- Email: [email protected]
Mo1770 Depression, Anxiety, and Stress Reduction After Bariatric Surgery
Mo1766
were analyzed. When divided by surgery type, those undergoing gastric bypass showed significant reduction in all measures. Patients undergoing sleeve gastrectomy only improved their stress scores (p = 0.031) while patients undergoing gastric banding improved their stress (p = 0.016) and total DASS (p = 0.05) scores. Depression was self-reported in 49% of patients. Those that reported depression pre-operatively had significantly higher depression specific scores than those without self-reported depression (p = 0.045). Anxiety and stress specific scores, as well as total DASS scores, were not significantly different between those with and without self-reported depression (all p values .0.252). Three months after surgery, those with pre-operative self-reported depression had greater percent reduction in all scores, although none of these differences were significant. BMI, weight, and excess weight loss were found to have no correlation to reduction of DASS scores. Waist circumference reduction, however, was correlated with reduction in depression specific (p = 0.096) and anxiety specific (p = 0.011) scores. Conclusion: Weight loss surgery provides promising reductions in DASS scores, even at the 3-month time point. Those with depression scored higher at baseline, but fortunately had greater improvement of those scores at 3-months. Waist circumference was also found to be associated with change in DASS scores.
Current Treatment Strategy for Early Gastric Cancer At a New York Urban Medical Center Shinichi Fukuhara, Marissa M. Montgomery, Steven T. Brower, Martin S. Karpeh Background: Gastrectomy with lymph node (LN) dissection was considered as the gold standard for early gastric cancer (EGC) in the past. However, expansion of the criteria for endoscopic treatment has been currently proposed. This study aims to investigate the histopathologic determinants and outcomes of EGC in order to redefine the current treatment strategy. Methods: The gastric cancer tumor registry at our institution was reviewed. Sixtyseven patients were identified who underwent either endoscopic mucosal resection (EMR) or gastrectomy for EGC or high grade dysplasia between 2006 and 2011. A retrospective analysis was performed on the medical records of these patients. Mean follow-up period was 21+/-18 (1-73) months. Results: The study population consisted of 25 (37.9%) Asians, 24 (36.4%) Caucasians, 11 (16.7%) Hispanics, 7 (10.6%) African-Americans. The incidence of lymph node metastasis was 3.1% in Asians and 17.1% in non-Asians, respectively. Nine patients underwent EMR and 58 patients underwent gastrectomy with LN dissection. Among the latter group, eight (13.8%) patients had LN metastasis. Subgroup analysis comparing the histopathologic characteristics of T1b with T1a EGC was performed; nine (36.0%) patients with T1a and 11 (40.7%) patients with T1b had diffuse type histology (p=0.26). The incidence of lymph node metastasis was 4.0% with T1a in comparison to 25.9% with T1b (p=0.03). The survival rate for the T1b group (92.6%) did not differ significantly from that of the T1a group (93.5%) during the follow-up period. Conclusions: EGC in Asian Americans is less likely to be associated with LN metastases than non-Asian EGC regardless of depth or histotype. In our small series with ethnic diversity, patients with T1b EGC had significantly higher LN metastasis rate but did not have a significantly different survival rate from those with T1a, indicating that gastrectomy with LN dissection should remain the standard strategy for T1b EGC.
Mo1834
Mo1767 Development and Validation of Pgsas-45, an Integrated Questionnaire to Assess Postgastrectomy Syndrome Koji Nakada, Masami Ikeda, Masazumi Takahashi, Shinichi Kinami, Masashi Yoshida, Yoshikazu Uenosono, Yoshiyuki Kawashima, Atsushi Oshio, Yoshimi Suzukamo, Masanori Terashima, Yasuhiro Kodera BACKGROUND: Postgastrectomy syndrome (PGS) is common after gastrectomy. Information regarding actual details of the PGS and their relation to surgical procedures, however, is limited possibly due to the fact that optimal instrument to assess PGS is lacking. A questionnaire, Postgastrectomy Syndrome Assessment Scale (PGSAS)-45, was therefore developed by a voluntary group, Japan Postgastrectomy Syndrome Working Party. PGSAS-45 was designed to assess severity of the PGS, the status of oral food intake and degree of recovery in terms of social roles, and impact of these factors on patients' well-being. METHODS: PGSAS-45 is an integrated questionnaire consisting of 45 items including items selectively taken with permission from the standardized generic QOL questionnaire SF-8 (8 items) and the symptom-specific QOL questionnaire gastrointestinal symptom rating scale (GSRS; 15 items). Items selected from an item pool as being clinical relevant by 47 gastric surgeons were added to these to constitute the PGSAS-45. In the current study, 52 institutions were involved in "Postgastrectomy Syndrome Assessment Study (PGSAS)", a nation-wide study to validate PGSAS-45, in which a total of 2520 PGSAS-45 questionnaires (86% of those that were originally sent out) were retrieved from the patients who received either of the six different types of gastrectomy procedures. Of these, 1516 questionnaires retrieved from the patients who received conventional gastrectomy (total with Roux-en-Y [n=393], distal with Billroth-I [n=909], distal with Roux-en-Y [n=475]) were statistically analyzed. RESULTS: The 23 symptom items of PGSAS-45 was composed of seven symptom subscales (SS), 'esophageal reflux SS', 'abdominal pain SS', 'meal-related distress SS', 'indigestion SS', 'diarrhea SS', 'constipation SS' and 'dumping SS' by factor analysis. The seven symptom subscales and other two domains, 'quality of ingestion SS' and 'dissatisfaction for daily life SS', had good internal consistency in terms of Cronbach's alpha (.65-.88). Multiple regression analysis demonstrated that the sum of newly added 8 symptoms had larger impact [Beta] compared to the sum of 15 symptoms of GSRS, in ingestion (.32, .02), ability for working (.35, .09), loss in body weight (.24, .07), physical component summary (PCS) (.35, .17) and dissatisfaction for daily life SS (.60, .11). The associations between patient's condition (symptoms, ingestion, ability for working) and HRQOL (PCS and mental component summary [MCS] of SF-8, dissatisfaction for daily life SS) was evident. The effect size [Beta, R2] was medium to large for all domains (.32 to .60, all p ,0.0001). CONCLUSIONS: The results indicated that the PGSAS-45 provides a valid and reliable integrated measurement of QOL in gastrectomized patients. Mo1770 Depression, Anxiety, and Stress Reduction After Bariatric Surgery Natalia Leva, Chris S. Crowe, Nayna A. Lodhia, John M. Morton Introduction Bariatric surgery is an effective and enduring therapy for weight loss and comorbidity remission. This study assesses patients' depression, anxiety, and stress before and after bariatric surgery utilizing the DASS questionnaire. Methods: Demographic, preoperative, and three-month postop data were prospectively collected for 135 consecutive surgeries at a single academic institution. Before surgery and at a 3 months post op, the DASS questionnaire was administered. Weight, anthropometric features, and demographic data were collected. DASS scores were compared to demographic, preop, and postop data by student T-test and chi-squared analysis for continuous and dichotomous variables respectively using GraphPad Prisim 6. Results: All 135 patients completed preoperative DASS questionnaires. Of these, 93 patients were at or beyond the 3-month postoperative time point. 55% of these patients completed their 3-month questionnaires. Patient demographics included an average BMI 45, age 47, 51% white, and 4 total preoperative comorbidities. Depression, anxiety, stress, and total DASS scores reduced significantly at 3 months when all patients
S-1111
Introduction: It has been shown that the proangiogenic proteins angiogenin (ANG) and interleukin-8 (IL8) are produced by endothelial cells (EC), fibroblasts and peripheral blood cells. Also, some colon, breast, and prostate cancers have been shown to over express ANG and IL8. EC surface actins are receptors for ANG; the binding of ANG to actin on EC's promotes degradation of the basement membrane which facilitates EC migration, an essential early step in angiogenesis. EC's also express the IL-8 receptors CXCR1 and CXCR2; tumor derived IL8, via binding to these receptors, in an autocrine fashion, enhances tumor cell proliferation and survival and also promotes pathologic angiogenesis. IL8's pro-angiogenic effects are independent of VEGF. Plasma ANG and IL8 levels in patients with colorectal cancer (CRC) have not been well studied. This study's purpose was to compare preoperative (PreOp) plasma ANG and IL8 levels in patients with CRC and benign colonic diseases (BCD). Method: Patients undergoing colorectal resection for CRC or BCD prospectively enrolled in an IRB approved tissue/data bank, for whom PreOp plasma was available, were studied. Clinical, operative and pathologic data were collected. Plasma ANG (ng/ml) and IL8 (pg/ml) levels were determined via ELISA in duplicate and reported as median 95%CI. Levels between groups were compared by the Mann- Whitney test (significance p ,0.05). Results: A total of 122 CRC (66% colon, 34% rectal) and 96 BCD (adenoma 50%, diverticulitis 47%, other 3%) patients were included. Plasma stores (PreOp samples) did not permit both assays to be done for all patients. In regards to ANG, 86 CRC and 80 BCD patients were studied while the IL8 assay included 73 CRC and 62 BCD patients. The median PreOp CRC ANG level (ng/ml) (339.9, CI: 339.6, 373.2) was significantly higher than the BCD group result (295.6, CI: 276.0, 306.6; p ,0.0001). Similarly, for IL8, the median PreOp CRC level (pg/ml) (17.3, CI 17.8, 22.8) was higher than the BCD groups outcome (14.2, CI: 12.8, 16.8; p,0.001). Of note no correlation was found between ANG or IL8 plasma levels and cancer stage. Conclusion: The median PreOp plasma ANG and IL8 levels in the CRC group were modestly increased (21-25%) vs. the BCD patients. ANG and IL8 shed from tumors expressing these proteins may be responsible for the increase. Alternate sources may be neovascularization and inflammation at the tumor site. Further study of larger groups with concomitant tumor analysis would help determine the clinical relevance, if any, of these changes, the source of the added protein and would better define the relationship between cancer stage and blood levels. Mo1835 Intestinal Permeability Is Increased During Postoperative Ileus in Mice Xue Zhao, Till M. Macheroux, Michael S. Kasparek, Mario Mueller, Martin E. Kreis Introduction: Pathophysiology of postoperative ileus (POI) involves an intestinal inflammatory response. One potential mechanism is translocation of macromolecules from the gut lumen. We aimed to investigate whether the time course of translocation is dependent on molecular weight. Methods: C57Bl6 mice were deeply anesthetized by isoflurane inhalation and gavaged with flourescein isothiocyanate conjugated dextrane (FITC-dextrane, 4.4 kDa) and horseradish peroxidase (HRP, 40 kDa). One hour later, a mini-laparotomy was performed and the small intestine manipulated in standardized fashion to induce POI, while control animals received sham laparotomy without manipulation. Intestinal permeability was assessed in POI animals or sham controls 1, 3 and 9 hours later in different subgroups (each n=6). For this purpose blood was taken by right ventricular puncture and serum concentrations of FITC-dextrane and HRP determined by spectrophotometry. Data are mean±SEM. Results: Serum levels of FITC-dextrane (4.4 kDa) in ng/ml; *p ,0.05; **p,0.001 POI vs. sham Sham 72 ± 5 83 ± 2 56 ± 6 (1h / 3h / 9h) POI 120 ± 8* 183 ± 22** 65 ± 5 (1h / 3h / 9h) Serum levels of horse radish peroxidase (40 kDa) in ng/ml; *p ,0.05 POI vs. sham. Sham 198 ± 18 240 ± 29 226 ± 24 (1h / 3h / 9h) POI 350 ± 38* 388 ± 38* 300 ± 28 (1h / 3h / 9h) Conclusions: Intestinal permeability for macromolecules was already increased a few hours after induction of postoperative ileus. This appeared to be independent of their molecular weight. Translocation of macromolcules into the intestinal wall early after induction of postoperaitve ileus is a potential trigger of subsequet intestinal inflammatory responses. Supported by the Else Kröner-Fresenius Stiftung 2011_A214.
SSAT Abstracts
SSAT Abstracts
Plasma Levels of the Proangiogenic Proteins Angiogenin and Interleukin-8 Are Significantly Increased in Patients With Colorectal Cancer M. C. Shantha Kumara H, Hiromichi Miyagaki, Xiaohong Yan, Elizabeth Myers, Sonali A. Herath, Sahani De Silva, Linda Njoh, Vesna Cekic, Richard L. Whelan
were analyzed. When divided by surgery type, those undergoing gastric bypass showed significant reduction in all measures. Patients undergoing sleeve gastrectomy only improved their stress scores (p = 0.031) while patients undergoing gastric banding improved their stress (p = 0.016) and total DASS (p = 0.05) scores. Depression was self-reported in 49% of patients. Those that reported depression pre-operatively had significantly higher depression specific scores than those without self-reported depression (p = 0.045). Anxiety and stress specific scores, as well as total DASS scores, were not significantly different between those with and without self-reported depression (all p values .0.252). Three months after surgery, those with pre-operative self-reported depression had greater percent reduction in all scores, although none of these differences were significant. BMI, weight, and excess weight loss were found to have no correlation to reduction of DASS scores. Waist circumference reduction, however, was correlated with reduction in depression specific (p = 0.096) and anxiety specific (p = 0.011) scores. Conclusion: Weight loss surgery provides promising reductions in DASS scores, even at the 3-month time point. Those with depression scored higher at baseline, but fortunately had greater improvement of those scores at 3-months. Waist circumference was also found to be associated with change in DASS scores.
Current Treatment Strategy for Early Gastric Cancer At a New York Urban Medical Center Shinichi Fukuhara, Marissa M. Montgomery, Steven T. Brower, Martin S. Karpeh Background: Gastrectomy with lymph node (LN) dissection was considered as the gold standard for early gastric cancer (EGC) in the past. However, expansion of the criteria for endoscopic treatment has been currently proposed. This study aims to investigate the histopathologic determinants and outcomes of EGC in order to redefine the current treatment strategy. Methods: The gastric cancer tumor registry at our institution was reviewed. Sixtyseven patients were identified who underwent either endoscopic mucosal resection (EMR) or gastrectomy for EGC or high grade dysplasia between 2006 and 2011. A retrospective analysis was performed on the medical records of these patients. Mean follow-up period was 21+/-18 (1-73) months. Results: The study population consisted of 25 (37.9%) Asians, 24 (36.4%) Caucasians, 11 (16.7%) Hispanics, 7 (10.6%) African-Americans. The incidence of lymph node metastasis was 3.1% in Asians and 17.1% in non-Asians, respectively. Nine patients underwent EMR and 58 patients underwent gastrectomy with LN dissection. Among the latter group, eight (13.8%) patients had LN metastasis. Subgroup analysis comparing the histopathologic characteristics of T1b with T1a EGC was performed; nine (36.0%) patients with T1a and 11 (40.7%) patients with T1b had diffuse type histology (p=0.26). The incidence of lymph node metastasis was 4.0% with T1a in comparison to 25.9% with T1b (p=0.03). The survival rate for the T1b group (92.6%) did not differ significantly from that of the T1a group (93.5%) during the follow-up period. Conclusions: EGC in Asian Americans is less likely to be associated with LN metastases than non-Asian EGC regardless of depth or histotype. In our small series with ethnic diversity, patients with T1b EGC had significantly higher LN metastasis rate but did not have a significantly different survival rate from those with T1a, indicating that gastrectomy with LN dissection should remain the standard strategy for T1b EGC.
Mo1834
Mo1767 Development and Validation of Pgsas-45, an Integrated Questionnaire to Assess Postgastrectomy Syndrome Koji Nakada, Masami Ikeda, Masazumi Takahashi, Shinichi Kinami, Masashi Yoshida, Yoshikazu Uenosono, Yoshiyuki Kawashima, Atsushi Oshio, Yoshimi Suzukamo, Masanori Terashima, Yasuhiro Kodera BACKGROUND: Postgastrectomy syndrome (PGS) is common after gastrectomy. Information regarding actual details of the PGS and their relation to surgical procedures, however, is limited possibly due to the fact that optimal instrument to assess PGS is lacking. A questionnaire, Postgastrectomy Syndrome Assessment Scale (PGSAS)-45, was therefore developed by a voluntary group, Japan Postgastrectomy Syndrome Working Party. PGSAS-45 was designed to assess severity of the PGS, the status of oral food intake and degree of recovery in terms of social roles, and impact of these factors on patients' well-being. METHODS: PGSAS-45 is an integrated questionnaire consisting of 45 items including items selectively taken with permission from the standardized generic QOL questionnaire SF-8 (8 items) and the symptom-specific QOL questionnaire gastrointestinal symptom rating scale (GSRS; 15 items). Items selected from an item pool as being clinical relevant by 47 gastric surgeons were added to these to constitute the PGSAS-45. In the current study, 52 institutions were involved in "Postgastrectomy Syndrome Assessment Study (PGSAS)", a nation-wide study to validate PGSAS-45, in which a total of 2520 PGSAS-45 questionnaires (86% of those that were originally sent out) were retrieved from the patients who received either of the six different types of gastrectomy procedures. Of these, 1516 questionnaires retrieved from the patients who received conventional gastrectomy (total with Roux-en-Y [n=393], distal with Billroth-I [n=909], distal with Roux-en-Y [n=475]) were statistically analyzed. RESULTS: The 23 symptom items of PGSAS-45 was composed of seven symptom subscales (SS), 'esophageal reflux SS', 'abdominal pain SS', 'meal-related distress SS', 'indigestion SS', 'diarrhea SS', 'constipation SS' and 'dumping SS' by factor analysis. The seven symptom subscales and other two domains, 'quality of ingestion SS' and 'dissatisfaction for daily life SS', had good internal consistency in terms of Cronbach's alpha (.65-.88). Multiple regression analysis demonstrated that the sum of newly added 8 symptoms had larger impact [Beta] compared to the sum of 15 symptoms of GSRS, in ingestion (.32, .02), ability for working (.35, .09), loss in body weight (.24, .07), physical component summary (PCS) (.35, .17) and dissatisfaction for daily life SS (.60, .11). The associations between patient's condition (symptoms, ingestion, ability for working) and HRQOL (PCS and mental component summary [MCS] of SF-8, dissatisfaction for daily life SS) was evident. The effect size [Beta, R2] was medium to large for all domains (.32 to .60, all p ,0.0001). CONCLUSIONS: The results indicated that the PGSAS-45 provides a valid and reliable integrated measurement of QOL in gastrectomized patients. Mo1770 Depression, Anxiety, and Stress Reduction After Bariatric Surgery Natalia Leva, Chris S. Crowe, Nayna A. Lodhia, John M. Morton Introduction Bariatric surgery is an effective and enduring therapy for weight loss and comorbidity remission. This study assesses patients' depression, anxiety, and stress before and after bariatric surgery utilizing the DASS questionnaire. Methods: Demographic, preoperative, and three-month postop data were prospectively collected for 135 consecutive surgeries at a single academic institution. Before surgery and at a 3 months post op, the DASS questionnaire was administered. Weight, anthropometric features, and demographic data were collected. DASS scores were compared to demographic, preop, and postop data by student T-test and chi-squared analysis for continuous and dichotomous variables respectively using GraphPad Prisim 6. Results: All 135 patients completed preoperative DASS questionnaires. Of these, 93 patients were at or beyond the 3-month postoperative time point. 55% of these patients completed their 3-month questionnaires. Patient demographics included an average BMI 45, age 47, 51% white, and 4 total preoperative comorbidities. Depression, anxiety, stress, and total DASS scores reduced significantly at 3 months when all patients
S-1111
Introduction: It has been shown that the proangiogenic proteins angiogenin (ANG) and interleukin-8 (IL8) are produced by endothelial cells (EC), fibroblasts and peripheral blood cells. Also, some colon, breast, and prostate cancers have been shown to over express ANG and IL8. EC surface actins are receptors for ANG; the binding of ANG to actin on EC's promotes degradation of the basement membrane which facilitates EC migration, an essential early step in angiogenesis. EC's also express the IL-8 receptors CXCR1 and CXCR2; tumor derived IL8, via binding to these receptors, in an autocrine fashion, enhances tumor cell proliferation and survival and also promotes pathologic angiogenesis. IL8's pro-angiogenic effects are independent of VEGF. Plasma ANG and IL8 levels in patients with colorectal cancer (CRC) have not been well studied. This study's purpose was to compare preoperative (PreOp) plasma ANG and IL8 levels in patients with CRC and benign colonic diseases (BCD). Method: Patients undergoing colorectal resection for CRC or BCD prospectively enrolled in an IRB approved tissue/data bank, for whom PreOp plasma was available, were studied. Clinical, operative and pathologic data were collected. Plasma ANG (ng/ml) and IL8 (pg/ml) levels were determined via ELISA in duplicate and reported as median 95%CI. Levels between groups were compared by the Mann- Whitney test (significance p ,0.05). Results: A total of 122 CRC (66% colon, 34% rectal) and 96 BCD (adenoma 50%, diverticulitis 47%, other 3%) patients were included. Plasma stores (PreOp samples) did not permit both assays to be done for all patients. In regards to ANG, 86 CRC and 80 BCD patients were studied while the IL8 assay included 73 CRC and 62 BCD patients. The median PreOp CRC ANG level (ng/ml) (339.9, CI: 339.6, 373.2) was significantly higher than the BCD group result (295.6, CI: 276.0, 306.6; p ,0.0001). Similarly, for IL8, the median PreOp CRC level (pg/ml) (17.3, CI 17.8, 22.8) was higher than the BCD groups outcome (14.2, CI: 12.8, 16.8; p,0.001). Of note no correlation was found between ANG or IL8 plasma levels and cancer stage. Conclusion: The median PreOp plasma ANG and IL8 levels in the CRC group were modestly increased (21-25%) vs. the BCD patients. ANG and IL8 shed from tumors expressing these proteins may be responsible for the increase. Alternate sources may be neovascularization and inflammation at the tumor site. Further study of larger groups with concomitant tumor analysis would help determine the clinical relevance, if any, of these changes, the source of the added protein and would better define the relationship between cancer stage and blood levels. Mo1835 Intestinal Permeability Is Increased During Postoperative Ileus in Mice Xue Zhao, Till M. Macheroux, Michael S. Kasparek, Mario Mueller, Martin E. Kreis Introduction: Pathophysiology of postoperative ileus (POI) involves an intestinal inflammatory response. One potential mechanism is translocation of macromolecules from the gut lumen. We aimed to investigate whether the time course of translocation is dependent on molecular weight. Methods: C57Bl6 mice were deeply anesthetized by isoflurane inhalation and gavaged with flourescein isothiocyanate conjugated dextrane (FITC-dextrane, 4.4 kDa) and horseradish peroxidase (HRP, 40 kDa). One hour later, a mini-laparotomy was performed and the small intestine manipulated in standardized fashion to induce POI, while control animals received sham laparotomy without manipulation. Intestinal permeability was assessed in POI animals or sham controls 1, 3 and 9 hours later in different subgroups (each n=6). For this purpose blood was taken by right ventricular puncture and serum concentrations of FITC-dextrane and HRP determined by spectrophotometry. Data are mean±SEM. Results: Serum levels of FITC-dextrane (4.4 kDa) in ng/ml; *p ,0.05; **p,0.001 POI vs. sham Sham 72 ± 5 83 ± 2 56 ± 6 (1h / 3h / 9h) POI 120 ± 8* 183 ± 22** 65 ± 5 (1h / 3h / 9h) Serum levels of horse radish peroxidase (40 kDa) in ng/ml; *p ,0.05 POI vs. sham. Sham 198 ± 18 240 ± 29 226 ± 24 (1h / 3h / 9h) POI 350 ± 38* 388 ± 38* 300 ± 28 (1h / 3h / 9h) Conclusions: Intestinal permeability for macromolecules was already increased a few hours after induction of postoperative ileus. This appeared to be independent of their molecular weight. Translocation of macromolcules into the intestinal wall early after induction of postoperaitve ileus is a potential trigger of subsequet intestinal inflammatory responses. Supported by the Else Kröner-Fresenius Stiftung 2011_A214.
SSAT Abstracts
SSAT Abstracts
Plasma Levels of the Proangiogenic Proteins Angiogenin and Interleukin-8 Are Significantly Increased in Patients With Colorectal Cancer M. C. Shantha Kumara H, Hiromichi Miyagaki, Xiaohong Yan, Elizabeth Myers, Sonali A. Herath, Sahani De Silva, Linda Njoh, Vesna Cekic, Richard L. Whelan