- Email: [email protected]
Tu1826 Tumor-Induced Stenosis Can Be Considered a Prognostic Factor in Colorectal Cancer
approach, only 53.2% (n=34,505) of those performed in 2012 was via an open approach (p<0.001). Postoperative morbidity was 15.9% and was higher among patients who underwent open surgery compared with patients who underwent a MIS surgery (18.4% vs. 12.4%, p<0.001; OR 1.43, 95%CI 1.35-1.51; p<0.001). Of note, among patients who underwent MIS, patients those who had robotic surgery were more likely to develop surgical site infections compared to patients who underwent laparoscopic surgery (3.6% vs. 2.6%, p= 0.024). Similarly, patients who underwent MIS surgery had shorter LOS compared to patients undergoing open surgery (extended LOS [LOS>8 days]: laparoscopic: OR 0.55, 95%CI 0.520.58, robotic: OR 0.58, 95%CI 0.49-0.69; both p<0.001). While the costs of surgery remained constant over time (all p>0.05), robotic surgery was consistently associated with a highest mean cost; however, costs were comparable between laparoscopic and open surgery (p>0.05). Conclusion: Minimally invasive colorectal surgery is increasingly being performed. Patients undergoing MIS colorectal surgery had a lower postoperative morbidity and shorter LOS compared with patients undergoing open colorectal surgery.
Tu1826
(*) after continent ileostomy creation, (**) within the patients who had revision IPAA: Ileal pouch anal anastomosis
Tu1824
In addition to modern research in the fields of genomics & proteomics, analyses of macroscopic tumor characteristics & their prognostic relevance appear as "old fashion". However, there is no sufficient molecular parameter or a set of markers on the horizon, which are suitable to assess appropriately the prognosis of colorectal cancer. Beside the genotype, there is also the phenotype of a tumor lesion, whereby almost no data on precisely structured patient cohorts has been published so far. Aim: By systematic additional analysis in a formerly documented historical study cohort, impact of macroscopic tumor issues as alternative to the today's rather molecularbiological characteristics onto tumor outcome was to be investigated. Patients & Methods: Over a time period of 3 years, all consecutive patients with colorectal cancer at the Carl-Thiem Hospital of Cottbus ( n=205) who had undergone an elective, oncologically adequate resection were documented, in particular, their parameters of a minimally residual tumor disease. Among the 140 items, established clinical & histopathological data (re-checked by an investigation called "reference pathology") added by further parameters on macroscopic tumor characteristics (obtained from tumor specimens) such as growing types were evaluated. With regard to the occurrence of a stenosis, only a subjective yes-/no-option of response including data registration was possible. Median follow-up time period was 61 months. End point of the study was the tumor-related death. Results: In 199 patients (97.1%), sufficient information on tumor stenosis was available. There were significant associations between tumor stenosis & i) pT stage ( p<0.001), stage according to UICC classification (p=0.018), type of tumor growth (insular vs. circular, p<0.001), grading (p= 0.044), preoperative serum CEA level (p<0.001), L status (p=0.007) & intraoperative mobility of tumor lesion (p<0.001). There was no significant correlation with nodal status, peritumorous tumor cell dissociation, tumor shape & tumor site. Cases with a tumor-based stenosis were associated with a significantly worse tumor-dependent survival in both univariate Kaplan-Meier assessment (p=0.001) & in multivariate Cox regression analysis ( p=0.045). Conclusion: In a controlled patient cohort, detection of a stenosing tumor growth is considered an independent prognostic parameter. Macroscopic tumor issues characterizing tumor phenotype & manifestation of genotype should be included in the overall prognostic assessment of a tumor disease.
Fistula Tract Transposition for Extrasphincteric Perianal Fistulae in Crohn's Disease Antonio Baldin Introduction: Perianal fistulas in patients with Crohns disease are usually multiple, complex, and hard to treat. Fistulotomy and fistulectomy are the techniques most commonly used, but are associated to significant recurrence rates and sphincter damage. Fistula track transposition has rarely been used to treat Crohn's perianal fistulae and has the potential to reduce reccurence and incontinence rates. The aim of this study is to report results obtained with the use of fistula tract transposition for a group of selected patients with Crohn's Disease and complex extrasphincteric perianal fistulae. Methods: Retrospective review of results obtained in selected patients with Crohn's Disease and complex extrasphincteric perianal fistulae treated with fistula track transposition. The technique consists in dissecting and medially transposing the fistula tract into the intersphincteric plane, aimed at involving a smaller internal sphincter segment into an intersphincteric position. The internal and external orifice stay close and a second treatment is planned with a simple fistulotomy to preserve the anal continence. Results: Five patients were treated in between December/2013 and March/2015. Four patients were male. Median age was 43,6 (range 32-56) years. Three of them were under combined terapy with azatioprine and biological drugs and two were under isolated biological therapy. Four patients have already been submited to perianal fistula repair with seton and one had a recto-vaginal fistula. At a median follow-up of 15,2 months (range 9-23), only one patient had a recurrence, associated with a new tract formation. All patients remained continent. Conclusion: Fistula transposition seems to be a appropriate surgical alternative for selected patients with Crohn's Disease and complex extrasphincteric perianal fistulae; and may decreases recurrence rates and the risk of anal incontinence. Larger series with longer follow-up are needed to confirm our results.
Tu1825 Trends and Short-Term Outcomes of Surgical Methods for Bowel Resection In Colorectal Cancer Patients Jamin K. Addae, Faiz Gani, Joseph K. Canner, Sandy Fang, Eric B. Schneider
Tu1827 Predictors of Postoperative Complications Associated with Loop Ileostomy Closure Tamar B. Nobel, Jordan A. Munger, David Chessin, Daniel Popowich, Stephen R. Gorfine, Joel Bauer
Background: Current trends regarding surgical approach for colorectal cancer surgery remain undetermined. Additionally, national data comparing postoperative clinical outcomes relative to cost for open vs. laparoscopic vs. robotic approaches is lacking. We sought to report on national trends of colorectal cancer surgery as well as compare postoperative outcomes by surgical approach. Methods: Patients undergoing surgery for colorectal cancer were identified using the Nationwide Inpatient Sample from January 1, 2009 to December 31, 2012. Trends in surgical approach were assessed using the Cochrane-Armitage test of trends. Multivariable logistic and linear regression analyses were performed to compare length-of-stay (LOS), postoperative complications and costs between open and MIS surgery. Results: A total of 261,886 patients were identified. The median age of the cohort was 67 years (IQR 19-104) while 51.1% (n=133,940) were male. 72.2% (n=188,989) of patients underwent a colon surgery while 27.8% (n=72,897) underwent a rectal procedure. At the time of surgery, 57.5% (n=150,683) underwent an open procedure, while 42.4% (n=111,203) underwent either a laparoscopic (39.9%, n=104,574) or robotic (2.5%, n=6,629) colorectal surgery. Overtime, the use of MIS was noted to increase with an almost four-fold increase in the use of a robotic approach (2009 vs. 2012: 1.1% [n=714] vs. 4.2% [n=2740]; p<0.001). In contrast, while 62.7% (n=40,631) of colorectal surgery performed in 2009 was via an open
Introduction: A defunctioning loop ileostomy is often utilized to protect an anastomosis at high risk for leakage with the aim of reducing incidence of postoperative complications. Despite the associated benefits, loop ileostomies themselves are not without complications. Previous studies have demonstrated significant morbidity and mortality associated with the closure of a loop ileostomy. The objective of this study was to identify patient factors predictive of complications following loop ileostomy closure and to determine the morbidity and mortality rate associated with this procedure in a large series of patients. Methods: A retrospective review of a prospectively maintained database was used to identify patients who underwent loop ileostomy closure from 1981-2011 at a single surgical practice. Demographic, surgical, pathologic and postoperative outcome data were collected. Risk factors evaluated include age, gender, pre-operative lab tests, interval time between creation and closure, weight change between procedures, perioperative steroid use, indication for ileostomy, pathology and anastomosis type for ileostomy closure. Postoperative complications evaluated
S-1263
X : 10052$CH03 03-28-16 22:41:04 PDFd : 10052B : o
Page 1263
SSAT Abstracts
SSAT Abstracts
Tumor-Induced Stenosis Can Be Considered a Prognostic Factor in Colorectal Cancer Ralf Steinert, Frank Meyer, Henry Ptok, Michael Vieth, Ingo Gastinger
Tu1826
(*) after continent ileostomy creation, (**) within the patients who had revision IPAA: Ileal pouch anal anastomosis
Tu1824
In addition to modern research in the fields of genomics & proteomics, analyses of macroscopic tumor characteristics & their prognostic relevance appear as "old fashion". However, there is no sufficient molecular parameter or a set of markers on the horizon, which are suitable to assess appropriately the prognosis of colorectal cancer. Beside the genotype, there is also the phenotype of a tumor lesion, whereby almost no data on precisely structured patient cohorts has been published so far. Aim: By systematic additional analysis in a formerly documented historical study cohort, impact of macroscopic tumor issues as alternative to the today's rather molecularbiological characteristics onto tumor outcome was to be investigated. Patients & Methods: Over a time period of 3 years, all consecutive patients with colorectal cancer at the Carl-Thiem Hospital of Cottbus ( n=205) who had undergone an elective, oncologically adequate resection were documented, in particular, their parameters of a minimally residual tumor disease. Among the 140 items, established clinical & histopathological data (re-checked by an investigation called "reference pathology") added by further parameters on macroscopic tumor characteristics (obtained from tumor specimens) such as growing types were evaluated. With regard to the occurrence of a stenosis, only a subjective yes-/no-option of response including data registration was possible. Median follow-up time period was 61 months. End point of the study was the tumor-related death. Results: In 199 patients (97.1%), sufficient information on tumor stenosis was available. There were significant associations between tumor stenosis & i) pT stage ( p<0.001), stage according to UICC classification (p=0.018), type of tumor growth (insular vs. circular, p<0.001), grading (p= 0.044), preoperative serum CEA level (p<0.001), L status (p=0.007) & intraoperative mobility of tumor lesion (p<0.001). There was no significant correlation with nodal status, peritumorous tumor cell dissociation, tumor shape & tumor site. Cases with a tumor-based stenosis were associated with a significantly worse tumor-dependent survival in both univariate Kaplan-Meier assessment (p=0.001) & in multivariate Cox regression analysis ( p=0.045). Conclusion: In a controlled patient cohort, detection of a stenosing tumor growth is considered an independent prognostic parameter. Macroscopic tumor issues characterizing tumor phenotype & manifestation of genotype should be included in the overall prognostic assessment of a tumor disease.
Fistula Tract Transposition for Extrasphincteric Perianal Fistulae in Crohn's Disease Antonio Baldin Introduction: Perianal fistulas in patients with Crohns disease are usually multiple, complex, and hard to treat. Fistulotomy and fistulectomy are the techniques most commonly used, but are associated to significant recurrence rates and sphincter damage. Fistula track transposition has rarely been used to treat Crohn's perianal fistulae and has the potential to reduce reccurence and incontinence rates. The aim of this study is to report results obtained with the use of fistula tract transposition for a group of selected patients with Crohn's Disease and complex extrasphincteric perianal fistulae. Methods: Retrospective review of results obtained in selected patients with Crohn's Disease and complex extrasphincteric perianal fistulae treated with fistula track transposition. The technique consists in dissecting and medially transposing the fistula tract into the intersphincteric plane, aimed at involving a smaller internal sphincter segment into an intersphincteric position. The internal and external orifice stay close and a second treatment is planned with a simple fistulotomy to preserve the anal continence. Results: Five patients were treated in between December/2013 and March/2015. Four patients were male. Median age was 43,6 (range 32-56) years. Three of them were under combined terapy with azatioprine and biological drugs and two were under isolated biological therapy. Four patients have already been submited to perianal fistula repair with seton and one had a recto-vaginal fistula. At a median follow-up of 15,2 months (range 9-23), only one patient had a recurrence, associated with a new tract formation. All patients remained continent. Conclusion: Fistula transposition seems to be a appropriate surgical alternative for selected patients with Crohn's Disease and complex extrasphincteric perianal fistulae; and may decreases recurrence rates and the risk of anal incontinence. Larger series with longer follow-up are needed to confirm our results.
Tu1825 Trends and Short-Term Outcomes of Surgical Methods for Bowel Resection In Colorectal Cancer Patients Jamin K. Addae, Faiz Gani, Joseph K. Canner, Sandy Fang, Eric B. Schneider
Tu1827 Predictors of Postoperative Complications Associated with Loop Ileostomy Closure Tamar B. Nobel, Jordan A. Munger, David Chessin, Daniel Popowich, Stephen R. Gorfine, Joel Bauer
Background: Current trends regarding surgical approach for colorectal cancer surgery remain undetermined. Additionally, national data comparing postoperative clinical outcomes relative to cost for open vs. laparoscopic vs. robotic approaches is lacking. We sought to report on national trends of colorectal cancer surgery as well as compare postoperative outcomes by surgical approach. Methods: Patients undergoing surgery for colorectal cancer were identified using the Nationwide Inpatient Sample from January 1, 2009 to December 31, 2012. Trends in surgical approach were assessed using the Cochrane-Armitage test of trends. Multivariable logistic and linear regression analyses were performed to compare length-of-stay (LOS), postoperative complications and costs between open and MIS surgery. Results: A total of 261,886 patients were identified. The median age of the cohort was 67 years (IQR 19-104) while 51.1% (n=133,940) were male. 72.2% (n=188,989) of patients underwent a colon surgery while 27.8% (n=72,897) underwent a rectal procedure. At the time of surgery, 57.5% (n=150,683) underwent an open procedure, while 42.4% (n=111,203) underwent either a laparoscopic (39.9%, n=104,574) or robotic (2.5%, n=6,629) colorectal surgery. Overtime, the use of MIS was noted to increase with an almost four-fold increase in the use of a robotic approach (2009 vs. 2012: 1.1% [n=714] vs. 4.2% [n=2740]; p<0.001). In contrast, while 62.7% (n=40,631) of colorectal surgery performed in 2009 was via an open
Introduction: A defunctioning loop ileostomy is often utilized to protect an anastomosis at high risk for leakage with the aim of reducing incidence of postoperative complications. Despite the associated benefits, loop ileostomies themselves are not without complications. Previous studies have demonstrated significant morbidity and mortality associated with the closure of a loop ileostomy. The objective of this study was to identify patient factors predictive of complications following loop ileostomy closure and to determine the morbidity and mortality rate associated with this procedure in a large series of patients. Methods: A retrospective review of a prospectively maintained database was used to identify patients who underwent loop ileostomy closure from 1981-2011 at a single surgical practice. Demographic, surgical, pathologic and postoperative outcome data were collected. Risk factors evaluated include age, gender, pre-operative lab tests, interval time between creation and closure, weight change between procedures, perioperative steroid use, indication for ileostomy, pathology and anastomosis type for ileostomy closure. Postoperative complications evaluated
S-1263
X : 10052$CH03 03-28-16 22:41:04 PDFd : 10052B : o
Page 1263
SSAT Abstracts
SSAT Abstracts
Tumor-Induced Stenosis Can Be Considered a Prognostic Factor in Colorectal Cancer Ralf Steinert, Frank Meyer, Henry Ptok, Michael Vieth, Ingo Gastinger