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Mo1673 Outcomes After Completion Total Gastrectomy for Gastric Remnant Cancer
retrospective analysis showed that perianal disease is associated with early need for surgery. If a deviation becomes necessary for perianal Crohn's disease the rate of enterostomy closure was low. Additionally, a detailed clinical and molecularbiological analysis of patients with Crohn's related carcinoma is necessary in order to detect a possible predisposition in time.
Mo1673 Outcomes After Completion Total Gastrectomy for Gastric Remnant Cancer Etienne St-Louis, Stephen D. Gowing, Mara L. Leimanis, Pedram Mossallanejad, Carmen L. Mueller, Lorenzo E. Ferri Gastric remnant cancer (GRC) arises in the residual gastric stump following partial gastrectomy. There is controversy about the safety and prognosis of completion total gastrectomy (GTC). We sought to describe our experience with this procedure and compare outcomes in patients undergoing CTG for GRC with patients undergoing primary total gastrectomy (PTG) for sporadic gastric cancer (SGC) in a high throughput tertiary care center. A single institution, prospectively entered, clinical database of gastrectomy patients from 2005-2014 was retrospectively analyzed for demographic, surgical and clinical data as well as tumor pathology data and post-operative outcomes including complications and length of stay (LOS). Patients undergoing CTG were compared in these variables to patients undergoing PTG. Data is presented as median (range) and Chi-square, Fisher's exact and Wilcoxon rank sum tests were used to compare groups (* p<0.05). Out of 264 patients undergoing gastrectomy, we identified 37 who had non-palliative total gastrectomy for cancer (16 CTG, 33 PTG). Patient demographics were equivalent at baseline. There were no significant differences in operative or oncologic characteristics between CTG and PTG, pT≥4a (29% vs. 22% - NS) and pN≥1 (77% vs. 61% - NS), R0 resection rate (86% vs. 79% - NS), lymphadenectomy ≥D2 (64% vs. 87% - NS) or positive to negative lymph node (LN) ratio (0.1 (0.03-0.3) vs. 0.09 (0-0.65) - NS). However, median LN retrieval was significantly lower in CTG compared with PTG (14 (10-21) vs. 29 (20-48))*. CTG was associated with a slightly higher rate of overall complications (Clavien I-V) and reoperations (25% vs. 3%)* but this did not impact length of stay (8 (6-14) vs. 9 (7-18) days - NS) or in-hospital mortality (none in either group). There were no significant differences in median overall survival (10 (9-13) vs. 35 (14-56) months - NS), disease free survival (DFS) at 3 years (32% vs. 40% - NS) or overall survival (OS) at 3 years (32% vs. 50% - NS) - see figure. Treating surgeons should recognize that although more technically challenging, completion total gastrectomy can be performed with equivalent post-operative and oncologic outcomes as primary total gastrectomy.
Mo1671 Trends in Non-Traumatic Abdominal Compartment Syndrome John Afthinos, Karen E. Gibbs Introduction: Although abdominal compartment syndrome (ACS) has been recognized as a clinical entity since the early part of the 20th century, there has been a long delay in accepting it as a cause of death in critically ill patients. If left untreated it is uniformly fatal. Current literature reports a mortality rate of 50% even when treated. We sought to evaluate the trend in diagnosis of ACS and its mortality in a large national database. Methods: The NIS database was queried for the years 2005 to 2010. All patients developing non-traumatic ACS were identified. The most common associated diagnoses were recorded. The population was evaluated for age, gender, comorbid conditions and post-operative complications Bivariate logistic regression analyses were performed to identify risk factors for mortality. Results: We identified a total of 10,345 patients. The patients were largely male (59%) and were 54.4 + 22 years old. In 2006, there were only 184 cases, increasing to 3453 in 2010. Ruptured abdominal aortic aneurysm, sepsis, pancreatitis, adhesive bowel obstruction and mesenteric ischemia were among the more common associated diagnoses. Post-operative morbidity was 85% and mortality was 50%. Significant risk factors predictive of mortality were history of MI (OR 1.9), COPD (OR 1.3), PVD (OR 1.9), CAD (OR 1.4) and severe liver disease (OR 2, p < 0.05). Persistent post-operative acidosis was the strongest predictor of post-operative mortality (OR 2, p < 0.001). Conclusions: ACS is increasingly recognized as an important clinical entity. It carries a very high mortality rate, even when treated. It is unclear from the study if this is due to the natural course of the primary disease or delayed recognition. The high mortality rate suggests that patients should be aggressively assessed for its presence in the early phases of treatment in order to attempt to derail this deadly syndrome. Mo1672
SSAT Abstracts
Candy Cane Roux Syndrome: an Under Recognized Complication of an Excessive Roux Limb After Roux-en-Y Gastric Bypass Surgery Abdul Rehman, Siegfried W. Yu, Muhammed Sherid, Neal Patel, Brian F. Lane, Sean M. Lee, Sherman Chamberlain Introduction: An increasing number of patients are undergoing weight loss surgery due to the obesity epidemic. Roux-en-Y gastric bypass surgery (RYGB) is the most common bariatric surgery and is associated with a wide range of complications such as nutritional deficiencies, strictures, marginal ulcers, leaks and fistula formations. "Candy Cane" Roux Syndrome (CCRS) is an under recognized syndrome in patients with RYGB in which an excessive length of Roux limb proximal to the gastrojejunostomy can cause symptoms including nausea, vomiting, abdominal pain and diarrhea. We present a series of 2 patients with CCRS. Cases: Two post-op RYGB patients were evaluated between January, 2012, and July, 2014, for various severe GI symptoms, after having undergone prior unremarkable work up for their complaints. A 57 year-old female patient presented with a 4 month history of nausea, vomiting, abdominal pain, and GERD, occurring 9 years after an uneventful RYGB. She underwent an EGD which showed an 8 cm long blind Roux limb. CCRS was suspected, and this led to laparoscopic resection of the Roux limb, and complete resolution of her GI symptoms. A 42 year-old female presented with persistent watery diarrhea along with epigastric pain which started after 2 months of RYGB surgery. An upper endoscopy revealed 15 cm Roux limb. She underwent surgical resection of the Roux limb which resulted in complete resolution of her abdominal pain and diarrhea. Discussion: CCRS is a rarely reported complication of RYGB, with only four prior cases described in the literature, and is probably under recognized. It occurs when the excessive length, longer than 2-4cm, of the Roux limb proximal to the gastrojejunostomy results in various gastrointestinal symptoms including nausea, vomiting, abdominal pain and diarrhea. The symptoms of CCRS may result from small intestinal bacterial overgrowth due to poor drainage. Clinical suspicion of CCRS and endoscopic recognition by measurement of the Roux limb in our 2 cases led to the appropriate surgical resection of the excessive Roux limb, and subsequent resolution of a wide spectrum of GI symptoms. Conclusion: Minimizing redundancy in the Roux limb during the primary RYGB procedure and/or subsequent surgical shortening of these excessive limbs can prevent and minimize CCRS. Surgeons and gastroenterologists who evaluate GI symptoms in post-RYGB patients should be aware of CCRS to appropriately evaluate these patients, which should include a formal measurement of the blind Roux limb during endoscopy. We propose that blind limbs longer than 4 cm should prompt referral for consideration of surgical correction once other causes of upper GI symptoms in post-RYGB patients have been excluded. Further studies are needed to better characterize CCRS, and to establish guidelines for surgeons and gastroenterologists who evaluate post-RYGB patients. Table-1 Patient's clinical findings and response to treatment
Mo1674 Treatment Modalities for Delayed Gastric Emptying Following Esophagectomy Francis J. DeAsis, Matthew E. Gitelis, John G. Linn, JoAnn Carbray, Michael B. Ujiki Introduction: Delayed gastric emptying (DGE) after esophagectomy is a common and debilitating complication. Management options include observation, endoscopic balloon dilation with Botox injection (EBD), and rescue pyloroplasty (rPP). Methods: A multisurgeon, multi-hospital retrospective review of post-esophagectomy patients from 2008 to 2014 was conducted. Patients were screened based upon a confirmed DGE diagnosis. Methods of treatment were observation over time, EBD, or laparoscopic rPP. Demographics, pre- and postoperative symptoms, and perioperative data were assessed. Treatment success was defined as a resolution of symptoms after intervention. Results: DGE was radiologically confirmed in 26.5% of esophagectomy patients (9 out of 34). Median time between esophagectomy and diagnosis was 37 days (range 5-464). Gender was 88% male. Mean age was 54±16.5 years. Mean BMI was 30.8±10.1 kg/m2. Four patients (44%) had prior smoking history. Three (33%) patients were diabetic. Two patients were managed with observation. Three patients were treated with balloon dilatation and Botox. Four patients underwent
SSAT Abstracts
S-1168
Mo1673 Outcomes After Completion Total Gastrectomy for Gastric Remnant Cancer Etienne St-Louis, Stephen D. Gowing, Mara L. Leimanis, Pedram Mossallanejad, Carmen L. Mueller, Lorenzo E. Ferri Gastric remnant cancer (GRC) arises in the residual gastric stump following partial gastrectomy. There is controversy about the safety and prognosis of completion total gastrectomy (GTC). We sought to describe our experience with this procedure and compare outcomes in patients undergoing CTG for GRC with patients undergoing primary total gastrectomy (PTG) for sporadic gastric cancer (SGC) in a high throughput tertiary care center. A single institution, prospectively entered, clinical database of gastrectomy patients from 2005-2014 was retrospectively analyzed for demographic, surgical and clinical data as well as tumor pathology data and post-operative outcomes including complications and length of stay (LOS). Patients undergoing CTG were compared in these variables to patients undergoing PTG. Data is presented as median (range) and Chi-square, Fisher's exact and Wilcoxon rank sum tests were used to compare groups (* p<0.05). Out of 264 patients undergoing gastrectomy, we identified 37 who had non-palliative total gastrectomy for cancer (16 CTG, 33 PTG). Patient demographics were equivalent at baseline. There were no significant differences in operative or oncologic characteristics between CTG and PTG, pT≥4a (29% vs. 22% - NS) and pN≥1 (77% vs. 61% - NS), R0 resection rate (86% vs. 79% - NS), lymphadenectomy ≥D2 (64% vs. 87% - NS) or positive to negative lymph node (LN) ratio (0.1 (0.03-0.3) vs. 0.09 (0-0.65) - NS). However, median LN retrieval was significantly lower in CTG compared with PTG (14 (10-21) vs. 29 (20-48))*. CTG was associated with a slightly higher rate of overall complications (Clavien I-V) and reoperations (25% vs. 3%)* but this did not impact length of stay (8 (6-14) vs. 9 (7-18) days - NS) or in-hospital mortality (none in either group). There were no significant differences in median overall survival (10 (9-13) vs. 35 (14-56) months - NS), disease free survival (DFS) at 3 years (32% vs. 40% - NS) or overall survival (OS) at 3 years (32% vs. 50% - NS) - see figure. Treating surgeons should recognize that although more technically challenging, completion total gastrectomy can be performed with equivalent post-operative and oncologic outcomes as primary total gastrectomy.
Mo1671 Trends in Non-Traumatic Abdominal Compartment Syndrome John Afthinos, Karen E. Gibbs Introduction: Although abdominal compartment syndrome (ACS) has been recognized as a clinical entity since the early part of the 20th century, there has been a long delay in accepting it as a cause of death in critically ill patients. If left untreated it is uniformly fatal. Current literature reports a mortality rate of 50% even when treated. We sought to evaluate the trend in diagnosis of ACS and its mortality in a large national database. Methods: The NIS database was queried for the years 2005 to 2010. All patients developing non-traumatic ACS were identified. The most common associated diagnoses were recorded. The population was evaluated for age, gender, comorbid conditions and post-operative complications Bivariate logistic regression analyses were performed to identify risk factors for mortality. Results: We identified a total of 10,345 patients. The patients were largely male (59%) and were 54.4 + 22 years old. In 2006, there were only 184 cases, increasing to 3453 in 2010. Ruptured abdominal aortic aneurysm, sepsis, pancreatitis, adhesive bowel obstruction and mesenteric ischemia were among the more common associated diagnoses. Post-operative morbidity was 85% and mortality was 50%. Significant risk factors predictive of mortality were history of MI (OR 1.9), COPD (OR 1.3), PVD (OR 1.9), CAD (OR 1.4) and severe liver disease (OR 2, p < 0.05). Persistent post-operative acidosis was the strongest predictor of post-operative mortality (OR 2, p < 0.001). Conclusions: ACS is increasingly recognized as an important clinical entity. It carries a very high mortality rate, even when treated. It is unclear from the study if this is due to the natural course of the primary disease or delayed recognition. The high mortality rate suggests that patients should be aggressively assessed for its presence in the early phases of treatment in order to attempt to derail this deadly syndrome. Mo1672
SSAT Abstracts
Candy Cane Roux Syndrome: an Under Recognized Complication of an Excessive Roux Limb After Roux-en-Y Gastric Bypass Surgery Abdul Rehman, Siegfried W. Yu, Muhammed Sherid, Neal Patel, Brian F. Lane, Sean M. Lee, Sherman Chamberlain Introduction: An increasing number of patients are undergoing weight loss surgery due to the obesity epidemic. Roux-en-Y gastric bypass surgery (RYGB) is the most common bariatric surgery and is associated with a wide range of complications such as nutritional deficiencies, strictures, marginal ulcers, leaks and fistula formations. "Candy Cane" Roux Syndrome (CCRS) is an under recognized syndrome in patients with RYGB in which an excessive length of Roux limb proximal to the gastrojejunostomy can cause symptoms including nausea, vomiting, abdominal pain and diarrhea. We present a series of 2 patients with CCRS. Cases: Two post-op RYGB patients were evaluated between January, 2012, and July, 2014, for various severe GI symptoms, after having undergone prior unremarkable work up for their complaints. A 57 year-old female patient presented with a 4 month history of nausea, vomiting, abdominal pain, and GERD, occurring 9 years after an uneventful RYGB. She underwent an EGD which showed an 8 cm long blind Roux limb. CCRS was suspected, and this led to laparoscopic resection of the Roux limb, and complete resolution of her GI symptoms. A 42 year-old female presented with persistent watery diarrhea along with epigastric pain which started after 2 months of RYGB surgery. An upper endoscopy revealed 15 cm Roux limb. She underwent surgical resection of the Roux limb which resulted in complete resolution of her abdominal pain and diarrhea. Discussion: CCRS is a rarely reported complication of RYGB, with only four prior cases described in the literature, and is probably under recognized. It occurs when the excessive length, longer than 2-4cm, of the Roux limb proximal to the gastrojejunostomy results in various gastrointestinal symptoms including nausea, vomiting, abdominal pain and diarrhea. The symptoms of CCRS may result from small intestinal bacterial overgrowth due to poor drainage. Clinical suspicion of CCRS and endoscopic recognition by measurement of the Roux limb in our 2 cases led to the appropriate surgical resection of the excessive Roux limb, and subsequent resolution of a wide spectrum of GI symptoms. Conclusion: Minimizing redundancy in the Roux limb during the primary RYGB procedure and/or subsequent surgical shortening of these excessive limbs can prevent and minimize CCRS. Surgeons and gastroenterologists who evaluate GI symptoms in post-RYGB patients should be aware of CCRS to appropriately evaluate these patients, which should include a formal measurement of the blind Roux limb during endoscopy. We propose that blind limbs longer than 4 cm should prompt referral for consideration of surgical correction once other causes of upper GI symptoms in post-RYGB patients have been excluded. Further studies are needed to better characterize CCRS, and to establish guidelines for surgeons and gastroenterologists who evaluate post-RYGB patients. Table-1 Patient's clinical findings and response to treatment
Mo1674 Treatment Modalities for Delayed Gastric Emptying Following Esophagectomy Francis J. DeAsis, Matthew E. Gitelis, John G. Linn, JoAnn Carbray, Michael B. Ujiki Introduction: Delayed gastric emptying (DGE) after esophagectomy is a common and debilitating complication. Management options include observation, endoscopic balloon dilation with Botox injection (EBD), and rescue pyloroplasty (rPP). Methods: A multisurgeon, multi-hospital retrospective review of post-esophagectomy patients from 2008 to 2014 was conducted. Patients were screened based upon a confirmed DGE diagnosis. Methods of treatment were observation over time, EBD, or laparoscopic rPP. Demographics, pre- and postoperative symptoms, and perioperative data were assessed. Treatment success was defined as a resolution of symptoms after intervention. Results: DGE was radiologically confirmed in 26.5% of esophagectomy patients (9 out of 34). Median time between esophagectomy and diagnosis was 37 days (range 5-464). Gender was 88% male. Mean age was 54±16.5 years. Mean BMI was 30.8±10.1 kg/m2. Four patients (44%) had prior smoking history. Three (33%) patients were diabetic. Two patients were managed with observation. Three patients were treated with balloon dilatation and Botox. Four patients underwent
SSAT Abstracts
S-1168