Tu1606 Hypopharyngeal Multichannel Intraluminal Impedance Improves the Outcome of Antireflux Surgery on Patients With Laryngeal Symptoms

cohort) (p=0.06). There was an overall 5% in-hospital/ 30-day post-operative mortality (refer table 2). Conclusion: Progressive improvement in operative parameters along with improved lymphatic clearance was noted in our single center experience of Minimally Invasive Transthoracic Esophagectomies. Oncological efficacy was noticeable after the initial 24 patients, whereas more patient experience (up to 48) was needed to improve on intra-operative and post-operative complications. Table 1

Tu1607 Impact of Venous Thromboembolism on Outcomes After Esophagectomy for Esophageal Cancer Abhishek Sundaram, Sarah Baker, Ananth Srinivasan, Ilya Berim, sumeet K. mittal Background: Esophagectomy for esophageal cancer is one of the more morbid surgical procedures in practice today. Emphasis has been placed on preventing venous thromboembolism (VTE) after surgery. However, limited reports exist on how VTE impacts outcomes and resource utilization after esophagectomy. Objective: Evaluate the impact of venous thromboembolism (VTE) on outcomes and resource utilization after esophagectomy for esophageal cancer. Methods: Retrospective review of the American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) 2011-12 database was performed to identify patients who underwent elective esophagectomy for esophageal cancer. Patient who developed deep venous thrombosis or pulmonary embolism within 30 days of surgery were categorized as having VTE. Results: One thousand one hundred and three patients satisfied study criteria. Fifty-four patients (4.9%) developed VTE. VTE patients were significantly older (mean: 66.6 years vs. 63.9 years, p=0.04), more likely to have received neo adjuvant therapy (75% vs. 42%, p=0.02), had a preoperative myocardial infarction (8.3% vs. 0.8%, p=0.009) and have a higher American Society of Anesthesiologists' (ASA) class (p<0.001), than patients without VTE. There was no significant difference between the groups in terms of gender, type of esophagectomy performed, history of pulmonary disease. Operative time in minutes was longer in patients with VTE (mean: 393.5 vs. 354.6, p= 0.03). Patients with VTE had a significantly higher incidence of postoperative pulmonary complications like pneumonia (25.9% vs. 13%, p=0.007), had difficulty being weaned of the ventilator (31.5% vs. 10.3%, p<0.001), and were more likely to be reintubated (25.9% vs. 10.5%, p<0.001). VTE patients have a significantly longer hospital stay (mean: 20.4 days vs. 14 days, p=0.01) and higher 30-day readmission rate (29.6% vs. 11.5%, p<0.001). Thirty-day mortality was higher in patients with VTE (5.5% vs. 3.05%, p=0.24). On multivariate regression analysis, ASA class was significantly (p=0.04) associated with VTE. Conclusions: Patients undergoing esophagectomy for esophageal cancer are at a high risk for VTE. VTE significantly adds to the morbidity associated with an esophagectomy resulting in increased resource utilization. Stringent peri-operative prophylaxis is needed to combat this dreaded complication.

Table 2

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Background: With optimization of surgical technique and perioperative care, the mortality rate from hepatectomy has declined substantially over the last two decades. Readmission rate has been proposed as a primary endpoint for quality assurance in addition to the traditional measures of morbidity and mortality. The aim of this study was to identify risk factors associated with unplanned readmissions following hepatectomy. Method: Patients who underwent hepatectomies between January-December 2011 were identified using the ACS-NSQIP procedure-specific database. A multivariable logistic regression analysis was performed to determine predictors of unplanned readmissions related to the procedure (UPRR) within 30 days. Result: Unplanned rehospitalization occurred in 10.5% of patients undergoing hepatectomy in this national cohort. On multivariate analysis, transfusion within 72 hrs (odds ratio [OR] 1.74, p<0.001), complexity of procedure (extended, OR 1.84, p= 0.004; right hepatectomy, OR 1.66, p=0.003), and longer operative time (> median 320 min, OR 2.43, p<0.001) were independent perioperative predictors of UPRR. Independent preoperative risk factors included elevated alkaline phosphatase (OR 1.45, p=0.017), hypoalbuminemia (OR 1.30, p=0.036), and bleeding disorder (OR 1.72, p=0.051). Conclusion: Transfusion, complexity of procedure, and duration of operation were the strongest predictors of unplanned readmissions after hepatectomy. These risk factors help identify patients at greater risk of unplanned readmission in order to optimize preoperative screening strategies and preventive measures at time of discharge.

Tu1606 Hypopharyngeal Multichannel Intraluminal Impedance Improves the Outcome of Antireflux Surgery on Patients With Laryngeal Symptoms Yoshihiro Komatsu, Toshitaka Hoppo, Blair A. Jobe Introduction: Patient selection is critical for the successful surgical treatment of gastroesophageal reflux disease (GERD). Previously, we established the normative data of laryngopharyngeal reflux (LPR) and high-esophageal reflux (HER: reflux up to 2cm distal to upper esophageal sphincter) events for 24-hour hypopharyngeal multichannel intraluminal impedance (HMII). Based on the data, we have constructed the criteria to define "abnormal proximal exposure (APE)" as LPR ≥1/day and/or HER ≥5/day. Previous retrospective analyses have suggested that HMII may increase the sensitivity in selecting patients with LPR symptoms who likely respond antireflux surgery (ARS). The purpose of this study was to objectively evaluate the outcome of ARS on patients selected based on our criteria by using validated questionnaires. Methods: This is a retrospective review of prospectively collected data from patients who underwent HMII. Patients with APE as measured by HMII and subsequently underwent ARS, were identified. The outcome of surgery included improvement in clinical symptoms and quality of life, both of which were assessed based on the personal interview and the validated questionnaires such as GERD-HRQL, Respiratory Symptom Index (RSI) and SF-36 before and after ARS. Results: From September 2012 to October 2013, 171 patients underwent HMII. Of 118 patients with APE, 26 patients underwent ARS (7 men and 19 women; mean age 51.6). Twenty-one patients (81%) had LPR symptoms including cough (n=20), throat burning (n=3), cervical dysphagia (n=3), throat tightness/pressure (n= 2), and hoarseness (n=1). Of 21 with LPR symptoms, 11 (42%) had concomitant typical GERD symptom such as heartburn and regurgitation. The mean DeMeester score was 15.7 (range 1-54.8) and 15 patients (58%) had negative DeMeester score. Clinical symptoms completely resolved in 20 patients (77%) and significantly improved in 5 patients (19%) at 6 weeks after the surgery. Anti-secretory medications were discontinued in 25 patients (96%) at a mean follow-up period of 2.1 months (0.36-5.3). Complete validated questionnaires before and after ARS were available for 11 patients. Of them, there was a significant improvement in GERD-HRQL (Pre-op 20.7; post-op 6.9, p= 0.016) and RSI scores (Pre-op 23.9; post-op 15, p=0.001) post-operatively. However, there was no significant difference in SF-36 scores on either physical component scores (pre-op 33.6; post-op 32.8, p=0.853) or mental component scores (pre-op 44.7; post-op 47.5, p=0.49). Conclusion: APE as measured by HMII, regardless of whether there is positive DeMeester score, may identify patients with laryngeal symptoms, who likely respond ARS, potentially improving the surgical outcome. Data set is currently being expanded and will be presented at the conference.

Tu1609 Sorafenib Use After Prior Surgical Resection or Transplant in Hepatocellular Carcinoma: US Regional Analysis of GIDEON Robert C. Martin, Allen Cohn, Jean-Francois Geschwind, Alec Goldenberg, Parvez S. Mantry, Brendan M. McGuire, Rebecca Miksad, Bilal Piperdi, Arun J. Sanyal, Alan Venook, Ellen Zigmont, Pierre M. Gholam Background: Experience using sorafenib (SOR) after prior surgical resection (PSR) or transplant (OLT) for recurrent hepatocellular carcinoma (HCC) is limited. GIDEON is a global, prospective, non-interventional study to evaluate SOR safety under real-life conditions. We aimed to examine US patients (pts) who received SOR for recurrent HCC after PSR or OLT. The GIDEON registry contains one of the largest data series collected in US pts. Methods: Pts with unresectable HCC who were candidates for systemic therapy and for whom a decision was made to treat with SOR were eligible for inclusion; pts may have undergone PSR or OLT. Disease characteristics, safety, and treatment duration were evaluated. All results are descriptive. Results: In the US, 563 pts were evaluable for safety. 53 had PSR, 27 had OLT, and 6 had both. Median time in months from PSR to start of SOR was 9.3 (range 0.7-61.3) and from OLT was 23.7 (range 1.2-78.3; data were missing for 7 [26%] pts). Median SOR doses were similar among all groups (Table). Grade 3/4 serious adverse events (SAEs) were 32%/8% for pts with PSR and 31%/6% without PSR; 4%/4% for pts with OLT and 14%/5% without OLT. Grade 3/4 drug-related SAEs (DRSAEs) were 42%/6% for pts with PSR and 20%/2% without PSR; 11%/4% for pts with OLT and 4%/1% without OLT. Treatment-emergent deaths occurred in 26% of PSR pts, 33% of pts without PSR, 22% of OLT pts, and 33% of pts without OLT. No drug-related deaths occurred in PSR or OLT patients (<1% overall). Median overall survival [95% confidence interval] in the ITT population (n=553) from start of SOR was 471 [284-689] days for PSR and 338 [234-910] days

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SSAT Abstracts

SSAT Abstracts

Risk Factors for 30-Day Readmissions After Hepatectomy: Analysis of 2,444 Patients From the ACS-NSQIP Database Sooyeon Kim, Erin Maynard, Malay Shah, Michael Daily, Ching-Wei Tzeng, Daniel Davenport, Roberto Gedaly