- Email: [email protected]
Management of Retroperitoneal Tumours: A Single Institution Experience
ABSTRACTS
1169
a median of 12 lymph nodes. Our aim was to assess reporting of lymph node evaluation in Dukes B colorectal cancer patients treated at our institution. Methods: All patients with Dukes B histology were selected from a prospectively collected database of all colorectal cancers resected between 1997 and 2007 at our institution. Data including demographics, histopathology and adjuvant treatment were analysed. Survival from date of operation was calculated using Kaplan-Meier estimates and log rank test. Results: Of 1098 patients who underwent colorectal cancer resections, 37 % (405/1098) were staged as Dukes B (235 males). 25% (103/405) of patients received adjuvant chemotherapy. The median number of lymph nodes evaluated was 9 (range 0-35). 67% of patients had less than 12 lymph nodes evaluated (73/102 who received chemotherapy, 196/300 who received no chemotherapy). In patients who received chemotherapy, 5 year survival was equivalent in those with less than 12, or 12 or more lymph nodes harvested (p ¼ 0.89).When no chemotherapy was given there was a trend towards improved survival in patients with more than 12 lymph nodes harvested (70% 5 year survival, median survival not reached vs 59% 5 year survival, median survival 78 months, p ¼ 0.13). Conclusion: Understaging of Dukes B colorectal cancer may occur if insufficient lymph nodes are evaluated. The impact of this on overall survival needs further investigation. P12. Changing Trends In Rectal Cancer - The Nineties To Now A. Ben Sassi, S. Eccles, A. Woodward, J. Shannon, M. Foster Royal Glamorgan Hospital, Surgical Department, Glamorgan, CF72 8XR Introduction: The investigation and management of rectal cancer has evolved over the past two decades. The present study looked at trends in rectal cancer in 2003e2007, and compared the results with two previously published studies from the same institution on cases from 1991 onwards. Methods: Histologically-proven cases of rectal adenocarcinoma resected with curative intent between 2003e2007 at the Royal Glamorgan Hospital were identified and analysed from pathology reports. Data was compared with results from two previous studies conducted between 1996-2000 and 1991-97 respectively. Results: Eighty-six cases of rectal cancer excision with curative intent were identified from 2003-07. The key results are summarised in the table below. 20032007
19962000
19911997
Median age (yrs)
65
70
M - 69, F - 74
% % % % %
30.2 29.1 25.6 45.3 15.1
31.5 22.2 26.9 50.9 13.4
48.0 16.3 35.8 47.9 -
-
1991 - 0% 1997 - 85%
underwent AP resection Dukes A Dukes B Dukes C with tumour within 1mm of circumferential excision margin % with circumferential resection margin (CRM) reported in mm
Discussion: The present study highlights interesting trends in rectal cancer presentation and management over the past two decades. Patients undergoing rectal cancer resection now have a younger median age, and the percentage of patients with Dukes A disease has almost doubled. These findings may be due to increased awareness of colorectal cancer amongst the general population. The move away from AP resection has been maintained, whilst CRM reporting has continued to increase. These trends are consistent with best practice and comparable to national standards.
P13. Management of Retroperitoneal Tumours: A Single Institution Experience Bobby V. M. Dasari, B. Lee, D. Carey Belfast City Hospital, Level 5, Belfast Health and Social Care Trust, Lisburn Road, Belfast , BT9 7AB Introduction: Retroperitoneal tumours (RPT) account for 0.2% of all tumor types and 10-25% of all soft tissue tumors. Complete resection is the treatment of choice; however, this is often challenging due to the location of tumour, delay in clinical presentation, and frequent involvement of surrounding structures. Objectives of this study are to review the immediate and long-term postoperative outcomes of the RPTs. Methods: Patients who underwent laparotomy for the management of RPTs between 1998 and 2008 are included in the study. Operative details, postoperative morbidity, 30-day mortality and recurrence rates are assessed by retrospective review of the notes. Surgical team comprised of a general and a vascular surgeon with special interest in RPTs. Results: Twelve patients underwent surgery for primary RPTs. Median age at surgery is 46 years (range 18-81 years). Liposarcoma (2/12) and leiomyosarcoma (2/12) are the most common tumours. 11/12 tumours were completely resected; adjacent structures were resected in 5 patients. Repair of the inferior vena cava (2/13) is the most common additional intraoperative procedure. Two patients died in the immediate postoperative period (respiratory failure in 1 patient, small bowel ischemia and renal failure in 1 patient). None of the patients had local recurrence; one patient had distant bony metastases. Overall mortality rate at a median follow up period of 17 months (range of 6 - 58 months) is 33%. Conclusions: Long-term prognosis of RPTs remains poor. Complete en bloc resection (including the surrounding structures involved) at the initial operation is important in preventing the recurrence of RPTs.
P14. Are obesity (expressed as body mass index [BMI] [ 25kg/m2) and hepatic steatosis contraindications to patients undergoing hepatectomy for colorectal liver metastases (CRLM)? Joseph Tang, S. Pathak, M. Terlizzo, M. Haqqani, A. Wu, G. Poston University Hospital Aintree, Lower Lane, Liverpool, L9 7AL Background: Neoadjuvant chemotherapy is now employed in treating patients with CRLM. Chemotherapy increases the risk of steatohepatitis, thus increasing post-operative mortality. Furthermore, our society is getting larger, with increasing BMIs also predisposing to ‘‘fatty’’ liver, possibly also affecting post-operative outcome. We examined the relationship between BMI, degree of steatosis and post-operative survival. Methods: Retrospective analysis of a prospective consecutive cohort of 102 CRLM patients undergoing hepatectomy with 60 months followup. Resection specimens were examined to determine the degree of steatosis in the ‘normal’ liver. Data compared to BMIs and other relevant history. Statistical analyses by log rank and Fisher’s Exact Test. Results: 27(26.5%) had no detectable fatty change; 1(1.0%) cirrhotic, 17(16.7%) were indeterminate. 57 were steatotic(55.9%): 26(25.5%) graded mild; 10(9.8%) graded moderate; 21 (20.6%) graded severe. 1 patient (BMI 29.5 kg/m2) had steatohepatitis but survived surgery. No steatosis in patients with BMI < 25. No significant difference in median survival between patients with and without steatosis(28.6 vs 32.3 months, log rank p ¼ 0.340). Survival outcomes similar between patients with BMI < 25 and BMI ¼ 25 (30.3 vs. 36.9 months, log rank p ¼ 0.361) and between patients with BMI < 30 and BMI ¼ 30 (34.4 vs. 27.2 months, log rank p ¼ 0.381). Significant correlation between BMI ¼25 and presence of steatosis (p ¼ 0.0097) but lost between BMI < 30 vs. ¼30(p ¼ 0.0612). Conclusion: Raised BMI ( ¼ 25 kg/m2) is associated with increased risk of steatosis however, neither raised BMI, nor the presence of steatosis influence long-term survival. We conclude that obesity and the presence of steatosis are not contraindications when considering patients with CRLM for hepatectomy.
1169
a median of 12 lymph nodes. Our aim was to assess reporting of lymph node evaluation in Dukes B colorectal cancer patients treated at our institution. Methods: All patients with Dukes B histology were selected from a prospectively collected database of all colorectal cancers resected between 1997 and 2007 at our institution. Data including demographics, histopathology and adjuvant treatment were analysed. Survival from date of operation was calculated using Kaplan-Meier estimates and log rank test. Results: Of 1098 patients who underwent colorectal cancer resections, 37 % (405/1098) were staged as Dukes B (235 males). 25% (103/405) of patients received adjuvant chemotherapy. The median number of lymph nodes evaluated was 9 (range 0-35). 67% of patients had less than 12 lymph nodes evaluated (73/102 who received chemotherapy, 196/300 who received no chemotherapy). In patients who received chemotherapy, 5 year survival was equivalent in those with less than 12, or 12 or more lymph nodes harvested (p ¼ 0.89).When no chemotherapy was given there was a trend towards improved survival in patients with more than 12 lymph nodes harvested (70% 5 year survival, median survival not reached vs 59% 5 year survival, median survival 78 months, p ¼ 0.13). Conclusion: Understaging of Dukes B colorectal cancer may occur if insufficient lymph nodes are evaluated. The impact of this on overall survival needs further investigation. P12. Changing Trends In Rectal Cancer - The Nineties To Now A. Ben Sassi, S. Eccles, A. Woodward, J. Shannon, M. Foster Royal Glamorgan Hospital, Surgical Department, Glamorgan, CF72 8XR Introduction: The investigation and management of rectal cancer has evolved over the past two decades. The present study looked at trends in rectal cancer in 2003e2007, and compared the results with two previously published studies from the same institution on cases from 1991 onwards. Methods: Histologically-proven cases of rectal adenocarcinoma resected with curative intent between 2003e2007 at the Royal Glamorgan Hospital were identified and analysed from pathology reports. Data was compared with results from two previous studies conducted between 1996-2000 and 1991-97 respectively. Results: Eighty-six cases of rectal cancer excision with curative intent were identified from 2003-07. The key results are summarised in the table below. 20032007
19962000
19911997
Median age (yrs)
65
70
M - 69, F - 74
% % % % %
30.2 29.1 25.6 45.3 15.1
31.5 22.2 26.9 50.9 13.4
48.0 16.3 35.8 47.9 -
-
1991 - 0% 1997 - 85%
underwent AP resection Dukes A Dukes B Dukes C with tumour within 1mm of circumferential excision margin % with circumferential resection margin (CRM) reported in mm
Discussion: The present study highlights interesting trends in rectal cancer presentation and management over the past two decades. Patients undergoing rectal cancer resection now have a younger median age, and the percentage of patients with Dukes A disease has almost doubled. These findings may be due to increased awareness of colorectal cancer amongst the general population. The move away from AP resection has been maintained, whilst CRM reporting has continued to increase. These trends are consistent with best practice and comparable to national standards.
P13. Management of Retroperitoneal Tumours: A Single Institution Experience Bobby V. M. Dasari, B. Lee, D. Carey Belfast City Hospital, Level 5, Belfast Health and Social Care Trust, Lisburn Road, Belfast , BT9 7AB Introduction: Retroperitoneal tumours (RPT) account for 0.2% of all tumor types and 10-25% of all soft tissue tumors. Complete resection is the treatment of choice; however, this is often challenging due to the location of tumour, delay in clinical presentation, and frequent involvement of surrounding structures. Objectives of this study are to review the immediate and long-term postoperative outcomes of the RPTs. Methods: Patients who underwent laparotomy for the management of RPTs between 1998 and 2008 are included in the study. Operative details, postoperative morbidity, 30-day mortality and recurrence rates are assessed by retrospective review of the notes. Surgical team comprised of a general and a vascular surgeon with special interest in RPTs. Results: Twelve patients underwent surgery for primary RPTs. Median age at surgery is 46 years (range 18-81 years). Liposarcoma (2/12) and leiomyosarcoma (2/12) are the most common tumours. 11/12 tumours were completely resected; adjacent structures were resected in 5 patients. Repair of the inferior vena cava (2/13) is the most common additional intraoperative procedure. Two patients died in the immediate postoperative period (respiratory failure in 1 patient, small bowel ischemia and renal failure in 1 patient). None of the patients had local recurrence; one patient had distant bony metastases. Overall mortality rate at a median follow up period of 17 months (range of 6 - 58 months) is 33%. Conclusions: Long-term prognosis of RPTs remains poor. Complete en bloc resection (including the surrounding structures involved) at the initial operation is important in preventing the recurrence of RPTs.
P14. Are obesity (expressed as body mass index [BMI] [ 25kg/m2) and hepatic steatosis contraindications to patients undergoing hepatectomy for colorectal liver metastases (CRLM)? Joseph Tang, S. Pathak, M. Terlizzo, M. Haqqani, A. Wu, G. Poston University Hospital Aintree, Lower Lane, Liverpool, L9 7AL Background: Neoadjuvant chemotherapy is now employed in treating patients with CRLM. Chemotherapy increases the risk of steatohepatitis, thus increasing post-operative mortality. Furthermore, our society is getting larger, with increasing BMIs also predisposing to ‘‘fatty’’ liver, possibly also affecting post-operative outcome. We examined the relationship between BMI, degree of steatosis and post-operative survival. Methods: Retrospective analysis of a prospective consecutive cohort of 102 CRLM patients undergoing hepatectomy with 60 months followup. Resection specimens were examined to determine the degree of steatosis in the ‘normal’ liver. Data compared to BMIs and other relevant history. Statistical analyses by log rank and Fisher’s Exact Test. Results: 27(26.5%) had no detectable fatty change; 1(1.0%) cirrhotic, 17(16.7%) were indeterminate. 57 were steatotic(55.9%): 26(25.5%) graded mild; 10(9.8%) graded moderate; 21 (20.6%) graded severe. 1 patient (BMI 29.5 kg/m2) had steatohepatitis but survived surgery. No steatosis in patients with BMI < 25. No significant difference in median survival between patients with and without steatosis(28.6 vs 32.3 months, log rank p ¼ 0.340). Survival outcomes similar between patients with BMI < 25 and BMI ¼ 25 (30.3 vs. 36.9 months, log rank p ¼ 0.361) and between patients with BMI < 30 and BMI ¼ 30 (34.4 vs. 27.2 months, log rank p ¼ 0.381). Significant correlation between BMI ¼25 and presence of steatosis (p ¼ 0.0097) but lost between BMI < 30 vs. ¼30(p ¼ 0.0612). Conclusion: Raised BMI ( ¼ 25 kg/m2) is associated with increased risk of steatosis however, neither raised BMI, nor the presence of steatosis influence long-term survival. We conclude that obesity and the presence of steatosis are not contraindications when considering patients with CRLM for hepatectomy.