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Concurrent Cholecystectomy at Time of Surgery for Small Bowel Neuroendocrine Tumor Is Not Associated with Increased Morbidity
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Scientific Forum Abstracts
treated cells. The top resistance genes were validated in cisplatintreated knockout/activated cells compared with nontarget controls. RESULTS: MAGeCK analysis and subsequent validation identified multiple genes associated with platinum resistance (log p > 5) (Figure). Included in this group are several members of the Wnt-pathway (WNT3A, CTNNB1, SOX9, TCF7L2), membrane channels (LRRC8a), and key antioxidant mediators (KEAP1, GCLC, SLC7A11). Several novel genes with unknown function were also identified.
CONCLUSIONS: The successful application of CRISPR technology in complementary loss- and gain-of-function experiments revealed known and novel mediators of platinum resistance, including members of the Wnt-pathway. Furthermore, these results indicate an important role for antioxidant pathways in chemoresistance. These results offer new avenues for mechanistic investigation and provide support in developing diagnostic tools to assess and direct colon cancer treatment. Concurrent Cholecystectomy at Time of Surgery for Small Bowel Neuroendocrine Tumor Is Not Associated with Increased Morbidity Andrew J Sinnamon, MD, Madalyn Neuwirth, MD, Catherine E Sharoky, MD, Rachel R Kelz, MD, FACS, Douglas L Fraker, MD, FACS, Robert E Roses, MD, FACS, Giorgos C Karakousis, MD, FACS Hospital of the University of Pennsylvania, Philadelphia, PA INTRODUCTION: Prophylactic cholecystectomy at time of surgery for small bowel neuroendocrine tumors (SNCT) has been advocated, as these patients often go on to require somatostatin analogue therapy, which is known to increase risk of cholestasis and associated complications. Little is known regarding patterns of adopting this practice or its associated morbidity. METHODS: The American College of Surgeons NSQIP dataset (2008 to 2014) was queried to identify patients undergoing resection, with postoperative diagnosis of SNCT. Patient characteristics and postoperative outcomes were compared between patients undergoing concurrent cholecystectomy (cCCY) at time of tumor resection using logistic regression. RESULTS: Among 1,472 patients who underwent resection of SBCT, 158 (10.7%) underwent cCCY. Median age of patients undergoing cCCY was 62 years (interquartile range [IQR] 52 to 69), and 83 were male. Patient age, sex, race, and comorbidities
J Am Coll Surg
were not significantly different than those of patients not undergoing cholecystectomy. Factors independently associated with complication were older age (odds ratio [OR] 1.02, p ¼ 0.002), female sex (OR 1.33, p ¼ 0.037), smoking (OR 1.57, p ¼ 0.016), disseminated cancer (OR 1.53, p ¼ 0.017), COPD (OR 2.01, p ¼ 0.019), and hypertension (1.48, p ¼ 0.009). Concurrent cholecystectomy was not associated with higher rate of complication (19.0%), 30-day readmission (1.9%), 30-day mortality (1.3%), or increased length of stay (Figure). This remained true after additional adjustment for factors associated with receipt of cholecystectomy and/or complication.
CONCLUSIONS: Concurrent cholecystectomy at time of resection of small bowel carcinoid tumor is safe and not associated with higher morbidity, mortality, or length of hospitalization, yet is performed in a minority of patients. Further prospective study can identify which patients may derive benefit from this approach.
Correlation between Clinical and Pathologic Staging in Colon Cancer: Implications for Neoadjuvant Treatment Ahmed Dehal, MD, Amanda Graff-Baker, MD, Brooke Vuong, MD, David Y Lee, MD, Anton J Bilchik, MD, PhD John Wayne Cancer Institute at Saint Johns Health Center, Santa Monica, CA INTRODUCTION: Recent randomized trials have suggested improved outcomes in patients with locally advanced colon cancer (LACC) treated with neoadjuvant chemotherapy (NAC). Clinical T and/or N stage was used to identify patients with LACC and consequently, candidates for NAC. The objective of this study was to examine the correlation between clinical and pathologic staging in patients with colon cancer (CC) using a national database. METHODS: Adult patients with nonmetastatic CC, who underwent surgery, were identified from the National Cancer Data Base between 2006 and 2014. Data on clinical and pathologic staging were obtained. The kappa index was used to determine the correlation between clinical and pathologic staging.
Scientific Forum Abstracts
treated cells. The top resistance genes were validated in cisplatintreated knockout/activated cells compared with nontarget controls. RESULTS: MAGeCK analysis and subsequent validation identified multiple genes associated with platinum resistance (log p > 5) (Figure). Included in this group are several members of the Wnt-pathway (WNT3A, CTNNB1, SOX9, TCF7L2), membrane channels (LRRC8a), and key antioxidant mediators (KEAP1, GCLC, SLC7A11). Several novel genes with unknown function were also identified.
CONCLUSIONS: The successful application of CRISPR technology in complementary loss- and gain-of-function experiments revealed known and novel mediators of platinum resistance, including members of the Wnt-pathway. Furthermore, these results indicate an important role for antioxidant pathways in chemoresistance. These results offer new avenues for mechanistic investigation and provide support in developing diagnostic tools to assess and direct colon cancer treatment. Concurrent Cholecystectomy at Time of Surgery for Small Bowel Neuroendocrine Tumor Is Not Associated with Increased Morbidity Andrew J Sinnamon, MD, Madalyn Neuwirth, MD, Catherine E Sharoky, MD, Rachel R Kelz, MD, FACS, Douglas L Fraker, MD, FACS, Robert E Roses, MD, FACS, Giorgos C Karakousis, MD, FACS Hospital of the University of Pennsylvania, Philadelphia, PA INTRODUCTION: Prophylactic cholecystectomy at time of surgery for small bowel neuroendocrine tumors (SNCT) has been advocated, as these patients often go on to require somatostatin analogue therapy, which is known to increase risk of cholestasis and associated complications. Little is known regarding patterns of adopting this practice or its associated morbidity. METHODS: The American College of Surgeons NSQIP dataset (2008 to 2014) was queried to identify patients undergoing resection, with postoperative diagnosis of SNCT. Patient characteristics and postoperative outcomes were compared between patients undergoing concurrent cholecystectomy (cCCY) at time of tumor resection using logistic regression. RESULTS: Among 1,472 patients who underwent resection of SBCT, 158 (10.7%) underwent cCCY. Median age of patients undergoing cCCY was 62 years (interquartile range [IQR] 52 to 69), and 83 were male. Patient age, sex, race, and comorbidities
J Am Coll Surg
were not significantly different than those of patients not undergoing cholecystectomy. Factors independently associated with complication were older age (odds ratio [OR] 1.02, p ¼ 0.002), female sex (OR 1.33, p ¼ 0.037), smoking (OR 1.57, p ¼ 0.016), disseminated cancer (OR 1.53, p ¼ 0.017), COPD (OR 2.01, p ¼ 0.019), and hypertension (1.48, p ¼ 0.009). Concurrent cholecystectomy was not associated with higher rate of complication (19.0%), 30-day readmission (1.9%), 30-day mortality (1.3%), or increased length of stay (Figure). This remained true after additional adjustment for factors associated with receipt of cholecystectomy and/or complication.
CONCLUSIONS: Concurrent cholecystectomy at time of resection of small bowel carcinoid tumor is safe and not associated with higher morbidity, mortality, or length of hospitalization, yet is performed in a minority of patients. Further prospective study can identify which patients may derive benefit from this approach.
Correlation between Clinical and Pathologic Staging in Colon Cancer: Implications for Neoadjuvant Treatment Ahmed Dehal, MD, Amanda Graff-Baker, MD, Brooke Vuong, MD, David Y Lee, MD, Anton J Bilchik, MD, PhD John Wayne Cancer Institute at Saint Johns Health Center, Santa Monica, CA INTRODUCTION: Recent randomized trials have suggested improved outcomes in patients with locally advanced colon cancer (LACC) treated with neoadjuvant chemotherapy (NAC). Clinical T and/or N stage was used to identify patients with LACC and consequently, candidates for NAC. The objective of this study was to examine the correlation between clinical and pathologic staging in patients with colon cancer (CC) using a national database. METHODS: Adult patients with nonmetastatic CC, who underwent surgery, were identified from the National Cancer Data Base between 2006 and 2014. Data on clinical and pathologic staging were obtained. The kappa index was used to determine the correlation between clinical and pathologic staging.