Comparing simultaneous versus staged resection in patients with synchronous colorectal liver metastases: case match study

Vol. 219, No. 4S, October 2014

laparoscopically. However, outcomes following laparoscopic colectomy in this setting resulted in reduced length of stay, lower complication and mortality rates as well as reduced costs. Thus, increased rates of adoption may potentially be beneficial. Postoperative computed tomography (CT) scan after laparoscopic colorectal surgery: what does that fluid mean? Dana M Hayden, MD, Maria Mora-Pinzon, MD, Michael Dombrowski, BS, Timothy J Witalka, Daniel Neubauer, Michele I Slogoff, MD, FACS, Joshua M Eberhardt, MD, FACS, Theodore Saclarides, MD, FACS Loyola University Medical Center and Loyola University Stritch School of Medicine, Maywood, IL INTRODUCTION: CT scan is important for postoperative evaluation in laparoscopic colorectal surgery. However, postoperative fluid on CT may confound our management. METHODS: Retrospective review of laparoscopic colorectal operations at a single tertiary institution, 2006-2013. RESULTS: In 199 patients, mean age was 58.7 (18-92) and 51.3% female. Right (35.2%), sigmoid colectomy (26.8%) and LAR (16.2%) were most common. 67.4% had cancer, 20.9% diverticulitis and 7% IBD. Conversion rate was 10.7%. 51 (25.6%) had postoperative CT, most commonly for leukocytosis (25.5%), pain (23.5%) and ileus (17.6%). CT was more likely obtained if male, intraoperative complication, leukocytosis, lower albumin, longer operation, and larger specimen (p¼0.000-0.02). Findings included: normal postoperative changes (23.9%), air within fluid (19.7%), fluid collection (18.3%), free fluid (14.1%), suspected leak (9.9%), abscess (9.9%) and loculated fluid (4.2%). Radiographic suspected leak was not associated with diagnosis, stoma, radiation, adhesionolysis or conversion but was associated with low albumin (p¼0.04) and fever (p¼0.005). 10% received antibiotics, 7.5% IR-drainage, 15% operation and 57.5% had nothing done. Six with suspected leak had surgery; four had leak confirmed. Radiographic suspected leak (p¼0.04) and loculated fluid (p¼0.000) were associated with confirmed leak. Patients who had no treatment more likely had right colectomy (p¼0.025) and normal postoperative changes on CT (p¼0.001) and less likely received radiation or stoma (p¼0.026 and 0.03); they also had no increased risk of complications. CONCLUSIONS: Radiographic suspicion of leak does predict actual leak. Fever, malnutrition and intraoperative complications should lower threshold for CT. However, in light of normal CT, expectant management is not associated with increased complications. Endoscopic pilonidal sinus treatment (E.P.Si.T): a new mininvasive procedure Piercarlo Meinero, MD, Lorenzo Mori, MD ASL 4 Chiavarese, Chiavari, Italy

Scientific Poster Presentations: 2014 Clinical Congress

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INTRODUCTION: Moving from our experience in videoassisted treatment of anal fistulas (VAAFT) we decided to treat pilonidal disease and its recurrence with the same equipment. The rationale of this technique, ideated by Piercarlo Meinero, is the removal of all the infected area by an endoscopic approach. METHODS: Surgery is usually performed under local anesthesia. The external opening, normally situated on the midline cleft, is excised and the fistuloscope is introduced. The first diagnostic phase allows a complete sinus exploration whilst infusion of a glycine/mannitol 1 % solution assists in opening the underlying tract. In the successive operative phase, hairs and debris are removed by a forceps, the sinus walls granulation tissue is cauterized and necrotic material is removed by a brush. At the end of the procedure the entire area is cleaned and ablated under direct vision. External opening(s) is(are) not closed. RESULTS: Between March 2012 and January 2014 we operated on 119 patients. Only 76 patients with more than 6 months of follow up have been evaluated (median 10 months; range 6 e21 months. At 1 month postoperatively, the external opening(s) was(were) closed in all but 1 patients and there were 3 cases of recurrence (3,9%. CONCLUSIONS: The main feature of E.P.Si.T. is direct vision. This allows a complete definition of the involved area, thorough removal of hairs and debris and a complete cauterization of granulation tissue. Satisfaction of patients is very high. A longer follow up is needed in order to better clarify the definitive effectiveness of this mini-invasive technique. Comparing simultaneous versus staged resection in patients with synchronous colorectal liver metastases: case match study Faisal Elagili, MD, Gokhan Ozuner, MD, Eren Berber, MD, FACS, Muhammet Akyuz, MD, Ahmet Cem Dural, MD Cleveland Clinic, Cleveland, OH INTRODUCTION: There is no consensus on the optimal timing of liver resection in patients with synchronous colorectal liver metastasis. METHODS: Patients undergoing hepatic resections between 20042013 for synchronous colorectal liver metastases were analyzed from a prospectively maintained and institutional review board approved database. Patients who underwent simultaneous resection of a colorectal primary and hepatic metastasis in a single operation (Group I) were case-matched 1:1with patients who underwent staged operation (Group II) according to age, sex, ASA classification, size of liver lesion and number of liver lesion. RESULTS: 66 patients (33 Group I, 33 Group II) were matched from a total cohort of 106 patients with synchronous colorectal liver metastasis. The patients’ characteristics of both groups were similar. 62% were male and the mean age was 55.511 years. Blood loss and duration of surgery did not differ between

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Scientific Poster Presentations: 2014 Clinical Congress

simultaneous resections and staged resection (p¼0.63; p¼0.14, respectively). Perioperative complication rate were similar in both groups (P¼0.70). There was no mortality. The median number of in-hospital days during the course of treatment was 9 (4-23) days in Group I and 6 (3-17) days in Group II (p <0.001). There was no difference in 2 years disease free survival and overall survival were found between Group I and Group II ( 30% and 34%, p¼ 0.58; 67% and 62%, p¼0.86 respectively). CONCLUSIONS: Simultaneous liver resections result in similar short and long eterm outcomes as in patients undergoing sequential resections for synchronous colorectal cancer with comparable metastatic disease burden. Impact of comorbidity on anastomotic leakage in a nationwide cohort of colonic cancer patients Peter-Martin Krarup, MD, Andreas Nordholm-Carstensen, MD, Lars N Jørgensen, MD, DMSc Professor, Henrik Harling Bispebjerg Hospital, København NV, Denmark INTRODUCTION: Comorbidity has a negative influence on the prognosis for colorectal cancer patients, whereas the impact on anastomotic leakage (AL) is less clear. The aim of this nationwide study was to investigate the impact of comorbidity in the prediction of AL, 30-day mortality and length of hospital stay (LOS) after curative resection for colonic cancer. METHODS: Data were obtained from the Danish Colorectal Cancer Group and the National Patient Registry. Comorbidity was assessed by the Charlson Comorbidity Index (CCI). The associations between the CCI and AL were adjusted for age, gender and surgical variables and investigated using multivariable logistic regression and receiver operating characteristics (ROC) curves. RESULTS: The rate of AL was 593/9,333 (6.4%). The mean (95% CI) CCI score was 0.81 (0.71-0.91) and 0.64 (0.61-0.66) for patients with and without AL, p¼0.004. CCI as assessed by the multivariable analysis (adjusted odds ratio (aOR) ¼ 1.06; 95% CI: 0.99-1.13; p¼0.119) and the ROC curve analysis (AUC¼0.543) failed to predict AL. Thirty-day mortality was 524/9,329 (5.6%). Comorbidity (n¼3,122) increased mortality rates in patients with AL from aOR ¼ 6.20; 95% CI: 4.47-8.59 to aOR¼8.99; 95% CI 5.66-14.27; p<0.001. Mean LOS was 9 days (95% CI: 8-9 days) for all patients without AL, which increased to 26 days (95% CI: 24-28 days) in patients with AL and 31 days (95% CI: 26-36 days) in AL patients with comorbidity, p<0.001.

J Am Coll Surg

Eric A Weiss, MD, FACS, Steven D Wexner, MD, PHD, FACS, FRCS, FRCS(ED) Cleveland Clinic Florida, Weston, FL INTRODUCTION: Few studies have investigated outcomes of hand-assisted laparoscopic surgery (HALS) versus total laparoscopic (LAP) surgery for colorectal resections in patient subgroups. We compared postoperative outcomes of these approaches in elderly patients. METHODS: After institutional review board (IRB) approval, we reviewed records of patients >65 years of age who underwent LAP or HALS colorectal resections from 1/2006-8/2012. Procedures requiring splenic flexure mobilization, removal of the leftside colon or pelvic dissection were included. Data collected included demographics, pre-operative co-morbidities, operative variables, and postoperative outcomes including length of hospital stay (LOS), 30-day morbidity and mortality, number of nodes retrieved and clearance of margins. Chi-Square tests were performed to assess differences between the 2 groups; p <.05 was considered significant. RESULTS: 251 patients were included: LAP (151), HALS (100). Both groups did not differ among the preoperative variables evaluated. Most resections in both groups were for malignancy, diverticular disease, IBD and colonic polyps. The most common procedures were sigmoidectomy, anterior resection, APR and total colectomy. Operative time was longer in the LAP group (212 vs 190 mins, p¼.02). No differences between groups were observed for the following outcomes: estimated blood loss, anastomotic leak, LOS, postoperative ileus, rectal bleed, hematoma formation, medical complications including infections, 30-day morbidity, readmission, total nodes retrieved, number of positive nodes, and positive margins. A subgroup analysis of patients 65-79 or 80 years of age did not reveal any differences in outcomes of HALS versus LAP. CONCLUSIONS: HALS and LAP for colorectal resections remain equally viable options with similar outcomes in elderly patients including octogenarians. Risk factors of anastomotic leak after colectomy: a nationwide study Cigdem Benlice, MD, Emre Gorgun, MD, FACS, Xiaobo Liu, MS, Tracy L Hull, MD, FACS, Feza H Remzi, MD FACS Cleveland Clinic, Cleveland, OH

CONCLUSIONS: Comorbidity was associated with an inferior short-term outcome in patients with AL but failed to predict the occurrence of the surgical complication.

INTRODUCTION: Anastomotic leak (AL) is a serious complication after colon and rectal surgery that is associated with high mortality, morbidity and leads to increased healthcare costs. The purpose of the study was to determine the risk factors of AL after colectomy by using the new targeted nationwide database.

Hand-assisted laparoscopic surgery versus total laparoscopic colorectal resections: does age matter? Mohammed Iyoob Mohammed Ilyas, MBBS, Hoong-Yin Chong, MD, Giovanna M da Silva, MD, FACS,

METHODS: Patients who underwent colectomy in one year (2012) were identified from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) using the new targeted colectomy database and current procedural