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Outcome of open distal pancreatectomy: An audit at tertiary care hospital
S222 19. Presentation and outcome of young and old age rectal cancers at a tertiary care center in Pakistan e A six years’ experience Muhammad Asad Moosa, Iqra Jangda, Abdul Rehman Alvi Aga Khan University Hospital, Pakistan Aim: Rectal cancer is one of the most challenging problems and it is the second leading cause of cancer deaths in western countries. Incidence of rectal cancer is also increasing in Pakistan. In order to refine our understanding of how young-onset rectal cancer patients differ from older patients in our population, we conducted a study focusing on the clinicopathological features and oncologic outcomes in these two age groups. Method: Records of patients diagnosed with rectal cancer and treated in our hospital were reviewed from January 2005 to December 2010 retrospectively. Age of 40 was taken as a demarcation between young and old age. Results: Total of 143 patients were reviewed. 31% were below age 40. Mean age of total number of patients was 50.9 (15.9) and highest numbers of patients were within age between 60 and 70. Around 66% of patients were male and remaining 34% were females. Patients having tumor localized to upper one third of rectum were 54% and rest were having that of lower one third with no statistical significance seen between two age groups in terms of tumor location. Most common tumors presenting were moderately differentiated adenocarcinoma (70%) in both age groups however, poorly differentiated adenocarcinoma were seen more in young age then in elderlies. Patients in both the age groups presented as stage III rectal cancers (46.2%). Patients were followed for a period of 3 years and around 22% of patients had recurrence with the survival rates low in young age groups, equal in terms of gender and low in poorly differentiated, mucinous and stage III tumors. Conclusion: Results obtained from this study showed few differences in disease pattern and outcome between the two age groups. However, these findings can further be used in comparison with the international data and for our future references. http://dx.doi.org/10.1016/j.ejso.2016.07.033
21. Characterisation of the arachidonic acid metabolising pathway in colorectal cancer Graeme Murray1, Abdo Alnalbulsi1, Rebecca Swan1, Beatriz Cash2, Ayahm Alnabulsi2 1 University of Aberdeen, UK 2 Vertebrate Antibodies, UK Background: Colorectal cancer is one of the most common types of cancer in the developed world. Arachidonic acid is converted by individual cytochrome P450 enzymes to epoxyeicosatrienoic acids which have been implicated in various cancer-associated biological processes. Thus, the aim of this study was to profile the expression of arachidonic acid metabolising enzymes in primary colorectal cancer and assess the association between their expression and prognosis. Method: Monoclonal antibodies to CYP4A11, CYP4F11, CYP4V2 and CYP4Z1 were developed and successfully characterised by immunoblotting and immunohistochemistry. The antibodies were then used to profile the expression of those enzymes by immunohistochemistry on a large and well characterised colorectal cancer cohort (n ¼ 650) arrayed on a tissue microarray. The immunohistochemistry results were interpreted by light microscopy using a semi-quantitative scoring system. Results: For each antibody, immunoblotting using lysate overexpressing the relevant protein resulted in a band migrating at the expected molecular weight. The expression of CYP4A11 (p < 0.001), CYP4F11 (p < 0.001) and CYP4V2 (p < 0.001) were significantly higher in primary tumour when compared to normal mucosa. While, significant reduction in the expression of CYP4A11 (P ¼ 0.007), CYP4F11 (P < 0.001), CYP4V2 (P < 0.001) was observed in lymph node metastasis compared with their corresponding primary tumours. The presence of strong CYPA11
ABSTRACTS immunoreactivity was associated with significantly reduced survival in the whole patient cohort (c2 ¼ 7.234, p ¼ 0.007) and in mismatch repair (MMR) proficient tumours (c2 ¼ 9.404, p ¼ 0.002). CYP4F11 immunoreactivity was significantly associated with poor survival in MMR deficient tumours (c2 ¼ 4.684, p ¼ 0.03). Conclusion: In conclusion, arachidonic acid metabolising enzymes CYP4A11, CYP4V2 and CYP4F11 are significantly overexpressed in patients with colorectal cancer. The high expression of CYP4A11 is significantly associated with poor survival. http://dx.doi.org/10.1016/j.ejso.2016.07.034
22. Outcome of open distal pancreatectomy: An audit at tertiary care hospital Amyna Jiwani, Tabish Chawla Aga Khan University Hospital, Pakistan Method: From January 2004 till December 2015, peri-operative and post operative data of 38 patients underwent distal pancreatectomy were recorded by using ICD 9 coding. Data was collected on designed performa for all patients for pancreatic/peripancreatic diseases. Quantitative variables like age, operative time, ASA level, intra-operative blood loss and postoperative hospital stay are presented as mean with standard deviation or median with interquartile range depending on the distribution of data. Study endpoints for the risk factor for morbidity and the development of a pancreatic fistula. Univariate logistic regressions were performed associated with study endpoints. P value less than 0.05 will be considered significant. Results: There was an increase in the rate of operations in patients with benign or malignant diseases of pancreas and a significant change in operative techniques ranging from suture technique to staples and then both. Post operative pancreatic fistula was the most common peri-operative morbidity. Associated factor for pancreatic fistula was multivisceral resection as compared to spleen preserving distal pancreatectomy and distal pancreatectomy (p-value: 0.039). While age, ASA level, BMI and blood transfusion were not statistically significant. However, the technique of stump closure when opted for suture technique was seen to be associated with higher occurrence of POPF. The mortality rate was 2.6%. Out of 8 patients with POPF, 7 were type A and B and managed conservatively however; one was type C and managed with endoscopy and surgical drainage. Conclusion: Post operative pancreatic fistula is the most common complication seen after distal pancreatectomy as compared to other morbidity. The combination of stapler and suture closure shows superiority over suture closure alone. Prospective studies are needed for further establishment of this relationship. http://dx.doi.org/10.1016/j.ejso.2016.07.035
23. Outcomes and prognostic markers of patients admitted to intensive care: A six-year analysis Kenrick Ng, Sophie Joury, Roopinder Gillmore Royal Free Hospital, UK Background: Perceived dismal outcomes for oncology patients requiring life support means that decisions regarding ITU admission are challenging. Discussion whether cancer patients with advanced cancer should be admitted to ICU raises controversy, with concerns about inappropriate use of limited resources on one hand and denial of effective care on the other. Advances in both oncological and intensive care, however, mean that much greater numbers of critically ill cancer patients are surviving and benefiting from ITU support. We aim to identify the prognostic factors that can be used to predict outcomes for cancer patients requiring intensive care.
21. Characterisation of the arachidonic acid metabolising pathway in colorectal cancer Graeme Murray1, Abdo Alnalbulsi1, Rebecca Swan1, Beatriz Cash2, Ayahm Alnabulsi2 1 University of Aberdeen, UK 2 Vertebrate Antibodies, UK Background: Colorectal cancer is one of the most common types of cancer in the developed world. Arachidonic acid is converted by individual cytochrome P450 enzymes to epoxyeicosatrienoic acids which have been implicated in various cancer-associated biological processes. Thus, the aim of this study was to profile the expression of arachidonic acid metabolising enzymes in primary colorectal cancer and assess the association between their expression and prognosis. Method: Monoclonal antibodies to CYP4A11, CYP4F11, CYP4V2 and CYP4Z1 were developed and successfully characterised by immunoblotting and immunohistochemistry. The antibodies were then used to profile the expression of those enzymes by immunohistochemistry on a large and well characterised colorectal cancer cohort (n ¼ 650) arrayed on a tissue microarray. The immunohistochemistry results were interpreted by light microscopy using a semi-quantitative scoring system. Results: For each antibody, immunoblotting using lysate overexpressing the relevant protein resulted in a band migrating at the expected molecular weight. The expression of CYP4A11 (p < 0.001), CYP4F11 (p < 0.001) and CYP4V2 (p < 0.001) were significantly higher in primary tumour when compared to normal mucosa. While, significant reduction in the expression of CYP4A11 (P ¼ 0.007), CYP4F11 (P < 0.001), CYP4V2 (P < 0.001) was observed in lymph node metastasis compared with their corresponding primary tumours. The presence of strong CYPA11
ABSTRACTS immunoreactivity was associated with significantly reduced survival in the whole patient cohort (c2 ¼ 7.234, p ¼ 0.007) and in mismatch repair (MMR) proficient tumours (c2 ¼ 9.404, p ¼ 0.002). CYP4F11 immunoreactivity was significantly associated with poor survival in MMR deficient tumours (c2 ¼ 4.684, p ¼ 0.03). Conclusion: In conclusion, arachidonic acid metabolising enzymes CYP4A11, CYP4V2 and CYP4F11 are significantly overexpressed in patients with colorectal cancer. The high expression of CYP4A11 is significantly associated with poor survival. http://dx.doi.org/10.1016/j.ejso.2016.07.034
22. Outcome of open distal pancreatectomy: An audit at tertiary care hospital Amyna Jiwani, Tabish Chawla Aga Khan University Hospital, Pakistan Method: From January 2004 till December 2015, peri-operative and post operative data of 38 patients underwent distal pancreatectomy were recorded by using ICD 9 coding. Data was collected on designed performa for all patients for pancreatic/peripancreatic diseases. Quantitative variables like age, operative time, ASA level, intra-operative blood loss and postoperative hospital stay are presented as mean with standard deviation or median with interquartile range depending on the distribution of data. Study endpoints for the risk factor for morbidity and the development of a pancreatic fistula. Univariate logistic regressions were performed associated with study endpoints. P value less than 0.05 will be considered significant. Results: There was an increase in the rate of operations in patients with benign or malignant diseases of pancreas and a significant change in operative techniques ranging from suture technique to staples and then both. Post operative pancreatic fistula was the most common peri-operative morbidity. Associated factor for pancreatic fistula was multivisceral resection as compared to spleen preserving distal pancreatectomy and distal pancreatectomy (p-value: 0.039). While age, ASA level, BMI and blood transfusion were not statistically significant. However, the technique of stump closure when opted for suture technique was seen to be associated with higher occurrence of POPF. The mortality rate was 2.6%. Out of 8 patients with POPF, 7 were type A and B and managed conservatively however; one was type C and managed with endoscopy and surgical drainage. Conclusion: Post operative pancreatic fistula is the most common complication seen after distal pancreatectomy as compared to other morbidity. The combination of stapler and suture closure shows superiority over suture closure alone. Prospective studies are needed for further establishment of this relationship. http://dx.doi.org/10.1016/j.ejso.2016.07.035
23. Outcomes and prognostic markers of patients admitted to intensive care: A six-year analysis Kenrick Ng, Sophie Joury, Roopinder Gillmore Royal Free Hospital, UK Background: Perceived dismal outcomes for oncology patients requiring life support means that decisions regarding ITU admission are challenging. Discussion whether cancer patients with advanced cancer should be admitted to ICU raises controversy, with concerns about inappropriate use of limited resources on one hand and denial of effective care on the other. Advances in both oncological and intensive care, however, mean that much greater numbers of critically ill cancer patients are surviving and benefiting from ITU support. We aim to identify the prognostic factors that can be used to predict outcomes for cancer patients requiring intensive care.