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Impact of prolonged postoperative ileus on surgical outcome in elective colorectal cancer resections
Poster Session, Saturday 28 January 2017 33−77), were included in the study. Patients with colostomy, distant metastasis, ileostomy formation due to a reason except rectal cancer and type 1 diabetes were excluded. Weight data before ileostomy formation and on admission day to hospital due to the closure of ileostomy were used. Results: 8.7 percent of the patients included in the study were diagnosed with rectal cancer stage 0, 13 percent were stage 1, 34.8 percent were stage 2, 34.8 percent were stage 3 and 8.7 percent were stage 4. Mean time between ileostomy formation and closure was found to be 101.78±53.18 days (between 59–249 days). While 61 percent of the patients lost their 4.55±0.03 percent of their weights, 26 percent of the patients gained 4.3±0.06 percent of their weights and there was not any weight change in 13 percent of the patients. There was not any significant difference found between BMI values before the ileostomy formation (mean 27.89±5.73 kg/m2 ) and BMI values on the admission day to hospital due to the closure of ileostomy (mean 27.48±5.72 kg/m2 ) (p = 0.204). Furthermore, when the relationship between weight change and blood electrolyte (Na, K, Cl) levels was investigated, a significant difference was not found. Conclusions: Individuals with stoma are at risk for malnutrition due to decreased food intake, malabsorption and nutrient loss via stoma. However, in our study there was not any statistically significant difference in BMI values of patients during the process of ileostomy formation and closure. It is important that patients with stoma formation should be followed by a multidisciplinary team in order to meet the nutritional needs of the patients and resolve problems that patients may experience at an early stage. No conflict of interest. 469 POSTER Contributions of patient-, tumor-, and treatment-related factors to the patients’ outcome after curative liver resection among Egyptian patients with metastatic colorectal tumor M. Kamal1 , A. Abdelaal2 , K. El Husseiny1 . 1 Ain Shams University, Clinical Oncology Department, Cairo, Egypt; 2 Ain Shams University, Surgical Oncology Department, Cairo, Egypt Background: This study was conducted to identify the influencing factors on the outcome of Egyptian patients of colorectal cancer with liver metastasis. Materials and Methods: From June 2011 to June 2015, medical records of 44 patients who had undergone a first curative hepatectomy for colorectal cancer with liver metastasis were analyzed. Relationships between survival and patient demographics, selected biological tumor markers, degree of tumor differentiation, need for >3 resection(s), margin and lymph nodes (LNs) status were evaluated using Chi-square test. Results: Median age was 50.73 years (SD±11.99), 61% of the patients were males. The baseline CEA was 98.67±166.71. LNs in the primary tumor was positive in 43.2%. About 65.9% and 34.1% underwent unilobar and bilobar resection respectively. Median tumor burden and size of largest tumor in cm was 8.39±3.64 and 5.59±2.41 respectively. Portal vein thrombosis was seen in 13.64% of the patients. Grade I, II and III was presented in 2.27%, 90.9% and 6.82% respectively. Positive resection margin was observed in 4.55%. Disease free survival in relation to primary colon cancer was 11.05±15.57 months. About 81.82% received induction chemotherapy while only 63.64% responded. In a median follow-up time of 36 months, recurrence was observed in 43.2%. Recurrence was hepatic, extrahepatic and both hepatic and extrhepatic in 20.5%, 6.8% and 15.9% respectively. The median survival after recurrence was 12.0±7.77 months. Of all variables tested, LN status of the primary colon tumor, overall tumor burden and size of largest tumor in cm was statistically significantly with the recurrence with p value of 0.01, 0.049 and 0.008 respectively. Only the LNs status of the primary colon tumor (p = 0.022) was statistically significantly with the mortality. Conclusion: LNs status of the primary colon tumor was affecting both the recurrence and mortality after curative hepatectomy liver resection in Egyptian patients with metastatic colorectal tumor. No conflict of interest. 470 POSTER Impact of prolonged postoperative ileus on surgical outcome in elective colorectal cancer resections M. Nestorovic1 , G. Stanojevic1 , V. Pecic1 , B. Brankovic1 , L. Jeremic2 , M. Gmiovic2 . 1 Clinic for General Surgery- Clinical Center Nis, Department for Colorectal Surgery, Nis, Serbia; 2 Clinic for General Surgery- Clinical Center Nis, Department for Hepatobiliary Surgery, Nis, Serbia Background: Decrease of bowel motility is expected in postoperative period as part of complex response to surgery. The aim of this prospective study was to analyze development of prolonged postoperative ileus (PPOI)
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after elective colorectal surgery for cancer and its impact on early postoperative outcome. Material and Methods: All eligible patients eighteen years or older scheduled for open colorectal resection for cancer during eight month period, were included. Patients with metastatic disease, prior neoadjuvant chemoradiotherapy, or any resection other then curative were excluded from the study. All patients were operated by the same group of surgeons using the same protocol of preoperative and postoperative care. All had mechanical bowel preparation. In cases of placement of nasogastric catheter for decompression, same was removed at the conclusion of the operation. Liquid diet was prescribed to all patients on postoperative day one, followed by solid food as tolerated. None of the patients received opiate based analgesia postoperatively, nor were epidurals used. The study duration was up to 30 days after the surgery. Primary outcome measure was development of PPOI according to strict definition. Prospectively we analyzed the impact of PPOI on early postoperative morbidity and mortality and hospital stay. Results: Prospective analysis included 103 patients, 64 (37.9%) men and 39(62.1%) women, mean age 66.00±10.06 years, without statistically significant difference in age between men and women (p = 0.542). PPOI developed in 12 (11.3%) patients. Almost half of the patients (47.6%) had some grade of complication, while one third had some type of surgical site infection (SSI). The rate of anastomotic leakage was 5.4%. Ten patients (9.7%) required reoperation. Total length of hospital stay was mean 12.60±6.65 days (range 7−49). Comparing the group of patients with prolonged postoperative ileus with those without, there were no statistically significant differences in rates of SSI and anastomotic leakage. There was statistically significant difference in terms of complications (c2 = 34.966; p < 0001), complications grade III (c2 = 23.43; p < 0001) and reoperations (c2 = 15.724; p < 0001). Patients who developed PPOI had statistically significant longer postoperative hospital stay (Z = 2.291; p = 0.022) and longer total length of hospital stay (Z = 2.377; p = 0.015). According to regression analyzes PPOI is a risk factor for reoperations (OR = 12.286; p = 0.001). PPOI is not risk factor for development of other complications (OR = 1.197; p = 0.773). Our results show that patient who develops PPOI has 12 times more chance to undergo reoperation (OR = 12.286; p = 0.001), while PPOI poses no risk for mortality (OR = 0.291; p = 0.170). Conclusions: PPOI although not life-threatening complication effects recovery, increases length of hospital stay and contributes to poor surgical outcome. No conflict of interest. 471 POSTER Long-term results of total mesorectal excision for rectal cancer: prospective single-center study D. Sidorov1 , L. Petrov1 , M. Lozhkin1 , A. Troitskiy1 , A. Isaeva1 . 1 P. Hertsen Moscow Oncology Research Institute, Abdominal Oncology, Moscow, Russian Federation Background: The aim of this study was to access 7-year oncologic outcomes after TME for rectal cancer. Material and Methods: From June 2006 to August 2009, 112 patients with rectal cancer who had undergone TME in our center were assessed. The primary endpoints were disease-free survival and overall survival according to postoperative histopathological CRM examination. All operations were performed by the same team of surgeons. All surgical specimen was sent for histopathological examination which included macroscopic assessment of the rectal fascia propria to determine its completeness and thus its quality using the criteria proposed by Quirke. A microscopic examination was carried out to determine the state of the circumferential resection margin. Overall survival (OS) and disease-free survival (DFS) were compared by using the Kaplan–Meier method. A multivariable analysis was performed to identify predictors of poor survival. Results: Oncological results of 87 (78%) patients were available. Followup mediana was 4.1 year. Five-year local recurrence risk of patients undergoing a macroscopically complete local resection was 5.6% in case of the negative circumferential resection margin compared with 10.9% in patients with positive CRM (P < 0001). Overall survival at 5 years was 84.2% and 48.5%, respectively (P < 0001). 7-years overall survival was 78.2% and 47.3% (P < 0001). Median time to relapse was 1.4 years (range 0.8−5.0) for local recurrence and 3.4 years (0.8−7.5) for distant recurrence. The circumferential resection margin in the muscularis propria plane is associated with poorer long-term prognosis vs the intra-mesorectal and mesorectal plane (p = 0.04). Conclusions: A positive CRM and low quality of TME were confirmed to be negative prognostic factors for an overall survival of rectal cancer patients after surgical treatment. No conflict of interest.
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after elective colorectal surgery for cancer and its impact on early postoperative outcome. Material and Methods: All eligible patients eighteen years or older scheduled for open colorectal resection for cancer during eight month period, were included. Patients with metastatic disease, prior neoadjuvant chemoradiotherapy, or any resection other then curative were excluded from the study. All patients were operated by the same group of surgeons using the same protocol of preoperative and postoperative care. All had mechanical bowel preparation. In cases of placement of nasogastric catheter for decompression, same was removed at the conclusion of the operation. Liquid diet was prescribed to all patients on postoperative day one, followed by solid food as tolerated. None of the patients received opiate based analgesia postoperatively, nor were epidurals used. The study duration was up to 30 days after the surgery. Primary outcome measure was development of PPOI according to strict definition. Prospectively we analyzed the impact of PPOI on early postoperative morbidity and mortality and hospital stay. Results: Prospective analysis included 103 patients, 64 (37.9%) men and 39(62.1%) women, mean age 66.00±10.06 years, without statistically significant difference in age between men and women (p = 0.542). PPOI developed in 12 (11.3%) patients. Almost half of the patients (47.6%) had some grade of complication, while one third had some type of surgical site infection (SSI). The rate of anastomotic leakage was 5.4%. Ten patients (9.7%) required reoperation. Total length of hospital stay was mean 12.60±6.65 days (range 7−49). Comparing the group of patients with prolonged postoperative ileus with those without, there were no statistically significant differences in rates of SSI and anastomotic leakage. There was statistically significant difference in terms of complications (c2 = 34.966; p < 0001), complications grade III (c2 = 23.43; p < 0001) and reoperations (c2 = 15.724; p < 0001). Patients who developed PPOI had statistically significant longer postoperative hospital stay (Z = 2.291; p = 0.022) and longer total length of hospital stay (Z = 2.377; p = 0.015). According to regression analyzes PPOI is a risk factor for reoperations (OR = 12.286; p = 0.001). PPOI is not risk factor for development of other complications (OR = 1.197; p = 0.773). Our results show that patient who develops PPOI has 12 times more chance to undergo reoperation (OR = 12.286; p = 0.001), while PPOI poses no risk for mortality (OR = 0.291; p = 0.170). Conclusions: PPOI although not life-threatening complication effects recovery, increases length of hospital stay and contributes to poor surgical outcome. No conflict of interest. 471 POSTER Long-term results of total mesorectal excision for rectal cancer: prospective single-center study D. Sidorov1 , L. Petrov1 , M. Lozhkin1 , A. Troitskiy1 , A. Isaeva1 . 1 P. Hertsen Moscow Oncology Research Institute, Abdominal Oncology, Moscow, Russian Federation Background: The aim of this study was to access 7-year oncologic outcomes after TME for rectal cancer. Material and Methods: From June 2006 to August 2009, 112 patients with rectal cancer who had undergone TME in our center were assessed. The primary endpoints were disease-free survival and overall survival according to postoperative histopathological CRM examination. All operations were performed by the same team of surgeons. All surgical specimen was sent for histopathological examination which included macroscopic assessment of the rectal fascia propria to determine its completeness and thus its quality using the criteria proposed by Quirke. A microscopic examination was carried out to determine the state of the circumferential resection margin. Overall survival (OS) and disease-free survival (DFS) were compared by using the Kaplan–Meier method. A multivariable analysis was performed to identify predictors of poor survival. Results: Oncological results of 87 (78%) patients were available. Followup mediana was 4.1 year. Five-year local recurrence risk of patients undergoing a macroscopically complete local resection was 5.6% in case of the negative circumferential resection margin compared with 10.9% in patients with positive CRM (P < 0001). Overall survival at 5 years was 84.2% and 48.5%, respectively (P < 0001). 7-years overall survival was 78.2% and 47.3% (P < 0001). Median time to relapse was 1.4 years (range 0.8−5.0) for local recurrence and 3.4 years (0.8−7.5) for distant recurrence. The circumferential resection margin in the muscularis propria plane is associated with poorer long-term prognosis vs the intra-mesorectal and mesorectal plane (p = 0.04). Conclusions: A positive CRM and low quality of TME were confirmed to be negative prognostic factors for an overall survival of rectal cancer patients after surgical treatment. No conflict of interest.