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Does Mucinous Rectal Adenocarcinoma Benefit from Neoadjuvant Chemoradiation?
Vol. 223, No. 4S2, October 2016
Scientific Forum: 2016 Clinical Congress
p¼0.06) and readmission rate (22.5 vs 12.1%, p¼0.08) in the ERAS group compared to pre-ERAS group. There were average savings of $7,130 (p<0.05) per patient when ERAS protocol was followed. More savings were seen in the open group ($8,415, p<0.05) compared to laparoscopic group ($4,494, p¼0.115). In the sub-group analysis, all surgery types showed decrease in overall cost except for total colectomy. CONCLUSIONS: Implementation of an ERAS protocol resulted in decreased length of stay, postoperative complications and readmission rates. This was associated with cost savings for the patient’s hospital stay. Does Mucinous Rectal Adenocarcinoma Benefit from Neoadjuvant Chemoradiation? Tareq M Hassan, MD, Leonardo C Duraes, MD, PhD, Luca Stocchi, MD, FACS, Hermann P Kessler, MD, PhD, FACS Cleveland Clinic Foundation, Cleveland, OH INTRODUCTION: The purpose of this study was to compare clinical results of mucinous and non-mucinous rectal adenocarcinoma, and to assess the effectiveness of neoadjuvant chemoradiotherapy (CRT) on mucinous rectal adenocarcinoma for clinical stage III patients. METHODS: An institutional database was queried to identify patients with clinical stage III rectal adenocarcinoma confirmed by pelvic imaging, operated on curatively between 2000 and 2012. Exclusion criteria were emergent operations, inflammatory bowel disease, and hereditary colorectal neoplasia. Patients were divided into 2 groups according to their neoadjuvant treatment. Mucinous (M) and non-mucinous (NM) adenocarcinomas were compared to each-other. Univariate, multivariate, and KaplanMeier survival statistical analyses were performed. RESULTS: Out of 220 patients, 181 patients received CRT (23 M vs 158 NM), and 39 patients did not receive CRT (4 M vs 35 NM) Table. Oncologic Outcomes for Clinical Stage III Patients with Mucinous Compared to Non-Mucinous Rectal Adenocarcinoma Mucinous Patients who received neoadjuvant chemoradiation (n¼181) n 5-y overall survival % (CI) 5-y disease free survival % (CI) 5-y cancer specific survival % (CI) 5-y recurrence % (CI) Patients who did not receive neoadjuvant chemo-radiation (n¼39) n 5-y overall survival % (CI) 5-y disease free survival % (CI) 5-y cancer specific survival % (CI) 5-y recurrence % (CI)
Non-mucinous p Value
due to comorbidities and patients’ preference. Compared to M, NM patients had greater down-staging after CRT, and presented with lower post CRT pathological staging (yp stage I - 7.7% vs 35%, yp stage II - 27% vs 26.5%, and yp stage III - 65.4% vs 38.6% for M and NM respectively). Among patients who received CRT, M had worse overall survival and cancer specific survival than NM. On the other hand, no difference in oncologic outcomes was found between NM and M in patients who did not receive CRT (Table). CONCLUSIONS: In mucinous rectal adenocarcinoma, the indication for neoadjuvant therapy has to be balanced carefully with potential side effects, as less favorable oncologic outcomes are observed. Education Program for Prevention of Ileostomy Complications (EPPIC): A Randomized Trial Mary R Kwaan, MD, MPH, FACS, Sarah W Grahn, MD, FACS, Ann C Lowry, MD, FACS, Marc C Osborne, MD, Genevieve B Melton, MD, PhD, FACS, Wolfgang B Gaertner, MD, Sarah A Vogler, MD, MBA, Robert D Madoff, MD, FACS University of Minnesota, Minneapolis, MN, Colon and Rectal Surgery Associates, Ltd, St Paul, MN INTRODUCTION: Hospital readmission is common after ileostomy formation. Using a randomized study design, we sought to evaluate a published intervention to prevent hospital readmission. METHODS: Surgeons, advanced practice providers (APP), inpatient and outpatient RNs, and wound ostomy continence nurses (WOCN) at 3 hospitals were educated about the published intervention. After informed consent, patients were randomized to a postoperative compliance surveillance strategy or usual care (Table). New ileostomies were eligible. The primary outcome was unplanned hospital readmission within 30 days of discharge. Risk factors for readmission were assessed using logistic regression.
Compliance surveillance intervention American College of Surgeons ostomy home skills kit and video series Routine postoperative WOCN consultation
23 45.5 39.8 54.9 49.1
(24.4-64.5) (17.5-61.4) (29.9-74.2) (21.6-71.8)
158 71.3 60.9 83.4 68.9
(62.9-78.1) (52.5-68.3) (75.5-88.9) (60.5-75.9)
0.005 0.058 0.0005 0.12
4 42.9 42.9 71.4 57.1
(9.8-73.4) (9.8-73.4) (25.8-91.9) (17.2-83.7)
35 67.2 51.8 87.4 64.8
(51.0-79.0) (36.4-65.2) (71.2-94.8) (47.4-77.7)
0.23 0.7 0.19 0.54
e7
Educational session by surgeons for inpatient and outpatient RNs and WOCNs Expectation for teaching using updated educational brochure Study personnel remind the inpatient RN with a reminder to assess patient progress with education prior to discharge Study personnel ask inpatient RN to administer ileostomy quiz to patient Study personnel prompt either outpatient RN or APP to complete telephone follow up after patient discharge Study personnel request outpatient RN or APP to describe the patients’ ileostomy output volume
Usual care American College of Surgeons ostomy home skills kit and video series Routine postoperative WOCN consultation Educational session by surgeons for inpatient and outpatient RNs and WOCNs Expectation for teaching using updated educational brochure
Scientific Forum: 2016 Clinical Congress
p¼0.06) and readmission rate (22.5 vs 12.1%, p¼0.08) in the ERAS group compared to pre-ERAS group. There were average savings of $7,130 (p<0.05) per patient when ERAS protocol was followed. More savings were seen in the open group ($8,415, p<0.05) compared to laparoscopic group ($4,494, p¼0.115). In the sub-group analysis, all surgery types showed decrease in overall cost except for total colectomy. CONCLUSIONS: Implementation of an ERAS protocol resulted in decreased length of stay, postoperative complications and readmission rates. This was associated with cost savings for the patient’s hospital stay. Does Mucinous Rectal Adenocarcinoma Benefit from Neoadjuvant Chemoradiation? Tareq M Hassan, MD, Leonardo C Duraes, MD, PhD, Luca Stocchi, MD, FACS, Hermann P Kessler, MD, PhD, FACS Cleveland Clinic Foundation, Cleveland, OH INTRODUCTION: The purpose of this study was to compare clinical results of mucinous and non-mucinous rectal adenocarcinoma, and to assess the effectiveness of neoadjuvant chemoradiotherapy (CRT) on mucinous rectal adenocarcinoma for clinical stage III patients. METHODS: An institutional database was queried to identify patients with clinical stage III rectal adenocarcinoma confirmed by pelvic imaging, operated on curatively between 2000 and 2012. Exclusion criteria were emergent operations, inflammatory bowel disease, and hereditary colorectal neoplasia. Patients were divided into 2 groups according to their neoadjuvant treatment. Mucinous (M) and non-mucinous (NM) adenocarcinomas were compared to each-other. Univariate, multivariate, and KaplanMeier survival statistical analyses were performed. RESULTS: Out of 220 patients, 181 patients received CRT (23 M vs 158 NM), and 39 patients did not receive CRT (4 M vs 35 NM) Table. Oncologic Outcomes for Clinical Stage III Patients with Mucinous Compared to Non-Mucinous Rectal Adenocarcinoma Mucinous Patients who received neoadjuvant chemoradiation (n¼181) n 5-y overall survival % (CI) 5-y disease free survival % (CI) 5-y cancer specific survival % (CI) 5-y recurrence % (CI) Patients who did not receive neoadjuvant chemo-radiation (n¼39) n 5-y overall survival % (CI) 5-y disease free survival % (CI) 5-y cancer specific survival % (CI) 5-y recurrence % (CI)
Non-mucinous p Value
due to comorbidities and patients’ preference. Compared to M, NM patients had greater down-staging after CRT, and presented with lower post CRT pathological staging (yp stage I - 7.7% vs 35%, yp stage II - 27% vs 26.5%, and yp stage III - 65.4% vs 38.6% for M and NM respectively). Among patients who received CRT, M had worse overall survival and cancer specific survival than NM. On the other hand, no difference in oncologic outcomes was found between NM and M in patients who did not receive CRT (Table). CONCLUSIONS: In mucinous rectal adenocarcinoma, the indication for neoadjuvant therapy has to be balanced carefully with potential side effects, as less favorable oncologic outcomes are observed. Education Program for Prevention of Ileostomy Complications (EPPIC): A Randomized Trial Mary R Kwaan, MD, MPH, FACS, Sarah W Grahn, MD, FACS, Ann C Lowry, MD, FACS, Marc C Osborne, MD, Genevieve B Melton, MD, PhD, FACS, Wolfgang B Gaertner, MD, Sarah A Vogler, MD, MBA, Robert D Madoff, MD, FACS University of Minnesota, Minneapolis, MN, Colon and Rectal Surgery Associates, Ltd, St Paul, MN INTRODUCTION: Hospital readmission is common after ileostomy formation. Using a randomized study design, we sought to evaluate a published intervention to prevent hospital readmission. METHODS: Surgeons, advanced practice providers (APP), inpatient and outpatient RNs, and wound ostomy continence nurses (WOCN) at 3 hospitals were educated about the published intervention. After informed consent, patients were randomized to a postoperative compliance surveillance strategy or usual care (Table). New ileostomies were eligible. The primary outcome was unplanned hospital readmission within 30 days of discharge. Risk factors for readmission were assessed using logistic regression.
Compliance surveillance intervention American College of Surgeons ostomy home skills kit and video series Routine postoperative WOCN consultation
23 45.5 39.8 54.9 49.1
(24.4-64.5) (17.5-61.4) (29.9-74.2) (21.6-71.8)
158 71.3 60.9 83.4 68.9
(62.9-78.1) (52.5-68.3) (75.5-88.9) (60.5-75.9)
0.005 0.058 0.0005 0.12
4 42.9 42.9 71.4 57.1
(9.8-73.4) (9.8-73.4) (25.8-91.9) (17.2-83.7)
35 67.2 51.8 87.4 64.8
(51.0-79.0) (36.4-65.2) (71.2-94.8) (47.4-77.7)
0.23 0.7 0.19 0.54
e7
Educational session by surgeons for inpatient and outpatient RNs and WOCNs Expectation for teaching using updated educational brochure Study personnel remind the inpatient RN with a reminder to assess patient progress with education prior to discharge Study personnel ask inpatient RN to administer ileostomy quiz to patient Study personnel prompt either outpatient RN or APP to complete telephone follow up after patient discharge Study personnel request outpatient RN or APP to describe the patients’ ileostomy output volume
Usual care American College of Surgeons ostomy home skills kit and video series Routine postoperative WOCN consultation Educational session by surgeons for inpatient and outpatient RNs and WOCNs Expectation for teaching using updated educational brochure