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Colorectal Resection in Transplant Recipients: Is It Safe?
body-mass index (BMI), type of proctectomy, and preoperative use of anti-TNF medications. Retrospective analysis compared peri- and post-operative outcomes. A subset of patients receiving IPAA was evaluated for postoperative functional outcomes and quality of life (QOL). Results: Operative time was longer in the RP group (p=.01), while estimated blood loss was similar (344 mL in RP and 189 mL in LP, p=.07). Even though time to return of bowel function was similar, 3.4 days in RP and 2.2 days in LP (p=.06), the length of hospital stay was longer in RP vs. LP (7.7 vs. 5.3 days, p=.02). There was no difference in postoperative complications between the two groups, including anastomotic leak, wound infection, postoperative ileus, and bowel obstruction. Patients receiving IPAA (6 RP, 8 LP) reported similar functional outcomes with regard to mean number of daily bowel movements (6 RP vs. 7.3 LP). There was a trend towards decreased frequency of perianal pruritis in the RP group compared to LP. The IPAA groups reported similar improvement in QOL, satisfaction with procedure and recommendation of the procedure to others. Conclusion: This study reports the results of our initial series of consecutive RP compared to LP in IBD patients. While RP operative times and length of hospital stay were longer than LP, short-term outcomes including complications were similar between the groups. In a subset of RP patients undergoing IPAA, pouch functional outcomes were similar or slightly better compared to LP IPAA group. As experience accumulates we expect RP operative times and length of stay to approach those of LP. Larger studies will be required to further evaluate the role of RP for patients with IBD.
Tu1633 Population-Based Assessment of Prognostic Factors Associated With Neuroendocrine Tumors of the Colon Ryaz Chagpar, Yan Xing, Barry W. Feig, Yi-Ju Chiang, Y Nancy You, Janice N. Cormier Introduction: The incidence of neuroendocrine tumors (NETs) of the colon has been increasing over the past decade, although little is known about associated prognostic factors. We sought to determine clinicopathologic factors influencing overall survival (OS). Methods: The National Cancer Database (1998-2002) was used to identify patients diagnosed with colonic NETs. 5-year OS was determined using the methods of Kaplan-Meier and a Cox proportional hazards model was used to assess clinicopathologic factors associated with OS. Results: A total of 2,188 patients were identified with a median age of 62.0 years and a 5 yr OS of 56.8% (median follow up = 4.2 years). The majority of colonic NETS were localized to the cecum (41.1%), followed by the sigmoid (16.3%), ascending colon (11.7%), rectosigmoid (11.6%), transverse (6.4%) and descending colon (1.7%). Distal colonic NETs (sigmoid or rectosigmoid) had the most favorable prognosis (69.1%) compared to proximal NETS located in the cecum (57.3%), ascending (39.3%), and transverse/descending colon (31.1%) (p<0.001). Distal colonic NETs were also more likely to present in younger patients with tumors that were of low histologic grade, ≤ 2 cm in size, and confined to the muscularis propria. On multivariate analysis, age (>75 years), high histologic grade, positive nodal ratio (≥0.3), tumor depth, and distant metastases were all independently associated with poorer OS. Conclusion: Distal colonic NETS are associated with improved 5-year OS compared to more proximally located tumors, likely due to earlier presentation of disease. Tumor location itself, however, was not independently associated with OS after adjusting for other clinicopathologic factors.
Tu1631 Gastrointestinal Cancer Surgery in Patients With a Prior Ventriculoperitoneal Shunt Shilpi Wadhwa, Andrew Barina, Katherine S. Virgo, Edel M. Doorley, Anil Bahadursingh, Riccardo A. Audisio, Frank E. Johnson Background: The estimated prevalence of hydrocephalus in all age groups is between 11.5%. Placement of a ventriculoperitoneal (VP) shunt in such patients offers them relatively normal lives. There is minimal data concerning the risk of postoperative complications in shunted patients undergoing subsequent major visceral operations. We hypothesized that healthy adults who had VP shunts placed for acquired conditions and later underwent gastric or colon cancer surgery would frequently have dense shunt-related adhesions and high rates of adverse outcomes. Methods: We assumed that all veterans were healthy on entry into military service. We searched national VA databases from 1994-2003 to identify all VA patients with shunts for acquired conditions and a curative-intent operation for stomach or colon cancer. We conducted a chart review to determine their clinical courses. Results: Five patients had codes for VP shunt, gastric cancer, and gastrectomy; 3 met our inclusion criteria. Fourteen had codes for VP shunt, colon cancer, and colectomy; 4 met our criteria. One of the evaluable gastrectomy patients had dense shunt-related adhesions. There were no postoperative complications in any of the 7 patients. VP shunts were managed by administering prophylactic antibiotics preoperatively and isolating the shunt with surgical sponges intraoperatively. Conclusions: We believe this is the first report analyzing the clinical course of adults with VP shunts who later have major abdominal cancer surgery. The presence of a shunt was associated with dense adhesions in one of the 7 patients in this series (14%) but not with increased risk of post-operative complications.
Tu1634 Does Tumor Location in Colon and Rectum Correlate With the Risk of Nodal Metastasis in T1 Colorectal Cancer? Supakij Khomvilai, Pokala R. Kiran, Madhusudhan R. Sanaka, Ian C. Lavery Purpose : For T1 colorectal cancer resected endoscopically, the risk of lymph nodal involvement impacts further management. Whether this risk may vary depending upon the location in the colon and rectum has been poorly characterized. We evaluate the risk of lymph node metastasis in T1 colorectal cancer depending upon the location of the primary tumor and evaluate factors that may predict the presence of metastasis in each part of colon and rectum. Method : Data of all patients who underwent radical resection for T1 colorectal cancer from January 1997 - March 2010 were evaluated. Patient and tumor factors (location, grade, presence of lymphovascular invasion) associated with the finding of lymph nodal involvement for patients with a radical resection specimen were evaluated. Results : Of 150 patients (41% females, mean age 64 years and 59% males, mean age 65 years) undergoing radical resection for T1 colorectal cancer, 18 (12%) had nodal metastasis. The risk of nodal metastasis at individual tumor sites was 20.7% upper rectum, 18.2% lower rectum, 18.2% ascending colon, 12.5% sigmoid, 10.5% mid rectum, 4.3% cecum and 0% for hepatic flexure, transverse, splenic flexure and descending colon. Age of patients (P = 0.35 ), gender ( P = 0.82 ), size of lesion ( P = 0.58 ), tumor differentiation ( P = 0.33 ) and lymphovascular invasion ( P = 0.1 ) were not significantly associated with nodal metastasis.T1 rectal cancer had higher risk of nodal metastasis ( 16.9% ) compared to colon cancer ( 8.8% ) although this did not reach statistical significance ( P = 0.14, OR = 2.12). Conclusion : The risk of lymph node metastasis varies depending upon location of the T1 colorectal cancer. These findings support the incorporation of the location of the primary into the management algorhithm when faced with the decision whether to offer radical surgery or colonoscopic surveillance for patients with T1 cancers detected at polypectomy. Risk factor associated with nodal metastasis for T1 Colorectal Cancer
SSAT Abstracts
Tu1632 Colorectal Resection in Transplant Recipients: Is It Safe? Avraham Reshef, Luca Stocchi, Pokala R. Kiran Introduction Major abdominal procedures in transplant recipients are considered high-risk. The aim of this study is to evaluate the safety of colorectal resection in solid organ transplant recipients. Methods Solid organ transplant recipients who underwent elective and urgent colorectal procedures from 1994-2010 were identified from prospectively maintained databases. Demographics, indications, surgical procedures, graft survival and perioperative outcomes were assessed. Results Out of 7937 consecutive patients undergoing transplant since 1975, 90 patients who underwent colorectal resection after heart (23), lung (17), kidney (29) and liver (21) transplant (63 men, 27 women, mean age: 57±10 years) were identified. The most frequent indication for surgery was diverticulitis (58%) followed by cancer (25%) and IBD (15%). The mean interval time from transplantation to surgery was 6.3 years (ranges between 1 week and 33 years). Elective procedures were performed in 46 patients (sigmoidectomy in 17, right colectomy in 11, subtotal colectomy in 9, proctectomy in 8) and urgent procedures were performed in 44 (Hartmann's procedure in 29, sigmoidectomy in 9 and right colectomy in 2). Only 22 patients (24%) underwent primary anastomosis without diverting ileostomy. Six patients (7%) were left with a permanent stoma. When compared to elective surgeries, urgent procedures had significantly increased post-operative mortality (18% vs. 0%, p=0.002), longer length of stay (16.5±13 vs. 8.5±5 days, p<0.001) and non-significantly higher overall morbidity (40% vs. 28%, p=0.27). Kidney transplant recipients were the only group without any postoperative deaths (p=0.05). All patients except one (kidney) retained their graft function. Conclusions: Elective colorectal procedures in transplant recipients are safe and often associated with proximal diversion. Urgent surgery is associated with substantial mortality except in kidney transplant recipients. Short term (30 days) outcomes
SSAT Abstracts
S-1048
Tu1633 Population-Based Assessment of Prognostic Factors Associated With Neuroendocrine Tumors of the Colon Ryaz Chagpar, Yan Xing, Barry W. Feig, Yi-Ju Chiang, Y Nancy You, Janice N. Cormier Introduction: The incidence of neuroendocrine tumors (NETs) of the colon has been increasing over the past decade, although little is known about associated prognostic factors. We sought to determine clinicopathologic factors influencing overall survival (OS). Methods: The National Cancer Database (1998-2002) was used to identify patients diagnosed with colonic NETs. 5-year OS was determined using the methods of Kaplan-Meier and a Cox proportional hazards model was used to assess clinicopathologic factors associated with OS. Results: A total of 2,188 patients were identified with a median age of 62.0 years and a 5 yr OS of 56.8% (median follow up = 4.2 years). The majority of colonic NETS were localized to the cecum (41.1%), followed by the sigmoid (16.3%), ascending colon (11.7%), rectosigmoid (11.6%), transverse (6.4%) and descending colon (1.7%). Distal colonic NETs (sigmoid or rectosigmoid) had the most favorable prognosis (69.1%) compared to proximal NETS located in the cecum (57.3%), ascending (39.3%), and transverse/descending colon (31.1%) (p<0.001). Distal colonic NETs were also more likely to present in younger patients with tumors that were of low histologic grade, ≤ 2 cm in size, and confined to the muscularis propria. On multivariate analysis, age (>75 years), high histologic grade, positive nodal ratio (≥0.3), tumor depth, and distant metastases were all independently associated with poorer OS. Conclusion: Distal colonic NETS are associated with improved 5-year OS compared to more proximally located tumors, likely due to earlier presentation of disease. Tumor location itself, however, was not independently associated with OS after adjusting for other clinicopathologic factors.
Tu1631 Gastrointestinal Cancer Surgery in Patients With a Prior Ventriculoperitoneal Shunt Shilpi Wadhwa, Andrew Barina, Katherine S. Virgo, Edel M. Doorley, Anil Bahadursingh, Riccardo A. Audisio, Frank E. Johnson Background: The estimated prevalence of hydrocephalus in all age groups is between 11.5%. Placement of a ventriculoperitoneal (VP) shunt in such patients offers them relatively normal lives. There is minimal data concerning the risk of postoperative complications in shunted patients undergoing subsequent major visceral operations. We hypothesized that healthy adults who had VP shunts placed for acquired conditions and later underwent gastric or colon cancer surgery would frequently have dense shunt-related adhesions and high rates of adverse outcomes. Methods: We assumed that all veterans were healthy on entry into military service. We searched national VA databases from 1994-2003 to identify all VA patients with shunts for acquired conditions and a curative-intent operation for stomach or colon cancer. We conducted a chart review to determine their clinical courses. Results: Five patients had codes for VP shunt, gastric cancer, and gastrectomy; 3 met our inclusion criteria. Fourteen had codes for VP shunt, colon cancer, and colectomy; 4 met our criteria. One of the evaluable gastrectomy patients had dense shunt-related adhesions. There were no postoperative complications in any of the 7 patients. VP shunts were managed by administering prophylactic antibiotics preoperatively and isolating the shunt with surgical sponges intraoperatively. Conclusions: We believe this is the first report analyzing the clinical course of adults with VP shunts who later have major abdominal cancer surgery. The presence of a shunt was associated with dense adhesions in one of the 7 patients in this series (14%) but not with increased risk of post-operative complications.
Tu1634 Does Tumor Location in Colon and Rectum Correlate With the Risk of Nodal Metastasis in T1 Colorectal Cancer? Supakij Khomvilai, Pokala R. Kiran, Madhusudhan R. Sanaka, Ian C. Lavery Purpose : For T1 colorectal cancer resected endoscopically, the risk of lymph nodal involvement impacts further management. Whether this risk may vary depending upon the location in the colon and rectum has been poorly characterized. We evaluate the risk of lymph node metastasis in T1 colorectal cancer depending upon the location of the primary tumor and evaluate factors that may predict the presence of metastasis in each part of colon and rectum. Method : Data of all patients who underwent radical resection for T1 colorectal cancer from January 1997 - March 2010 were evaluated. Patient and tumor factors (location, grade, presence of lymphovascular invasion) associated with the finding of lymph nodal involvement for patients with a radical resection specimen were evaluated. Results : Of 150 patients (41% females, mean age 64 years and 59% males, mean age 65 years) undergoing radical resection for T1 colorectal cancer, 18 (12%) had nodal metastasis. The risk of nodal metastasis at individual tumor sites was 20.7% upper rectum, 18.2% lower rectum, 18.2% ascending colon, 12.5% sigmoid, 10.5% mid rectum, 4.3% cecum and 0% for hepatic flexure, transverse, splenic flexure and descending colon. Age of patients (P = 0.35 ), gender ( P = 0.82 ), size of lesion ( P = 0.58 ), tumor differentiation ( P = 0.33 ) and lymphovascular invasion ( P = 0.1 ) were not significantly associated with nodal metastasis.T1 rectal cancer had higher risk of nodal metastasis ( 16.9% ) compared to colon cancer ( 8.8% ) although this did not reach statistical significance ( P = 0.14, OR = 2.12). Conclusion : The risk of lymph node metastasis varies depending upon location of the T1 colorectal cancer. These findings support the incorporation of the location of the primary into the management algorhithm when faced with the decision whether to offer radical surgery or colonoscopic surveillance for patients with T1 cancers detected at polypectomy. Risk factor associated with nodal metastasis for T1 Colorectal Cancer
SSAT Abstracts
Tu1632 Colorectal Resection in Transplant Recipients: Is It Safe? Avraham Reshef, Luca Stocchi, Pokala R. Kiran Introduction Major abdominal procedures in transplant recipients are considered high-risk. The aim of this study is to evaluate the safety of colorectal resection in solid organ transplant recipients. Methods Solid organ transplant recipients who underwent elective and urgent colorectal procedures from 1994-2010 were identified from prospectively maintained databases. Demographics, indications, surgical procedures, graft survival and perioperative outcomes were assessed. Results Out of 7937 consecutive patients undergoing transplant since 1975, 90 patients who underwent colorectal resection after heart (23), lung (17), kidney (29) and liver (21) transplant (63 men, 27 women, mean age: 57±10 years) were identified. The most frequent indication for surgery was diverticulitis (58%) followed by cancer (25%) and IBD (15%). The mean interval time from transplantation to surgery was 6.3 years (ranges between 1 week and 33 years). Elective procedures were performed in 46 patients (sigmoidectomy in 17, right colectomy in 11, subtotal colectomy in 9, proctectomy in 8) and urgent procedures were performed in 44 (Hartmann's procedure in 29, sigmoidectomy in 9 and right colectomy in 2). Only 22 patients (24%) underwent primary anastomosis without diverting ileostomy. Six patients (7%) were left with a permanent stoma. When compared to elective surgeries, urgent procedures had significantly increased post-operative mortality (18% vs. 0%, p=0.002), longer length of stay (16.5±13 vs. 8.5±5 days, p<0.001) and non-significantly higher overall morbidity (40% vs. 28%, p=0.27). Kidney transplant recipients were the only group without any postoperative deaths (p=0.05). All patients except one (kidney) retained their graft function. Conclusions: Elective colorectal procedures in transplant recipients are safe and often associated with proximal diversion. Urgent surgery is associated with substantial mortality except in kidney transplant recipients. Short term (30 days) outcomes
SSAT Abstracts
S-1048