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Mo1756 Factors Associated With Survival Following Cytoreductive Surgery and Heated Intraperitoneal Chemotherapy for Colorectal Cancer
Mo1755 CDKN2A Hypermethylation and Synchronous Bilateral Colorectal Cancer Fabio Coppedè, Angela Lopomo, Lucia Migliore, Roberto Spisni The cyclin-dependent kinase inhibitor 2A protein, also known as p16, is a tumor suppressor protein encoded by the CDKN2A gene. CDKN2A promoter methylation is frequently observed in colorectal cancer (CRC) tissues and has been associated with bad prognosis and elevated risk of cancer recurrence. Moreover, CDKN2A methylation is detectable in the circulating free serum DNA and has been proposed as a follow-up marker to monitor for CRC recurrence. Over the past five years we have screened more than 100 sporadic CRC samples for aberrant DNA methylation of disease-related genes, observing that CDKN2A promoter hypermethylation was present in almost 20% of them (18 samples). Very interestingly, only one out of 18 CDKN2A hypermethylated CRC samples showed CDKN2A hypermethylation also in the adjacent healthy colonic mucosa, while the other 17 samples showed no detectable amount of methylation in the analyzed healthy mucosa tissues. Further characterization of the one patient showing CDKN2A hypermethylation in the mucosa adjacent to the CRC lesion revealed that the patient had a synchronous bilateral colorectal cancer, and particularly a scarcely differentiated adenocarcinoma in the right colon and a sigmoid mucinous adenocarcinoma with lymph-node metastasis. Both CRC lesions were characterized by CDKN2A promoter hypermethylation. Our present screening supports literature evidence of the association between CDKN2A methylation and CRC recurrence. The analysis of serum DNA is currently ongoing in our cohort searching for correlation between CDKN2A methylation and clinicopathological findings.
Mo1756 Factors Associated With Survival Following Cytoreductive Surgery and Heated Intraperitoneal Chemotherapy for Colorectal Cancer Sean Dineen, Kristen Robinson, Ching-Wei Tzeng, Karen Beaty, Paul Mansfield, Richard Royal, Keith Fournier Introduction: Patients with colorectal cancer and peritoneal carcinomatosis (CRC/PC) have a worse prognosis compared to patients with metastatic CRC to other organ sites, such as liver and lung. Cytoreductive surgery and heated intraperitoneal chemotherapy (CRS/HIPEC) has been shown to improve survival for select patients with CRC/PC, but carries a high morbidity rate. This study sought to determine factors associated with survival following CRS/HIPEC. Methods: Patients with CRC/PC evaluated in a peritoneal surface malignancy clinic between 2008 and 2014 were identified. Patients with appendiceal cancers and nonCRC were excluded. Clinicopathologic data were extracted from chart review, including peritoneal carcinomatosis index (PCI) and completeness of cytoreduction score. Factors associated with survival were assessed using univariate and multivariate analysis. 30-day complication rates were determined using the Clavien-Dindo classification. Results: 52 patients underwent operation with intent for CRS/HIPEC. 43 patients (82.7%) underwent complete cytoreduction (CCR 0/1). There were no significant differences in demographics between the groups. Median disease specific survival (DSS) was 55.1 months in the patients undergoing complete cytoreduction, compared to 12.8 months in patients who underwent incomplete cytoreduction (p < 0.05). Disease burden was a significant predictor of survival, as patients with a PCI score £6 demonstrated a significantly longer DSS compared to those with higher scores (p < 0.01). In patients who received a complete cytoreduction, poorly differentiated tumors demonstrated worse DSS (55 months vs 13 months, p < 0.0001). In 37 patients in whom KRAS mutation status was known, there was no significant survival difference based on KRAS status. In patients with CCR 0/1 resection, postoperative complications occurred in 73.2% of patients; with 29.2% of patients experiencing grade 3-4 complications (no postoperative deaths). Experiencing a postoperative complication was associated with decreased survival (33 months vs. median DSS not reached, p<0.05). On multivariate analysis of patients who received CCR 0/1 resection, poorly differentiated histology was associated with decreased DSS (HR 9.5, CI 2.1 - 44.2, p < 0.01). Conclusion: For patients with CRC/PC who qualify for CRS/HIPEC, intention for complete cytoreduction is essential for maximal oncologic benefit. Patients with lower volume of disease and less aggressive tumor grade also fare better in DSS. Given the high rate of complications and their negative survival impact, patient selection should be based on PCI, tumor grade, and performance status.
A. Following CRS/HIPEC, patients without 30-day complications demonstrated superior DSS compared to those with any complication (p < 0.05). B. In patients undergoing a complete cytoreduction, those with poorly differentiated tumors demonstrated significantly worse outcomes compared to those with less aggressive histology (p < 0.001).
Evolution of Short-Term Outcomes of Laparoscopic Surgery for Colon Cancer Ramzi Amri, Anne M. Dinaux, Liliana G. Bordeianou, David L. Berger Background Minimally invasive techniques to perform elective colectomy for colon cancer are becoming a more frequently chosen approach. General assumptions are that a laparoscopic procedure takes longer, but improves recovery and time to discharge. This study compares differences in operation duration and in-hospital admission duration between open and laparoscopic resections and their evolution over time. Methods All elective colon cancer cases with primary anastomosis and curative intent operated on at our center (2004-2011), using either an open or purely laparoscopic approach were included (n=785). Median admission and operation durations were compared between open (n=603) and laparoscopic resections (n=182), also comparing the 2004-2007 interval with 2008-2011. Multivariable regression assessed these relationships while controlling for the age, ASA-score, BMI, adhesions, operative complications, additional procedures, gender, multivisceral resection, procedure anatomical region, stapled anastomosis, and operating surgeon, where relevant. Results Patients with a laparoscopic approach initially underwent significantly longer operations (median: 147 vs. 111 minutes; P<0.001) but had shorter operation times in the second half (105 vs. 118; P<0.001). Admissions were a median of 5 days in open colectomies, while being shorter and decreasing in laparoscopic admissions (2004-2007:4 days; P=0.007; 20072011:3 days; P<0.001). Multivariable models confirm the odds of having an admission of 4 days or less became increasingly more likely in laparoscopic procedures (2004-2007:OR= 1.54;P=0.20; 2007-2011:OR=2.95;P<0.001). Conversely, the advantage of surgery duration in open procedures decreased and was no longer significant (2004-2007:OR=0.47;P=0.045; 2008-2011:OR=0.63;P=0.09) Conclusion Minimally invasive approaches for colon cancer resections initially increase operation duration, but also decrease admission duration compared to an open approach. Over time and with adequate selection, laparoscopic surgery does not take any longer than open procedures and can even become shorter on average, while the beneficial effect on admission duration improves further with time.
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Mo1756 Factors Associated With Survival Following Cytoreductive Surgery and Heated Intraperitoneal Chemotherapy for Colorectal Cancer Sean Dineen, Kristen Robinson, Ching-Wei Tzeng, Karen Beaty, Paul Mansfield, Richard Royal, Keith Fournier Introduction: Patients with colorectal cancer and peritoneal carcinomatosis (CRC/PC) have a worse prognosis compared to patients with metastatic CRC to other organ sites, such as liver and lung. Cytoreductive surgery and heated intraperitoneal chemotherapy (CRS/HIPEC) has been shown to improve survival for select patients with CRC/PC, but carries a high morbidity rate. This study sought to determine factors associated with survival following CRS/HIPEC. Methods: Patients with CRC/PC evaluated in a peritoneal surface malignancy clinic between 2008 and 2014 were identified. Patients with appendiceal cancers and nonCRC were excluded. Clinicopathologic data were extracted from chart review, including peritoneal carcinomatosis index (PCI) and completeness of cytoreduction score. Factors associated with survival were assessed using univariate and multivariate analysis. 30-day complication rates were determined using the Clavien-Dindo classification. Results: 52 patients underwent operation with intent for CRS/HIPEC. 43 patients (82.7%) underwent complete cytoreduction (CCR 0/1). There were no significant differences in demographics between the groups. Median disease specific survival (DSS) was 55.1 months in the patients undergoing complete cytoreduction, compared to 12.8 months in patients who underwent incomplete cytoreduction (p < 0.05). Disease burden was a significant predictor of survival, as patients with a PCI score £6 demonstrated a significantly longer DSS compared to those with higher scores (p < 0.01). In patients who received a complete cytoreduction, poorly differentiated tumors demonstrated worse DSS (55 months vs 13 months, p < 0.0001). In 37 patients in whom KRAS mutation status was known, there was no significant survival difference based on KRAS status. In patients with CCR 0/1 resection, postoperative complications occurred in 73.2% of patients; with 29.2% of patients experiencing grade 3-4 complications (no postoperative deaths). Experiencing a postoperative complication was associated with decreased survival (33 months vs. median DSS not reached, p<0.05). On multivariate analysis of patients who received CCR 0/1 resection, poorly differentiated histology was associated with decreased DSS (HR 9.5, CI 2.1 - 44.2, p < 0.01). Conclusion: For patients with CRC/PC who qualify for CRS/HIPEC, intention for complete cytoreduction is essential for maximal oncologic benefit. Patients with lower volume of disease and less aggressive tumor grade also fare better in DSS. Given the high rate of complications and their negative survival impact, patient selection should be based on PCI, tumor grade, and performance status.
A. Following CRS/HIPEC, patients without 30-day complications demonstrated superior DSS compared to those with any complication (p < 0.05). B. In patients undergoing a complete cytoreduction, those with poorly differentiated tumors demonstrated significantly worse outcomes compared to those with less aggressive histology (p < 0.001).
Evolution of Short-Term Outcomes of Laparoscopic Surgery for Colon Cancer Ramzi Amri, Anne M. Dinaux, Liliana G. Bordeianou, David L. Berger Background Minimally invasive techniques to perform elective colectomy for colon cancer are becoming a more frequently chosen approach. General assumptions are that a laparoscopic procedure takes longer, but improves recovery and time to discharge. This study compares differences in operation duration and in-hospital admission duration between open and laparoscopic resections and their evolution over time. Methods All elective colon cancer cases with primary anastomosis and curative intent operated on at our center (2004-2011), using either an open or purely laparoscopic approach were included (n=785). Median admission and operation durations were compared between open (n=603) and laparoscopic resections (n=182), also comparing the 2004-2007 interval with 2008-2011. Multivariable regression assessed these relationships while controlling for the age, ASA-score, BMI, adhesions, operative complications, additional procedures, gender, multivisceral resection, procedure anatomical region, stapled anastomosis, and operating surgeon, where relevant. Results Patients with a laparoscopic approach initially underwent significantly longer operations (median: 147 vs. 111 minutes; P<0.001) but had shorter operation times in the second half (105 vs. 118; P<0.001). Admissions were a median of 5 days in open colectomies, while being shorter and decreasing in laparoscopic admissions (2004-2007:4 days; P=0.007; 20072011:3 days; P<0.001). Multivariable models confirm the odds of having an admission of 4 days or less became increasingly more likely in laparoscopic procedures (2004-2007:OR= 1.54;P=0.20; 2007-2011:OR=2.95;P<0.001). Conversely, the advantage of surgery duration in open procedures decreased and was no longer significant (2004-2007:OR=0.47;P=0.045; 2008-2011:OR=0.63;P=0.09) Conclusion Minimally invasive approaches for colon cancer resections initially increase operation duration, but also decrease admission duration compared to an open approach. Over time and with adequate selection, laparoscopic surgery does not take any longer than open procedures and can even become shorter on average, while the beneficial effect on admission duration improves further with time.
S-1241
X : 10052$CH03 03-28-16 22:41:04 PDFd : 10052B : o
Page 1241
SSAT Abstracts
SSAT Abstracts
Mo1757