 40 patients underwent a procedure in their breast(s). A total of 12 open biopsies, 18 wide local excisions (12 wireguided), and 10 mastectomies (1 bilateral, 3 with reconstruction, 3 MRMs) were performed. SNB was performed in 20 patients and was positive in 7. Re-excision rates for inadequate margins were 0%. In a total of 25 cancer patients treated, the waiting time between the clinic visit and surgery was reduced to 12,7 days (from 16,25 days in 2013), and the waiting time between surgery and MDT discussion was reduced to 33,1 days (from 37,8 days in 2013). Conclusions: The audit of the management of patients visiting our Breast Clinic during the first year of its operation revealed significant information on potentially useful actions in order to improve patient care. By implementing most of the proposed changes, we managed to significantly improve patient outcomes. However, the need for modern equipment remains obvious, as well as the need to remain alert and seek constant improvement in patient care. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.358
Poster Session: Regional Cancer Treatment and Peritoneal Malignancy 700. Small bowel adenocarcinoma in a regional hospital - a series of cases A.T. Bernardo Silva Hospital Divino Espirito Santo, General Surgery, Ponta Delgada Azores, Portugal Background: Primary small bowel adenocarcinoma (SBA) accounts for less than 2% of all gastrointestinal tumours and its clinicopathologic characteristics have not been well elucidated. The unspecific and vague symptoms lead to a difficult and usually late diagnosis and consequently to a worse prognosis. In this study we analyse the experience of a regional institution in the management of this rare condition. Material and methods: Retrospective study of the patients diagnosed with SBA between 1995 and 2014 at our institution. The variables analysed were clinical presentation, diagnostic methods, therapeutic approach, surgical procedures, adjuvant treatment and global survival. Results: The study included 8 patients (4 males, 4 females). Median age at presentation was 64,1 years. The most frequent initial symptoms
were abdominal pain, nausea and vomiting. Four patients presented within acute clinical settings. Tumours were located at duodenum (n ¼ 4), jejunum (n ¼ 3) and ileum (n ¼ 1). Six patients were submitted to surgery, five of them with curative intent. Surgical treatments performed were segmental resection (n ¼ 3), ileocolic resection (n ¼ 1), pancreatoduodenectomy (n ¼ 1), gastroenterostomy (n ¼ 1). Adjuvant treatment was chemotherapy in 4 patients and radiotherapy in only one patient. Global survival of 46,5 months. Four patients are still alive with survivals between 1,5 and 20 years, free of disease. Conclusions: The early diagnosis is crucial to allow a radical surgical resection, which is the only potentially curative treatment. Its rarity makes difficult to gather evidence in order to establish therapeutic approach guidelines. Sharing the experience of cases from each center is important to a better knowledge about this entity. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.359