Christina E. Bailey

Experimentally Derived Metastasis Gene Expression Profile Predicts Recurrence and Death in Patients With Colon Cancer

BACKGROUND & AIMS Staging inadequately predicts metastatic risk in patients with colon cancer. We used a gene expression profile derived from invasive, murine colon cancer cells that were highly metastatic in an immunocompetent mouse model to identify patients with colon cancer at risk of recurrence. METHODS This phase 1, exploratory biomarker study used 55 patients with colorectal cancer from Vanderbilt Medical Center (VMC) as the training dataset and 177 patients from the Moffitt Cancer Center as the independent dataset. The metastasis-associated gene expression profile developed from the mouse model was refined with comparative functional genomics in the VMC gene expression profiles to identify a 34-gene classifier associated with high risk of metastasis and death from colon cancer. A metastasis score derived from the biologically based classifier was tested in the Moffitt dataset. RESULTS A high score was significantly associated with increased risk of metastasis and death from colon cancer across all pathologic stages and specifically in stage II and stage III patients. The metastasis score was shown to independently predict risk of cancer recurrence and death in univariate and multivariate models. For example, among stage III patients, a high score translated to increased relative risk of cancer recurrence (hazard ratio, 4.7; 95% confidence interval, 1.566-14.05). Furthermore, the metastasis score identified patients with stage III disease whose 5-year recurrence-free survival was >88% and for whom adjuvant chemotherapy did not increase survival time. CONCLUSION A gene expression profile identified from an experimental model of colon cancer metastasis predicted cancer recurrence and death, independently of conventional measures, in patients with colon cancer.

Gastric duplication cyst masquerading as a mucinous pancreatic cyst: case report and literature review

Gastric duplication cysts are rare cystic neoplasms that are often difficult to distinguish from other entities. We describe a healthy 44-year-old woman who presented with acute right lower quadrant abdominal and flank pain as well as chronic nausea and constipation. Her physical examination was unremarkable but contrasted computed tomography revealed a 6cm cystic lesion between the stomach and body of the pancreas. Endoscopic ultrasonography and fluid analysis were consistent with a mucinous cyst with a markedly elevated fluid carcinoembryonic antigen level. The patient subsequently underwent a laparoscopic distal pancreatectomy, which was converted to an open procedure when the lesion was noted to be adherent to the coeliac axis. Intraoperative endoscopy revealed no abnormality. Final pathology revealed a gastric duplication cyst. The patient recovered well and was asymptomatic on follow-up. In this report, we discuss the incidence, natural history and management of this rare entity.

Assessment of the risk of antiangiogenic agents before and after surgery

Angiogenesis plays a critical role in the growth, progression, and metastasis of numerous solid tumor types, and thus, antiangiogenic agents have been studied for many years as potential therapeutic agents. Many different antiangiogenic agents, including monoclonal antibodies and multi-targeted tyrosine kinase inhibitors (TKIs), have been approved for various oncology indications, and promising clinical activity has been demonstrated. However, some of these agents have also been associated with serious safety concerns. Because angiogenesis is an important step in the wound healing process, agents targeting the angiogenesis pathway may interfere with wound healing, thus increasing the risk of surgical wound complications, such as dehiscence, surgical site bleeding, and wound infection. Nevertheless, antiangiogenic agents can be safely used in the perioperative setting if oncologists and surgeons are educated on the biology and pharmacokinetics of these agents. This review discusses the available published literature regarding surgical complications associated with the use of antiangiogenic agents and provides updated clinical recommendations on the optimal timing between surgery and antiangiogenic therapy. Due to the paucity of data surrounding this topic, current and future clinical trials need to evaluate prospectively the potential risks for surgical complications associated with antiangiogenic therapies to establish specific guidelines for their safe and effective use within the surgical oncology community.

Modern Technical Approaches in Hepatic Surgery for Colorectal Metastases

The liver is the most common site of metastases from colorectal cancer and can present as synchronous or metachronous lesions. Successful, margin-negative resection of all liver metastases is associated with significant long-term survival, but was traditionally possible in only a minority of patients. Due to advances in multimodality systemic therapy, improved understanding of tumor biology, and new advances in technical and procedural strategies, a greater number of patients are eligible for resection and potential cure. The purpose of this report is to review the technical advances in liver resection for patients with colorectal liver metastases.

PD40-09 FACTORS CORRELATING WITH SEXUAL INTEREST AND FUNCTION IN LONG-TERM COLORECTAL CANCER SURVIVORS

implant placements and the remaining 3,721 procedures (32.4%) were revision procedures. Of the primary placements, there were 6,705 (86.3%) inflatable penile prostheses and 1,060 (13.7%) malleable penile prostheses placed. There were no differences in type of implant placed based on age or race. There were no differences between type of surgery or numbers of surgeries per patient between races. As age increased there were fewer implant placements and more revision surgeries, as well as more implant removals without replacement (see chart below). CONCLUSIONS: In contrast to previously studied populations, age and race do not appear to play a role in the selection of malleable penile prostheses compared to inflatable penile prostheses in the veteran population. As veterans age, they are more likely to undergo revision surgery and more likely to have implants removed without replacement. Further studies are warranted to determine preoperative risk factors for eventual revision surgery.

MP80-17 URINARY SYMPTOMS PERSIST IN YOUNG COLORECTAL SURVIVORS WHO UNDERWENT PELVIC SURGERY AT LONG-TERM FOLLOW-UP

RESULTS: Of the 128 patients who underwent SPC, 105 patients (64 female, 41 male) fit the inclusion criteria and were sent the PGI-I questionnaire. Response rate was 44.8% (47/105). Mean age at the time of SPC placement was 54.9 years. Mean follow up was 25.1 months (1-120). Overall, 53 pts had MS, 26 had SCI, 4 had PD, 22 had other neurologic disorders (cerebrovascular accident, cerebral palsy, brain tumor, seizure disorder, transverse myelitis). Overall, success was seen in 41/47 patients (87.2%). Only 6.4% (3/47) patients reported a negative PGI-I (score 5-7/7). An early postoperative complication (within 30 days of surgery) was seen in 1/ 128 patients (0.08%) and consisted of bowel perforation requiring small bowel resection. CONCLUSIONS: SPC is an effective solution in many carefully selected patients with NGB conditions. Over 85% considered the SPC to have improved their urological quality of life with a mean follow-up of over 2 years. Adverse events are rare, though can be particularly serious in this group of neurologically impaired patients.

367 Persistent Functional Deficits and Symptoms Among Long-Term Survivors of Colorectal Cancer Treated With Surgery and Multimodality Therapy: Differences by Age at Initial Diagnosis

S A T A b st ra ct s reoperations per year increased steadily from 3.1% in 2007 to 6.3% in 2012. Among patients undergoing reoperations 10,139 (50%) had previously undergone a laparoscopic adjustable band (LAGB) placement, 6411 (31%) a Roux-en-Y gastric bypass (RYGB), 444 (2%) a sleeve gastrectomy (SG), 1685 (8%) a vertical banded gastroplasty (VBG), and 236 (1.2%) a duodenal switch (DS). The operations were most commonly revised to a RYGB in 6801 (33.3%), LAGB (24.8%), SG 1684 (8.1%), DS 393 (1.9%), distal gastric bypass 259 (1.3%) and a group of other operations 6229 (30.6%). EWL at 1-year to RYGB was 27%, LAGB (15.4%), SG (16.5%) and DS (30.9%). The 30-day and 1-year morbidity and mortality rates of the four most common primary and reoperative bariatric operations are low and are shown in Table 1. Conclusions: Although, the rate of reoperations has steadily increased over the last five years to 6.3% per year, most bariatric surgery patients do not need reoperations. Among those who do, the complication rate is low and with satisfactory weight loss. These findings from a large database are critical to convince all stake-holders that outcomes after reoperative bariatric surgery are better than previously believed and are needed to help increase access of patients who need reoperations. Morbidity and Mortality Rates of Primary Bariatric Operations versus Reoperations