Masashi Yahagi

Non-alcoholic fatty liver disease fibrosis score predicts hematological toxicity of chemotherapy including irinotecan for colorectal cancer

Liver dysfunction that may affect drug metabolism is a major concern in patients treated with chemotherapy. Thus, assessment of the degree of liver dysfunction is crucial for predicting the adverse events of chemotherapy. The non-alcoholic fatty liver disease fibrosis score (NFS) is a non-invasive clinical scoring system constructed from routine clinical and laboratory variables. The aim of this study was to evaluate whether NFS was useful for predicting the adverse events of chemotherapy including irinotecan (CPT-11) for colorectal cancer. Between January, 2007 and May, 2013, a total of 87 patients with unresectable/recurrent colorectal cancer who received first-line chemotherapy including CPT-11 were reviewed. Demographic variables, including pretreatment NFS, were retrospectively collected from medical records. The primary outcome was the association between pretreatment NFS and adverse events, such as hematological and non-hematological toxicity, of chemotherapy including CPT-11. The median pretreatment NFS was 1.302 (range, 5.158-2.620). Pretreatment NFS was an independent risk factor for hematological toxicity in a multivariate analysis (coefficient=0.932, 95% CI: 0.083-1.781; P=0.031). Receiver operating characteristic curve analysis identified 0.347 as the optimal cut-off value associated with hematological toxicity. Using this cut-off, high NFS was found to be a significant risk factor for hematological toxicity (coefficient=2.019, 95% CI: 0.239-3.798, P=0.026), but not for non-hematological toxicity (P=0.546). Therefore, based on these results, NFS appears to be a significant predictor of hematological adverse events in chemotherapy including CPT-11 for colorectal cancer and it is a non-invasive, useful tool that may be used for determining regimens or doses of chemotherapy including CPT-11.

Is preoperative spirometry a predictive marker for postoperative complications after colorectal cancer surgery

Background Spirometry is a basic test that provides much information about pulmonary function; it is performed preoperatively in almost all patients undergoing colorectal cancer (CRC) surgery in our hospital. However, the value of spirometry as a preoperative test for CRC surgery remains unknown. The aim of this study was to determine whether spirometry is useful to predict postoperative complications (PCs) after CRC surgery. Methods The medical records of 1236 patients who had preoperative spirometry tests and underwent CRC surgery between 2005 and 2014 were reviewed. Preoperative spirometry results, such as forced vital capacity (FVC), one-second forced expiratory volume (FEV1), %VC (FVC/predicted VC) and FEV1/FVC (%FEV1), were analyzed with regard to PCs, including pneumonia. Results PCs were found in 383 (30.9%) patients, including 218 (56%) with surgical site infections, 67 (17%) with bowel obstruction, 62 (16%) with leakage and 20 (5.2%) with pneumonia. Of the spirometry results, %VC was correlated with PC according to logistic regression analysis (odds ratio, OR = 0.99, 95% confidence interval, CI = 0.98-0.99; P = 0.034). Multivariate analysis after adjusting for male sex, age, laparoscopic surgery, tumor location, operation time and blood loss showed that a lower %VC tends to be a risk factor for PC (OR = 0.99, 95% CI = 0.98-1.002; P = 0.159) and %VC was an independent risk factor for postoperative pneumonia in PCs (OR = 0.97, 95% CI = 0.94-0.99; P = 0.049). Conclusions In CRC surgery, %VC may be a predictor of postoperative complications, especially pneumonia.

Smoking is a risk factor for pulmonary metastasis in colorectal cancer

The hepatic microenvironment, which may include chronic inflammation and fibrosis, is considered to contribute to the pathogenesis of liver metastases of colorectal cancer. A similar mechanism is anticipated for pulmonary metastases, although no reports are available. Smoking causes pulmonary inflammation and fibrosis. Thus, we hypothesized that smokers would be especially affected by pulmonary metastases of colorectal cancer. In this study, we attempted to clarify the impact of smoking on pulmonary metastasis of colorectal cancer.

Muscle volume loss after the induction of first-line chemotherapy as a novel prognostic factor in metastatic colorectal cancer patients.

558 Background: Muscle volume loss (MVL) is observed in end-stage cancer patients as cachexia. However, the impact of MVL on tumor response and survival still remains unclear during chemotherapy in metastatic colorectal cancer (mCRC) patients. The aim of this study is to evaluate correlation between MVL and oncologic outcomes in mCRC patients. Methods: A total of 91 mCRC patients who received first-line chemotherapy were identified in our prospective registry between February 2007 and April 2013. Skeletal muscle index at the level of L3 vertebra (SMI) was calculated by muscle volume normalized by stature at the time of the induction of first-line chemotherapy (bSMI) and first evaluation of tumor response (fSMI). Patients whose SMI decreased more than 10% were classified as MVL group. The impact of these variables on oncologic outcomes (overall survival [OS], progression free survival [PFS], and tumor response rate [RR]) were analyzed. Results: Mean bSMI and fSMI were 35.0 (SD: 7.11) cm2/m2, and 34.2 (SD: ...

Impact of liver fibrosis on effects and adverse effects of unresectable colorectal cancer under first line chemotherapy including CPT-11.

556 Background: Liver dysfunction is one of the irritating adverse effects in chemotherapy for colorectal cancer. Polymorphisms of UGTIA1, which is related to metabolism of CPT-11 in the liver, cause severe adverse events. In addition, long-term induction of CPT-11 may involve steatohepatitis. Thus, it is critical to surrogate liver dysfunction in chemotherapy including CPT-11. In this current study, we evaluated whether NAHLD fibrosis score (NFS) which is liver fibrosis marker of nonalcoholic steatohepatitis, is feasible for predicting the effects and adverse events of chemotherapy including CPT-11 for colorectal cancer. Methods: From January 2007 to May 2013, of 118 patients who were diagnosed with unresectable advanced/recurrent colorectal cancer in our hospital, we retrospectively analyzed 89 patients who underwent first line chemotherapy including CPT-11. We statistically analyzed the value of the pretreatment NFS on response rate (RR), progression-free survival (PFS), and hematologic or non-hematolo...

The impact of hepatic fiblosis on the incidence of liver metastasis from colorectal cancer.

529 Background: Non-alcoholic steatohepatitis (NASH) is closely associated with hepatic fibrosis (HF). The number of patients who have NASH is increasing by eating high-calorie diet. It remains unclear how much impact such NASH and HF on the development of liver metastasis by colorectal cancer (CRC). The objectives of this study is to clarify the influence of HF on metachronous liver-specific recurrence in colorectal cancer patients who underwent colorectal surgery with curative intent. Methods: Between 2000 and 2010, patients who underwent a curative surgical resection for CRC were included in this study. We evaluated the progression of HF by using non-alcoholic fatty liver disease fibrosis score (NFS) based on preoperative blood test result, age, BMI and DM. The patients with NFS higher than 0.676 were objectively defined as HF. The influence of HF on hepatic recurrence was assessed by survival analyses. Results: A total of 953 CRC patients were enrolled, comprised of 293 in stage I, 327 in stage II and...

PTH-289 The poor overall survival of right-sided colon cancer compared with left-sided colon cancers: a systematic review and meta-analysis

Introduction Right-sided colon cancers (RCC) and left-sided colon cancers (LCC) are of different embryological origins, and there are various differences between them. However, the survival difference has not been evaluated. The aim of the present study was to quantify the difference of prognosis between RCC and LCC by meta-analysis. Method PubMed and the Cochrane Library were searched during May 2014 for literature on right- versus left-sided colon cancers. The MeSH terms “colonic neoplasm” and the terms “prognosis” or “survival analysis” were combined with terms “left” and “right” or “sub site”. The effects of tumour locations on survival outcome (overall survival [OS] and cancer-specific survival [CSS]) were assessed. Hazard ratio (HR) was used as a surrogate for effect size, and random-effects meta-regression was applied as a method to evaluate the influences of covariates. Heterogeneity and publication bias were assessed. Results 15 studies (108,474 participants) which compared the prognosis of colon cancer according to tumour location were included. With respect to OS, patients with RCC had a significantly worse prognosis (HR = 1.14, 95% confidence interval [CI]: 1.06 –1.22, p < 0.01, I2= 41.82%) than those with LCC. Though, this tendency was not evident for CSS, which might be because CSS was evaluated by a small number of studies included in this analysis. Subgroup analyses demonstrated significant prognostic differences in Western countries (HR = 1.15, 95% CI: 1.08 – 1.23, p < 0.01), a nationwide database (HR = 1.15, 95% CI: 1.05 – 1.27, p = 0.01), and a stage-adjusted analysis (HR = 1.14, 95% CI: 1.05 – 1.24, p < 0.01). The test of funnel plot identified no publication bias. The source of heterogeneity was not identified in meta-regression. Conclusion Our findings indicate that tumour location is closely associated with prognosis in colorectal cancer patients, and those with RCC have a significantly worse prognosis than those with LCC in regards to OS. Therefore, RCC should be treated distinctively from LCC, and the establishment of standardised management for colon cancer by tumour location is needed. Disclosure of interest None Declared.

PTU-008 Is cranial to caudal approach a feasible technique for complete mesocolic excision (cme) in laparoscopic transverse colectomy?

Introduction Laparoscopic transverse colectomy (LTC) is one of the most challenging techniques because the region of its mesentery and lymph node (LN) dissection is controversial. In addition, anatomical anomalies are often observed in the root of middle colic artery (MCA), which is surrounded by critical vessels such as superior mesenteric vein (SMV), splenic vein (SPV) and inferior mesenteric vein (IMV). We believe that cranial to caudal approach is one of the answers against how to overcome the hurdle of CME and LN dissection in LTC because it’s relatively easy to discern the border of transverse colon mesentery from pancreas. Another is to clarify the dominantly feeding vessel and establish the interest region of lymphandectomy by using CT colonography and angiography preoperatively. Method First, we open the bursa omentalis widely through the gastrocolic ligament, and subsequently mobilise and take down the hepatic and splenic flexure. The anterior lobe of transverse mesocolon is then dissected at the inferior border of the pancreas with the so-called cranial to caudal approach. Right gastroepiploic vein (RGEV) is a landmark to reach SMV. Exposing pancreatic head and second potion of duodenum and blunt dissection are also important to take down hepatic flexure of transverse colon and detach mesentery of transverse colon. In the process, we transect one or two accessory right colonic vein (ARCV). With skeletonizing SMV to proximal side, merging of SMV, SPV and IMV are uncovered. We think it’s critical to harvest the lymph nodes completely in the region enclosed by SMV, SPV and IMV where there should be generally the root of MCA. CT angiography is a robust support to comprehensively recognise the vessel anatomical anomalies and dissected region of colon mesentery. Continuously, it’s possible to dissect the root of ileocolic and right colic vessels with skeletonizing ventral surface of SMA and SMV in this approach. Results We herein present our practical laparoscopic transverse colectomy with LN dissection in video as attatched to demonstrate our concept and strategy in this field. Conclusion We think that cranial to caudal approach is a feasible technique for complete mesocolic excision in laparoscopic transverse colectomy. Disclosure of interest None Declared.