- Email: [email protected]
Emergency presentations of colorectal cancer in young patients (Under forty)
pathologist who was unaware of the diagnosis of the original specimen (benign versus malignant). Abnormal cytology was discovered for five of the wound protectors, each one corresponding to a resection performed for malignancy (3 grossly positive for malignant cells, 1 suspicious for malignant cells, 1 positive for "atypical" cells). Therefore, abnormal cytology was detected in 10.4% (5/48) of wound protectors used in this study during laparoscopic resection for malignancy. Conclusion: Malignant cells can be retrieved from the wound protecting devices used at the extraction sites for malignant specimens during laparuseopic colon surgery This should be considered further support tbr the practice of protecting all extraction sites during laparoscopic colectomy for known or suspected malignancy.
endoscopically relieved anastomotic stricture-2; bowel perforation-2; incisional hernia-l: and pneumonia-1.86.7% of patients tolerated clear liquids by POD 2 and 73.3% tolerated house diet by POD 3. Average length of stay 5 days (2q5). CONCLUSION: Our experience ~th laparoscopic colectomy for diverticulitis is offered in support of this technique as a ~afe and effective method with a low need for conversion and an acceptable incidence of morbidity and mortality in the treatment of diverticulitis.
M1954 A Report Card on Cancer in General Surgery lessica B. O'Connell, Jerome H. Liu, Mehnda A. Maggard, David A. Etzioni, Edward H. Livingston, Clifford Y. Ko
M1957
Introduction: The War on Cancer was declared over 30 years ago. Since that time, numerous advances have been made, particularly for cancers treated by general surgeons. It remains unknown however whether demonstrable clinical improvements have been made, specifically decreased incidences, earlier detection, and better survival. This study analyzes 30 years of data from a population-based, national-level cancer registry and produces a report card to detect if improvements in outcomes are being seen for 6 common general surgery cancers (esophageal, stomach, small intestine, colon, rectal, and bepatobiliary ). Methods: All patients diagnosed with the above specified cancers in the SEER Cancer Database (1973-1999) were analyzed. Overall changes in incidence rate, stage at presentation (local, regmnal, and distant), histological grade, and 5-year survivals were determined. Sub-analysis was performed to compare an older cohort (60-80 y/o, n = 106,535) to a younger cohort (20-40 y/o, n = 3,970), and provides the basis of this report. Results: For the older cohort, incidence rates decreased for 2 cancers (stomach and rectal); increased for 3 cancers (esophageal, small intestine, and hepatobiliary); and stayed constant for 1 (colon). Patients presented with earlier stage disease in the 1990s (as compared to 1970s) for 5 of the 6 tumors (p<0.05). However, for all 6 tumors there was a rise in the proportion of poorly differentiated lesions (p<0.05). While the 5-year overall survival improved for all 6 cancers (p<0.05), 5-year stage specific survival improved only for small intestine, colon, and rectal cancers (p<0 05). Interestingly, in the younger cohort, incidence rates increased for all 6 cancers (p<0.05), and more advanced stage and grade were seen for stomach, colon, and rectal cancers (p<0.05). Still, 5-year survival for all 6 cancers in the younger cohort significantly improved in the 1990s. Conclusions: Over the past 3 decades, there has been significant improvement in outcomes for several general surgery cancers in the older population. However, the fact that cancer rates are increasing across the board for the younger population is worrisome. Further study should focus on possible modalities for screening and earlier detection in the young, as well as evaluate the role of other factors that might contribute to the increasing incidence and more aggressive nature of these cancers.
Emergency Presentaions of Colorectal Cancer in Young Patients (Under Forty) Reza Saidi, Shariar Aghakhani, Parvin Mirbod Background: There is little known about emergency presentation of colorectal cancer in young adults and its cfinicopathological features. Method: Retrospective ananlysts of colorectal cancer in patients under forty with emrgency presentation Results: Out of 1056 patients treated for colorectal cancer, 227 (21.5%) were younger than 40 years old. Twenty four patients (10.6%) had emergency presentation: 14 (58.3%) with obstruction, 8 (33.3%) with perforation, and 2 (8.3%) with massive bleeding. Female to male ratio was 1.4(14/ 10). Tumors were at advance stages (60% C, and D). Tumor were infiltrative in 58.3% of cases and polypoid in %41.7. Obstructing tumor were mostly located at rectosigmoid (41.7%), and transverse colon (50%). The most common site for perforation were cecum. The two patients who presented with massive bleeding had cancer in sigmoid colon. The average tumor size was 6 c m Most of the tumors were poorly differentiated, with high incidence of signet cell adenocarcinoma. Resection and primary anastomosis was done in 21.1% of cases, 63.1% underwent resection and diversion, and 15.8% patient had unresectable disease and underwent diversion only. Conclusion: Colorectal cancer in young adult patients can present as acute surgical abdomen and it is associated with advance disease. Although, resection and primary anantomosis is the preferred treatment option, it was not feasible in most cases
M1958 Serous Cystadenoma of the Pancreas: Current Diagnosis, Treatment, and Outcomes Jennifer F. Tseng, Andrew L Warshaw, David W. Ratmer, Carlos Femandez-Del castillo
Haemorrhoidal disease affects apr. 4.4% of population. 5%-20% of those patients qualify for surgical treatment. Classical surgical treatment is based on excessive haemorrhoidal tissue excision leading to considerable pain and early and late postoperative complications. Implementation of circular stapled mucosectomy opened a new approach to the treatment of symptomatic haemorrhoids. The aim of the prospective trial was to assess the early results of surgical treatment of symptomatic haemorrhoids with circular stapled mucosectomy. Material and method: 50 patients with symptomatic haemorrhoids were enrolled into the prospective trial. 5(10%) patients were diagnosed with lI degree haemorrhoids, 34(68%) with ill degree, and 11 (22%) with 1V degree Results: No serious intraoperative or postoperative complications were noted. Mean procedure time was 30.42 rain. Mearl hospitalization time was 2.16 days. To evaluate postoperative pain an visual analogue scale (VAS) (O(no pain)10 max pain)) was used. Mean pain score was 1.83. Consumption of analgesics in post-op period was also evaluated. 36/50(72%) of patients required no medication or only OTC type within 0-24 hours, postoperatively. Within 24-48 hours the number was 46/49 (93.8%). The follow-up time was 12 weeks. Complete withdrawal of symptoms was achieved at 47 (94%) patients. At 3(6%) patients haemorrhoids were reduced, with 1 case of persistent bleeding requiring reoperation after 3 months. VAS (0-10) scale was also used to measure overall patient satisfaction with treatment results. The mean satisfaction score was 9.64. Conclusion: Treatment of symptomatic haemorrhoidal disease with circular stapled mucosectomy is an effective and safe alternative to classical surgical procedures. However, to evaluate long term results randomized, prospective trial with long follow-up time are required.
Serous cystadenoma is one of the most common cystic neoplasms of the pancreas. Nonetheless, pancreatic tumors are rare, and the characteristics and outcomes of patients with serous cystadenomas in the modem era remain incompletely delineated. We describe a large, singlecenter experience with such patients. Hospital records of 80 patients presenting with serous cystadenoma of the pancreas were evaluated~ 72 had sufficient data for in-depth analysts. Mean patient age was 61 +/-14 years. 78% of patients were female. Most common symptoms were abdominal pain (29%) and mass/fullness (10%); however, the largest group of patients (31%) were asymptomatic. 68% had tumors in the pancreatic body or tail, but were equally |ikely to be symptomatic when compared with patients with head/neck lesions (35% vs. 32% respectively). Only 3 patients (4%) presented with jaundice, and I with pancreatitis. 5 presented with other concurrent tumors, including 2 with pancreatic endocrine tumors, 2 with yon Hippel-Lindau, 1 with Zolfinger-Elhson syndrome, and 1 with bladder transitional cell carcinoma. Most (88%) underwent CT scanning. Mean tumor size was 5.2 +/-3.6 cm, which did not vary significantlyby location. Tumors < 4 cm were less likely to be symptomatic than tumors > = 4 cm (43% vs. 77%, p<0.01). Mean age of patients with tumors < 4 cm was less than those > = 4 cm (56 vs. 65, p = 0.01). 10 patients had serial radiography and mathematical curves for predicting tumor growth over time were generated. Patients who presented after 1998 were likely to undergo EUS (12/14 patients). Patients with serous cystadenoma were referred for surgical evaluation an average of 3 months after presentation (range 1-60 months). Of the 67 patients who underwent operation, 25 had standard Whippies. 2 patients underwent extended Whipples. 29 patients underwent distal pancreatectomy; of these, 12 were spleen-preserving Additional operations included middle (8) and total (1) pancreatectomy, and 2 patients underwent enucleation. No patients were diagnosed with cystadenocarcinoma. 11 patients (16%) had major complications, and there were 2 perioperative deaths. Length of stay averaged 8 days (range 4-42), which decreased over time (median= 10 days pre-1998 vs. 6.5 1998-2002, p<0.001). We have reported the largest single-center experience with serous cystadenoma of the pancreas. Our experience suggests that large, symptomatic, or enlarging serous cystadenomas of the pancreas can be successfully resected with a moderate complication rate and a decreasing length of stay.
M1956
M1959
Malignant Cells Can Be Detected in Washings from Wound Protecting Devices: Further Evidence to Support Protecting the Extraction Site During Laparoscopic Colon Resection for Malignancy Philip L. Leggett, Erik B. Wilson, Darren B. Miter
II10-1082 and TNFa-863 Gene Polymorphisms May Favor The Onset of Chronic Pancreatic Diseases and of The Associated Diabetes, But Not Pancreatic Cancer Outcome Paola Fogar, Carlo-Fedenco Zambon, Daniela Basso, Filippo Navagha, Efiana Greco, Nicoletta Gallo, Alessandra Falda, Claudio Pasqnafi, Cosimo Sperti, Sergio Pedrazzofi, Mario Plebani
M1955 Circular Stapled Mucosectomy in the Treatment of Haemorrhoidal Disease - a Prospective Trial ]arosfaw Leszczyszyn, Igor Lebski, Roman Massopnst, Marek Skoczylas, Piotr Chlosta, Andrzej Gebuza, Pawel Choroszczak
Introduction: A major concern in laparoscopic colon surgery for malignancy is the possible spread of tumor, specifically to the tmcar insertion sites and the site of specimen extraction from the abdomen. This study was designed to investigate whether tumor cells can be isolated from the wound protecting devices used at the extraction site during laparoscopic colon resection for malignancy Body: At our institution, 136 consecutive colon resections were carried out using identical wound protecting devices. Forty-eight of these cases were for malignancy. In each case, a wound protecting bag was inserted into the extraction site prior to specimen extraction, and removed from the wound after the specimen was passed offthe field. The surDcal specimen and wound protector were sent separately to the pathology department. Wound protectors were rimed with 50cc of normal saline. This solution was then centrifuged, and slides of any particulate matter were prepared and examined by a
Cytokines genes polymorphisms have been suggested to favor cancer onset in response to triggering factors and drive tumor progression. The aims of this study were to: 1. evaluate IL-lb-31, IL-1RN (VNTR intron 2), CTGF-447, IFNg + 874, TNFa-1031, TNFa-863, TNFa857, TNFa-308, 1L-10-1082, IL-10-819, IL-10-592 genes polymorphisms in patients with PC or chronic pancreatitis (CP) in comparison with controls (CS); 2. ascertain whether any of the above genes polymorphisms were associated with any clinical aspect of PC Patients: 60 with PC (28 metastatic and 32 locally advanced; 16 had normal glucose tolerance, 7 glucose intollerance and 37 frank diabetes melfitus); 30 with CP and 78 CS. Genomic DNA was extracted from whole blood; all cytokines genes polyraorphisms were PCR amplified
A-819
SSAT Abstracts
endoscopically relieved anastomotic stricture-2; bowel perforation-2; incisional hernia-l: and pneumonia-1.86.7% of patients tolerated clear liquids by POD 2 and 73.3% tolerated house diet by POD 3. Average length of stay 5 days (2q5). CONCLUSION: Our experience ~th laparoscopic colectomy for diverticulitis is offered in support of this technique as a ~afe and effective method with a low need for conversion and an acceptable incidence of morbidity and mortality in the treatment of diverticulitis.
M1954 A Report Card on Cancer in General Surgery lessica B. O'Connell, Jerome H. Liu, Mehnda A. Maggard, David A. Etzioni, Edward H. Livingston, Clifford Y. Ko
M1957
Introduction: The War on Cancer was declared over 30 years ago. Since that time, numerous advances have been made, particularly for cancers treated by general surgeons. It remains unknown however whether demonstrable clinical improvements have been made, specifically decreased incidences, earlier detection, and better survival. This study analyzes 30 years of data from a population-based, national-level cancer registry and produces a report card to detect if improvements in outcomes are being seen for 6 common general surgery cancers (esophageal, stomach, small intestine, colon, rectal, and bepatobiliary ). Methods: All patients diagnosed with the above specified cancers in the SEER Cancer Database (1973-1999) were analyzed. Overall changes in incidence rate, stage at presentation (local, regmnal, and distant), histological grade, and 5-year survivals were determined. Sub-analysis was performed to compare an older cohort (60-80 y/o, n = 106,535) to a younger cohort (20-40 y/o, n = 3,970), and provides the basis of this report. Results: For the older cohort, incidence rates decreased for 2 cancers (stomach and rectal); increased for 3 cancers (esophageal, small intestine, and hepatobiliary); and stayed constant for 1 (colon). Patients presented with earlier stage disease in the 1990s (as compared to 1970s) for 5 of the 6 tumors (p<0.05). However, for all 6 tumors there was a rise in the proportion of poorly differentiated lesions (p<0.05). While the 5-year overall survival improved for all 6 cancers (p<0.05), 5-year stage specific survival improved only for small intestine, colon, and rectal cancers (p<0 05). Interestingly, in the younger cohort, incidence rates increased for all 6 cancers (p<0.05), and more advanced stage and grade were seen for stomach, colon, and rectal cancers (p<0.05). Still, 5-year survival for all 6 cancers in the younger cohort significantly improved in the 1990s. Conclusions: Over the past 3 decades, there has been significant improvement in outcomes for several general surgery cancers in the older population. However, the fact that cancer rates are increasing across the board for the younger population is worrisome. Further study should focus on possible modalities for screening and earlier detection in the young, as well as evaluate the role of other factors that might contribute to the increasing incidence and more aggressive nature of these cancers.
Emergency Presentaions of Colorectal Cancer in Young Patients (Under Forty) Reza Saidi, Shariar Aghakhani, Parvin Mirbod Background: There is little known about emergency presentation of colorectal cancer in young adults and its cfinicopathological features. Method: Retrospective ananlysts of colorectal cancer in patients under forty with emrgency presentation Results: Out of 1056 patients treated for colorectal cancer, 227 (21.5%) were younger than 40 years old. Twenty four patients (10.6%) had emergency presentation: 14 (58.3%) with obstruction, 8 (33.3%) with perforation, and 2 (8.3%) with massive bleeding. Female to male ratio was 1.4(14/ 10). Tumors were at advance stages (60% C, and D). Tumor were infiltrative in 58.3% of cases and polypoid in %41.7. Obstructing tumor were mostly located at rectosigmoid (41.7%), and transverse colon (50%). The most common site for perforation were cecum. The two patients who presented with massive bleeding had cancer in sigmoid colon. The average tumor size was 6 c m Most of the tumors were poorly differentiated, with high incidence of signet cell adenocarcinoma. Resection and primary anastomosis was done in 21.1% of cases, 63.1% underwent resection and diversion, and 15.8% patient had unresectable disease and underwent diversion only. Conclusion: Colorectal cancer in young adult patients can present as acute surgical abdomen and it is associated with advance disease. Although, resection and primary anantomosis is the preferred treatment option, it was not feasible in most cases
M1958 Serous Cystadenoma of the Pancreas: Current Diagnosis, Treatment, and Outcomes Jennifer F. Tseng, Andrew L Warshaw, David W. Ratmer, Carlos Femandez-Del castillo
Haemorrhoidal disease affects apr. 4.4% of population. 5%-20% of those patients qualify for surgical treatment. Classical surgical treatment is based on excessive haemorrhoidal tissue excision leading to considerable pain and early and late postoperative complications. Implementation of circular stapled mucosectomy opened a new approach to the treatment of symptomatic haemorrhoids. The aim of the prospective trial was to assess the early results of surgical treatment of symptomatic haemorrhoids with circular stapled mucosectomy. Material and method: 50 patients with symptomatic haemorrhoids were enrolled into the prospective trial. 5(10%) patients were diagnosed with lI degree haemorrhoids, 34(68%) with ill degree, and 11 (22%) with 1V degree Results: No serious intraoperative or postoperative complications were noted. Mean procedure time was 30.42 rain. Mearl hospitalization time was 2.16 days. To evaluate postoperative pain an visual analogue scale (VAS) (O(no pain)10 max pain)) was used. Mean pain score was 1.83. Consumption of analgesics in post-op period was also evaluated. 36/50(72%) of patients required no medication or only OTC type within 0-24 hours, postoperatively. Within 24-48 hours the number was 46/49 (93.8%). The follow-up time was 12 weeks. Complete withdrawal of symptoms was achieved at 47 (94%) patients. At 3(6%) patients haemorrhoids were reduced, with 1 case of persistent bleeding requiring reoperation after 3 months. VAS (0-10) scale was also used to measure overall patient satisfaction with treatment results. The mean satisfaction score was 9.64. Conclusion: Treatment of symptomatic haemorrhoidal disease with circular stapled mucosectomy is an effective and safe alternative to classical surgical procedures. However, to evaluate long term results randomized, prospective trial with long follow-up time are required.
Serous cystadenoma is one of the most common cystic neoplasms of the pancreas. Nonetheless, pancreatic tumors are rare, and the characteristics and outcomes of patients with serous cystadenomas in the modem era remain incompletely delineated. We describe a large, singlecenter experience with such patients. Hospital records of 80 patients presenting with serous cystadenoma of the pancreas were evaluated~ 72 had sufficient data for in-depth analysts. Mean patient age was 61 +/-14 years. 78% of patients were female. Most common symptoms were abdominal pain (29%) and mass/fullness (10%); however, the largest group of patients (31%) were asymptomatic. 68% had tumors in the pancreatic body or tail, but were equally |ikely to be symptomatic when compared with patients with head/neck lesions (35% vs. 32% respectively). Only 3 patients (4%) presented with jaundice, and I with pancreatitis. 5 presented with other concurrent tumors, including 2 with pancreatic endocrine tumors, 2 with yon Hippel-Lindau, 1 with Zolfinger-Elhson syndrome, and 1 with bladder transitional cell carcinoma. Most (88%) underwent CT scanning. Mean tumor size was 5.2 +/-3.6 cm, which did not vary significantlyby location. Tumors < 4 cm were less likely to be symptomatic than tumors > = 4 cm (43% vs. 77%, p<0.01). Mean age of patients with tumors < 4 cm was less than those > = 4 cm (56 vs. 65, p = 0.01). 10 patients had serial radiography and mathematical curves for predicting tumor growth over time were generated. Patients who presented after 1998 were likely to undergo EUS (12/14 patients). Patients with serous cystadenoma were referred for surgical evaluation an average of 3 months after presentation (range 1-60 months). Of the 67 patients who underwent operation, 25 had standard Whippies. 2 patients underwent extended Whipples. 29 patients underwent distal pancreatectomy; of these, 12 were spleen-preserving Additional operations included middle (8) and total (1) pancreatectomy, and 2 patients underwent enucleation. No patients were diagnosed with cystadenocarcinoma. 11 patients (16%) had major complications, and there were 2 perioperative deaths. Length of stay averaged 8 days (range 4-42), which decreased over time (median= 10 days pre-1998 vs. 6.5 1998-2002, p<0.001). We have reported the largest single-center experience with serous cystadenoma of the pancreas. Our experience suggests that large, symptomatic, or enlarging serous cystadenomas of the pancreas can be successfully resected with a moderate complication rate and a decreasing length of stay.
M1956
M1959
Malignant Cells Can Be Detected in Washings from Wound Protecting Devices: Further Evidence to Support Protecting the Extraction Site During Laparoscopic Colon Resection for Malignancy Philip L. Leggett, Erik B. Wilson, Darren B. Miter
II10-1082 and TNFa-863 Gene Polymorphisms May Favor The Onset of Chronic Pancreatic Diseases and of The Associated Diabetes, But Not Pancreatic Cancer Outcome Paola Fogar, Carlo-Fedenco Zambon, Daniela Basso, Filippo Navagha, Efiana Greco, Nicoletta Gallo, Alessandra Falda, Claudio Pasqnafi, Cosimo Sperti, Sergio Pedrazzofi, Mario Plebani
M1955 Circular Stapled Mucosectomy in the Treatment of Haemorrhoidal Disease - a Prospective Trial ]arosfaw Leszczyszyn, Igor Lebski, Roman Massopnst, Marek Skoczylas, Piotr Chlosta, Andrzej Gebuza, Pawel Choroszczak
Introduction: A major concern in laparoscopic colon surgery for malignancy is the possible spread of tumor, specifically to the tmcar insertion sites and the site of specimen extraction from the abdomen. This study was designed to investigate whether tumor cells can be isolated from the wound protecting devices used at the extraction site during laparoscopic colon resection for malignancy Body: At our institution, 136 consecutive colon resections were carried out using identical wound protecting devices. Forty-eight of these cases were for malignancy. In each case, a wound protecting bag was inserted into the extraction site prior to specimen extraction, and removed from the wound after the specimen was passed offthe field. The surDcal specimen and wound protector were sent separately to the pathology department. Wound protectors were rimed with 50cc of normal saline. This solution was then centrifuged, and slides of any particulate matter were prepared and examined by a
Cytokines genes polymorphisms have been suggested to favor cancer onset in response to triggering factors and drive tumor progression. The aims of this study were to: 1. evaluate IL-lb-31, IL-1RN (VNTR intron 2), CTGF-447, IFNg + 874, TNFa-1031, TNFa-863, TNFa857, TNFa-308, 1L-10-1082, IL-10-819, IL-10-592 genes polymorphisms in patients with PC or chronic pancreatitis (CP) in comparison with controls (CS); 2. ascertain whether any of the above genes polymorphisms were associated with any clinical aspect of PC Patients: 60 with PC (28 metastatic and 32 locally advanced; 16 had normal glucose tolerance, 7 glucose intollerance and 37 frank diabetes melfitus); 30 with CP and 78 CS. Genomic DNA was extracted from whole blood; all cytokines genes polyraorphisms were PCR amplified
A-819
SSAT Abstracts