S146 ABSTRACTS

378. How does Ki-67 status influence outcomes for resectable

neuroendocrine liver metastases?

T. Hore1, M. Terlizzo1, S. Fenwick1, H. Malik1, G. Poston1

1 University Hospital Aintree, Department of Digestive Diseases,

Liverpool, United Kingdom

Background: The purpose of this study is to assess how Ki-67 influ-

ences outcome for patients undergoing resection of neuroendocrine liver

metastases (NELM).

Methods: A retrospective review of patients whom underwent liver

resection for NELM between January 1989 to October 2010 was per-

formed. Outcomes were collated and stratified against their tumour Ki-

67 grade.

Results: 33 patients (13 male, 20 female) underwent liver resec-

tion during the study period. Median age at the time of liver resec-

tion was 62 years of age. 20 patients underwent major liver

resection, 3 combined ablation and major liver resection and 10

segmentectomy/metastatectomies performed. Post-operative 90 day

mortality was 0%. 70% of NELM originated from a small bowel pri-

mary. 97% achieved immediate symptom control. Retrospective path-

ological review of Ki-67 was pending at the time of abstract

submission.

Conclusion: Resection of NELM reduces symptoms from patients with

functional tumours. Five-year overall survival is reported between

41e100% and five-year progression-free survival is reported between

5e54% in the literature. Further research is required in order to guide

the management of patients with NELM.

No conflict of interest.

http://dx.doi.org/10.1016/j.ejso.2014.08.368

379. How has the Advanced Colorectal Multidisciplinary Team

Meeting affected patient outcomes?

T. Hore1, A. Malik2, S. Fenwick1, H. Malik1, G. Poston1

1 University Hospital Aintree, Department of Digestive Diseases,

Liverpool, United Kingdom2University of Liverpool, School of Medicine, Liverpool, United Kingdom

Background: The purpose of this study was to audit the out-

comes of the Advanced Colorectal Multidisciplinary Team (MDT)

Meeting.

Methods: Patients discussed in the Advanced Colorectal MDT meeting

since its inception on the 1st April 2013 to 1st April 2014 were retrospec-

tively reviewed. Data was collected on colorectal cancer stage at the time

of diagnosis, proposed management plan, objectives of treatment(s), treat-

ment performed, morbidity and overall survival.

Results: Aintree University Hospital has an overall resection rate of

47.7% for colorectal liver metastases. Median overall survival for re-

sected patients is 46 months, with a 5-year survival approaching 42%.

Complete analysis of data is currently pending at the date of abstract

submission. We aim to investigate how the Advanced Colorectal

MDT has influenced the resection rate for colorectal liver metastases,

the timing of liver intervention with respect to other treatment modal-

ities and the outcomes with respect to operative morbidity, mortality

and overall survival.

Conclusion: Management of stage IV colorectal cancer has become

increasingly complex with multiple treatments available. The timing and

objective of treatment varies depending on the individual patient.

Consensus on the best management for each individual patient must now

be obtained across a wider cohort of specialities.

No conflict of interest.

http://dx.doi.org/10.1016/j.ejso.2014.08.369

380. Oxaliplatin-induced hepatic sinusoidal injury in patients

undergoing resection for colorectal liver metastases: An assessment

of its reversibility

E. Van der Stok1, D.J. Gr€unhagen1, C. Verhoef1

1 Daniel den Hoed Cancer Center, Surgery, Rotterdam, Netherlands

Background: A specific association of oxaliplatin to hepatic sinusoidal

obstruction syndrome (SOS) has been reported and confirmed in various

studies. The ability to predict risk for the development of SOS is limited,

however, multiple reports acknowledge the role of splenic volume as a

biomarker. In patients with colorectal liver metastases (CRLM) undergoing

hepatic resection after neoadjuvant oxaliplatin based chemotherapy, SOS is

common and has been correlated with an increase in morbidity. However,

very little is known about the reversibility of SOS. Potentially, SOS

induced by adjuvant treatments of primary colorectal tumours, also plays

a role. In this study, we assessed the reversibility of SOS in patients under-

going resection for CRLM.

Methods: From all patients that underwent curative surgery for CRLM

between 2000 and 2012, two groups were included. Firstly, a group of pa-

tients who received oxaliplatin based chemotherapy solely for primary

colorectal cancer in adjuvant setting was determined (n ¼ 35). Secondly,

patients who hadn’t been exposed to any form of systemic treatment

were identified (n ¼ 43). Exclusion criteria comprised: systemic therapy

<3 cycles, prior splenectomy and lymphohaematogenous disorders. Of

all patients, CT-scans were reviewed. CT scans were performed during

follow-up after resection of the primary colorectal tumour or CRLM.

Spleen length, width and thickness were objectified on the last scan before,

and the first 2 scans after resection for CRLM. From the average of these

measurements, splenic volume was calculated using the splenic index.

Splenomegaly was defined as a spleen >314.5 cm3.

Results: The last scan before, and the first two scans after resection of

CRLM were fulfilled with a median of 9 (0e42), 14 (3e50), and 18

(4e57) months after completion of adjuvant chemotherapy, respectively.

In the oxaliplatin group, splenomegaly was found in 51,4% of patients

vs. 20,9% in the oxaliplatin negative group (p ¼ 0.005). In univariate anal-

ysis, administration of oxaliplatin significantly correlated with splenomeg-

aly (OR 4; 95%CI 1,49e10,76; p ¼ 0.006) as well as gender (male: OR

5,16; 95%CI 1,4e19,4; p ¼ 0.015) and patients length (OR 1,06; 95%

CI 1,004e1,113; p ¼ 0.036). In multivariate analysis, solely administration

of oxaliplatin remained significant in relation to splenomegaly (OR 3,84;

95%CI 1,34e11,03; p ¼ 0.013).

Conclusion: This study demonstrates that when utilizing spleen vol-

ume as a biomarker, the incidence of SOS is higher in patients with

CRLM treated with adjuvant oxaliplatin based regimens for their primary

tumour as compared to patients where no systemic treatment is adminis-

tered. The significant time span between systemic treatment and objectified

splenomegaly suggests oxaliplatin induced SOS in the adjuvant setting

might be irreversible. Therefore, in this group of patients, potential pre-ex-

isting sinusoidal injury should be taken into consideration when planning

neoadjuvant therapy for CRLM prior to resection.

No conflict of interest.

http://dx.doi.org/10.1016/j.ejso.2014.08.370

381. Is the aggressive surgical resection mandatory for concomitant

liver and lung metastasis in colorectal cancer?

K.S. Kim1, S.H. Lee1, J.H. Lim2, S.H. Kim3, J.G. Lee4, D.J. Kim4, G.H.

Choi1, J.S. Choi1

1 Yonsei University College of Medicine, Surgery, Seoul, South Korea2 Yongin Severance Hospital, Surgery, Yongin, South Korea3 Yonsei University, Wonju College of Medicine, Surgery, Wonju, South

Korea4 Yonsei University College of Medicine, Thoracic and Cardiovascular

Surgery, Seoul, South Korea