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Tu1451 Centralization of Care and Histologic Grade Alters Survival in Gastric Neuroendocrine Tumors
inhibited cell proliferation in vitro by 10% and had an additive effect on oxaliplatin-induced inhibition. In INS-GAS mice with advanced gastric cancer (12 months of age, male:femal= 1:1), local injections of Botox (once a month) had a synergistic effect with oxaliplatin treatment (given by i.p. injections for 2 months) in terms of pathological criteria (dysplasia and gastric histologic activity index) and tumor size. Conclusions: The preliminary results of this clinical trial demonstrate the feasibility and the safety of this procedure as a potential treatment for advanced gastric cancer. To further demonstrate the efficacy of Botox endoscopic treatment in combination with chemotherapy, a randomized, double-blind, and placebocontrolled trial with an open-label extension study is in preparation.
Tu1449 Marginal Ulcerations Occur Later than Previously Described and Have a Long and Variable Time to Resolution Allison Schulman, Aoife Devery, Christopher C. Thompson Introduction: Ulceration at the gastrojejunal anastomosis (GJA), also known as marginal ulceration, is a common complication of Roux-en-Y gastric bypass (RYGB). While these ulcerations are thought to occur early in the post-operative course, large prospective trials are lacking. Aims: To determine (1) the time to marginal ulcer diagnosis and (2) ulcer resolution in RYGB patients. Methods: This was a multi-center retrospective review of a prospectively collected database. Primary outcome was time to ulcer diagnosis (days). Secondary outcome was time to ulcer resolution (days). All patients who underwent RYGB were prospectively enrolled in the Research Patient Data Registry, and all patients found to have marginal ulceration on endoscopy were reviewed for inclusion in this analysis. Maximum medical management including therapy with high dose PPI was initiated in all cases, and repeat endoscopy was performed as per surveillance recommendations until ulcer healing was confirmed. Only patients with follow-up after the index endoscopy were included in time to resolution analysis. Means and medians were compared with Student's t-test or Wilcoxon based on normality of the data, respectively. Proportional comparisons between groups were performed with Fisher's Exact test. All statistics are reported as mean ± SEM or median[IQR]. Multivariate regression analysis was also performed. Results: 340 patients (age 51.7 ± 0.6yr, 253F / 53M) had pre-RYGB BMI of 47.0± 0.5 kg/m2. 225 were performed laparoscopically. Baseline characteristics are shown in Table 1. Median time to development of marginal ulceration was 628.5 [157, 1,690] days after RYGB, and was significantly earlier in patients who had undergone laparoscopic vs. open RYGB procedures (451 vs. 1551 days, p=<0.001). Median time to ulcer healing was 124.0 [76, 267] days. No difference was found in median time to ulcer healing between laparoscopic and open RYGB procedures (116.5 vs. 128.0 days, p =0.71). Multivariable regression analysis demonstrated that having a laparoscopic RYGB (p<0.001) and fistula development (p=0.03) significantly decreased time to marginal ulcer diagnosis when controlling for ulcer size, smoking status, H. pylori infection, non-steroidal anti-inflammatory (NSAID) use, gastric pouch length, and foreign body (suture/ staple material). Furthermore, having a laparoscopic procedure (p=0.04) significantly decreased time to ulcer healing when controlling for other variables. Conclusions: Time to marginal ulcer diagnosis in RYGB patients appears to be considerably later than previously described. Significant differences in time to diagnosis are seen in patients who underwent laparoscopic versus open RYGB procedures, and in those with gastrogastric fistula. Given the long and variable time to resolution, endoscopy to confirm ulcer healing is critical in the management of this complication. Table 1: Baseline characteristics
Figure 1: Median time to ulcer development (days) in patients who underwent laparoscopic versus open Roux-en-Y gastric bypass.
Tu1450 Braun Enteroenterostomy: A Safe Technique to Minimize Risk of Delayed Gastric Emptying After Distal Gastrectomy Stephen Doane, Michael Pucci, Karen Chojnacki, Ernest L. Rosato Delayed gastric emptying (DGE) can be a significant complication after partial gastric resection for benign or malignant disease. Braun enteroenterostomy was originally designed to prevent afferent loop syndrome after a Billroth II gastrojejunal anastomosis. Adding a Braun anastomosis may also improve gastric emptying and decrease the risk of alkaline reflux gastritis while avoiding the possible dysmotility from Roux stasis syndrome. We reviewed the outcomes of all distal gastrectomy patients over a 14-year period who received Billroth II reconstruction with a Braun enteroenterostomy (n=34), most of which were performed in patients with malignancy (76%). There was a 9% incidence of delayed gastric emptying, which was defined as more than 10 days until final tolerance of solid food. The median time to tolerance of solid food was 5 days. The median post-operative length of stay was 7 days. Overall 30day re-admission rate, morbidity, and mortality were 3%, 21%, and 0% respectively. There was no morbidity attributable to the Braun anastomosis. Braun enteroenterostomy appears to be a valuable technique for accelerating the tolerance of a solid diet after distal gastrectomy and may have a role within enhanced recovery pathways for gastric surgery.
Tu1451 Centralization of Care and Histologic Grade Alters Survival in Gastric Neuroendocrine Tumors Renee Tholey, Suraj Panjwani, Maureen D. Moore, Cheguevera Afaneh, Thomas J. Fahey, Rasa Zarnegar
SSAT Abstracts
Background: Gastric Neuroendocrine Tumors (NETs) make up a small subset of gastrointestinal malignancies and survival prognosis is typically based upon American Joint Committee on Cancer (AJCC) staging. However, disparity of access to care and tumor biology has been highlighted to potentially alter outcomes independent of staging. We aimed to determine the impact of centralization of care and clinicopathologic features on patient outcomes. Methods: The National Cancer Database (NCDB) (2004-2012) was utilized to collect clinicopathologic and survival data for Gastric NETs. Survival outcomes were evaluated based on demographics, tumor histology and grading, staging, adjuvant therapy, and type of medical center. Results: There were 1,114 patients included in the analyses. Based on histological grade, five-year overall survival for well, moderately, and poorly differentiated tumors was 85%, 77%, and 67%, respectively (p=0.008). Unlike stage I (p<0.001) where poorly differentiated tumors had worse prognosis; for stages II, III and IV tumor grade did not affect survival (p=0.88, 0.56, 0.45). Academic medical centers had improved overall survival when compared to comprehensive community cancer centers (p=0.045). Academic medical centers and comprehensive community centers did not differ in approach regarding laparoscopic versus open surgery (p=0.27). There was no significant difference in lymph node procurement rates between academic and comprehensive community centers (p=0.73), nor was the rate of R0 resection (p=0.10). Adjuvant chemotherapy or radiation therapy was performed in only 14 patients. Conclusion: Histologic grade predicts five-year overall survival and may be used in addition to AJCC staging as a prognostic indicator for Gastric NETs. Although academic centers did not differ from comprehensive community cancer centers in regard to R0 resection rates or lymph node procurement rates, overall survival was significantly better, supporting the proposal that centralization of care improves outcomes in Gastric NETs.
C.I. = 95% confidence interval. *denotes p-value <0.05, NS denotes non-significance.
Tu1452 Pathological Response Does Mean Something: An Analysis of Gastric Adenocarcinoma Muhammad U. Butt, D Rohan Jeyarajah, Alyssa Chapates, Houssam Osman Introduction: Medical Research Council Adjuvant Gastric Infusional Chemotherapy (MAGIC) trial demonstrated a survival benefit of neoadjuvant chemotherapy in patients with resectable gastric cancer. The efficacy of chemotherapy is evaluated based on degree of response in the surgical specimen. This response is classified as pathological response (PR). Radiological response (RR) is based on preoperative CT and PET scan following neoadjuvant chemotherapy. Our aim was to determine whether there is a correlation between pathological and radiological response in resected gastric cancer patients undergoing neoadjuvant chemotherapy. We also looked whether there was any survival advantage. Methods: Twenty-seven patients with gastric adenocarcinoma, including GEJ per NCCN guidelines who underwent
SSAT Abstracts
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Tu1449 Marginal Ulcerations Occur Later than Previously Described and Have a Long and Variable Time to Resolution Allison Schulman, Aoife Devery, Christopher C. Thompson Introduction: Ulceration at the gastrojejunal anastomosis (GJA), also known as marginal ulceration, is a common complication of Roux-en-Y gastric bypass (RYGB). While these ulcerations are thought to occur early in the post-operative course, large prospective trials are lacking. Aims: To determine (1) the time to marginal ulcer diagnosis and (2) ulcer resolution in RYGB patients. Methods: This was a multi-center retrospective review of a prospectively collected database. Primary outcome was time to ulcer diagnosis (days). Secondary outcome was time to ulcer resolution (days). All patients who underwent RYGB were prospectively enrolled in the Research Patient Data Registry, and all patients found to have marginal ulceration on endoscopy were reviewed for inclusion in this analysis. Maximum medical management including therapy with high dose PPI was initiated in all cases, and repeat endoscopy was performed as per surveillance recommendations until ulcer healing was confirmed. Only patients with follow-up after the index endoscopy were included in time to resolution analysis. Means and medians were compared with Student's t-test or Wilcoxon based on normality of the data, respectively. Proportional comparisons between groups were performed with Fisher's Exact test. All statistics are reported as mean ± SEM or median[IQR]. Multivariate regression analysis was also performed. Results: 340 patients (age 51.7 ± 0.6yr, 253F / 53M) had pre-RYGB BMI of 47.0± 0.5 kg/m2. 225 were performed laparoscopically. Baseline characteristics are shown in Table 1. Median time to development of marginal ulceration was 628.5 [157, 1,690] days after RYGB, and was significantly earlier in patients who had undergone laparoscopic vs. open RYGB procedures (451 vs. 1551 days, p=<0.001). Median time to ulcer healing was 124.0 [76, 267] days. No difference was found in median time to ulcer healing between laparoscopic and open RYGB procedures (116.5 vs. 128.0 days, p =0.71). Multivariable regression analysis demonstrated that having a laparoscopic RYGB (p<0.001) and fistula development (p=0.03) significantly decreased time to marginal ulcer diagnosis when controlling for ulcer size, smoking status, H. pylori infection, non-steroidal anti-inflammatory (NSAID) use, gastric pouch length, and foreign body (suture/ staple material). Furthermore, having a laparoscopic procedure (p=0.04) significantly decreased time to ulcer healing when controlling for other variables. Conclusions: Time to marginal ulcer diagnosis in RYGB patients appears to be considerably later than previously described. Significant differences in time to diagnosis are seen in patients who underwent laparoscopic versus open RYGB procedures, and in those with gastrogastric fistula. Given the long and variable time to resolution, endoscopy to confirm ulcer healing is critical in the management of this complication. Table 1: Baseline characteristics
Figure 1: Median time to ulcer development (days) in patients who underwent laparoscopic versus open Roux-en-Y gastric bypass.
Tu1450 Braun Enteroenterostomy: A Safe Technique to Minimize Risk of Delayed Gastric Emptying After Distal Gastrectomy Stephen Doane, Michael Pucci, Karen Chojnacki, Ernest L. Rosato Delayed gastric emptying (DGE) can be a significant complication after partial gastric resection for benign or malignant disease. Braun enteroenterostomy was originally designed to prevent afferent loop syndrome after a Billroth II gastrojejunal anastomosis. Adding a Braun anastomosis may also improve gastric emptying and decrease the risk of alkaline reflux gastritis while avoiding the possible dysmotility from Roux stasis syndrome. We reviewed the outcomes of all distal gastrectomy patients over a 14-year period who received Billroth II reconstruction with a Braun enteroenterostomy (n=34), most of which were performed in patients with malignancy (76%). There was a 9% incidence of delayed gastric emptying, which was defined as more than 10 days until final tolerance of solid food. The median time to tolerance of solid food was 5 days. The median post-operative length of stay was 7 days. Overall 30day re-admission rate, morbidity, and mortality were 3%, 21%, and 0% respectively. There was no morbidity attributable to the Braun anastomosis. Braun enteroenterostomy appears to be a valuable technique for accelerating the tolerance of a solid diet after distal gastrectomy and may have a role within enhanced recovery pathways for gastric surgery.
Tu1451 Centralization of Care and Histologic Grade Alters Survival in Gastric Neuroendocrine Tumors Renee Tholey, Suraj Panjwani, Maureen D. Moore, Cheguevera Afaneh, Thomas J. Fahey, Rasa Zarnegar
SSAT Abstracts
Background: Gastric Neuroendocrine Tumors (NETs) make up a small subset of gastrointestinal malignancies and survival prognosis is typically based upon American Joint Committee on Cancer (AJCC) staging. However, disparity of access to care and tumor biology has been highlighted to potentially alter outcomes independent of staging. We aimed to determine the impact of centralization of care and clinicopathologic features on patient outcomes. Methods: The National Cancer Database (NCDB) (2004-2012) was utilized to collect clinicopathologic and survival data for Gastric NETs. Survival outcomes were evaluated based on demographics, tumor histology and grading, staging, adjuvant therapy, and type of medical center. Results: There were 1,114 patients included in the analyses. Based on histological grade, five-year overall survival for well, moderately, and poorly differentiated tumors was 85%, 77%, and 67%, respectively (p=0.008). Unlike stage I (p<0.001) where poorly differentiated tumors had worse prognosis; for stages II, III and IV tumor grade did not affect survival (p=0.88, 0.56, 0.45). Academic medical centers had improved overall survival when compared to comprehensive community cancer centers (p=0.045). Academic medical centers and comprehensive community centers did not differ in approach regarding laparoscopic versus open surgery (p=0.27). There was no significant difference in lymph node procurement rates between academic and comprehensive community centers (p=0.73), nor was the rate of R0 resection (p=0.10). Adjuvant chemotherapy or radiation therapy was performed in only 14 patients. Conclusion: Histologic grade predicts five-year overall survival and may be used in addition to AJCC staging as a prognostic indicator for Gastric NETs. Although academic centers did not differ from comprehensive community cancer centers in regard to R0 resection rates or lymph node procurement rates, overall survival was significantly better, supporting the proposal that centralization of care improves outcomes in Gastric NETs.
C.I. = 95% confidence interval. *denotes p-value <0.05, NS denotes non-significance.
Tu1452 Pathological Response Does Mean Something: An Analysis of Gastric Adenocarcinoma Muhammad U. Butt, D Rohan Jeyarajah, Alyssa Chapates, Houssam Osman Introduction: Medical Research Council Adjuvant Gastric Infusional Chemotherapy (MAGIC) trial demonstrated a survival benefit of neoadjuvant chemotherapy in patients with resectable gastric cancer. The efficacy of chemotherapy is evaluated based on degree of response in the surgical specimen. This response is classified as pathological response (PR). Radiological response (RR) is based on preoperative CT and PET scan following neoadjuvant chemotherapy. Our aim was to determine whether there is a correlation between pathological and radiological response in resected gastric cancer patients undergoing neoadjuvant chemotherapy. We also looked whether there was any survival advantage. Methods: Twenty-seven patients with gastric adenocarcinoma, including GEJ per NCCN guidelines who underwent
SSAT Abstracts
X : 10052$CH03 03-28-16 22:41:04 PDFd : 10052B : e
S-1252
Page 1252