Priscilla Magno

Infection during natural orifice transluminal endoscopic surgery: a randomized, controlled study in a live porcine model

BACKGROUND Currently reported natural orifice transluminal endoscopic surgery (NOTES) procedures in animals have been done in heterogeneous milieus ranging from nonsterile to sterile procedures, with mixed results, including no infection in those performed in nonsterile settings. OBJECTIVE To establish the potential frequency of infection during NOTES, comparing sterile to nonsterile approaches. SETTING Survival experiments on sixteen 50-kg pigs. DESIGN AND INTERVENTIONS From pilot data (100% infection frequency after nonsterile procedures), sample size (8 animals in each group) was calculated by using a power of 95% and an alpha risk of 0.05. The animals were randomly assigned to two groups: In the transgastric peritoneoscopy study group, liver and ovarian biopsies were performed with sterile overtubes, endoscopes, and accessories and the use of preoperative intravenous antibiotics and antiseptic gastric lavage. In the nonsterile (control) group, the same procedures were performed with nonsterile endoscopes and accessories without the use of gastric lavage and preoperative antibiotics. Complete transmural closure of the transgastric access site was made in all animals. After a 1-week survival time, all animals were killed for necropsy, which included Gram staining and peritoneal cultures. MAIN OUTCOME MEASUREMENTS Intraperitoneal infection on necropsy. RESULTS All necropsies revealed intraperitoneal infection (abscesses, fibrinopurulent exudates, and adhesions) in the control group (frequency of infection 100%). Peritoneal bacterial culture grew various aerobic and anaerobic organisms. No gross or bacteriological evidence of infection was seen in the sterile group (frequency of infection 0%, P value = <.0002). LIMITATIONS Animal experiments. CONCLUSION Nonsterile conditions invariably lead to intraperitoneal infection. Aseptic techniques during NOTES can prevent intra-abdominal infection. Future studies will determine which infection prevention steps are mandatory and which can be omitted during NOTES procedures.

Esophageal cancer incidence rates by histological type and overall: Puerto Rico versus the United States Surveillance, Epidemiology, and End Results population, 1992-2005.

OBJECTIVE The aim of our study was to compare the age-standardized incidence of esophageal cancer (EC) in Puerto Ricans (PRs) with that for non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic (USH), groups in the United States (US) as reported by the Surveillance, Epidemiology, and End Results program for the 1992-2005 period. METHODS We computed the age-standardized and age-specific incidence (per 100,000 individuals) of EC during 1992-2005 using the World Standard Population as reference. The percent changes for age-standardized rates (ASR), from 1992-1996 to 2001-2005, were calculated. The relative risks (RR) and the standardized rate ratios (SRR) were estimated, along with 95% confidence intervals (CIs). RESULTS The ASR of adenocarcinomas (AC) showed increases for most racial/ethnic groups from 1992-1996 to 2001-2005. All racial/ethnic groups showed ASR reductions for squamous cell carcinomas (SCC). For both sexes, PRs had lower AC incidences than NHW and USH but higher than NHB. For those younger than 80 years of age, PR men showed higher SCC incidences than NHW but lower than NHB (P < 0.05). The incidence of SCC was about two times higher in PR men than USH men (SRR: 2.16; 95% CI = 1.65-2.88). Among women, the RR for SCC increased with age when comparing PRs to groups in the US. CONCLUSION Incidence disparities were observed between PRs and other racial/ethnic groups in the US. These differences and trends may reflect lifestyles of each racial/ethnic group. Further studies are warranted to explain these disparities.

Use of adjuvant chemotherapy in patients with stage III colon cancer in Puerto Rico: A population-based study

Objective This study aims to examine factors associated with the use of adjuvant chemotherapy and the use of oxaliplatin after curative resection in stage III colon cancer patients and assesses the effect of their use in three-year survival. Methods This retrospective cohort study was conducted using Puerto Rico Central Cancer Registry-Health Insurance Linkage Database. The study cohort consisted of stage III colon cancer patients with a curative surgery in the period 2008–2012. Multivariate logistic regression was used to estimate adjusted odds ratios. Kaplan-Meier methods and Cox proportional hazards models were used to assess the association between adjuvant chemotherapy and oxaliplatin use and overall survival and risk of death, respectively. Results Overall, 75% of the study population received adjuvant chemotherapy during the study period. Factors statistically associated with receiving adjuvant chemotherapy within four months after resection included being married (adjusted odds ratio [AOR] 1.64; 95% CI 1.18–2.28; p = 0.003), and being enrolled in Medicare (AOR 1.68; 95% CI: 1.03–2.75; p = 0.039) or Medicaid and Medicare dual eligible (AOR 1.66; 95% CI: 1.06–2.60; p = 0.028). However, patients aged ≥70 years were less likely to receive adjuvant chemotherapy (AOR 0.22; 95%CI 0.14–0.36; p<0.001). Discussion We observed a significant reduction in mortality in adjuvant chemotherapy treated patients. Similarly, patients <70 years treated with oxaliplatin had significantly lower risk of death than those who did not, although for patients ≥70 years no statistical significance was achieved. Future studies should assess effective interventions to reduce barriers to access guideline-based recommended colon cancer treatment.

Abstract B82: Health disparities of esophageal cancer by histological type in Puerto Rico: 2000–2004

Background: Esophageal cancer (EC) has been ranked as the 8th most incident cancer and the 6th most common cause of death from cancer in the world. Hence, the primary aim of this study was to assess the age-standardized incidence (ASI) rates by histology type of EC in Puerto Rico (PR) and contrast these statistics with those of US Hispanics (USH), non-Hispanic Whites (NHW), and non-Hispanic Blacks (NHB) in the US. Methods: We applied the direct method to compute the ASI rates for EC (per 100,000 persons) by histology type during 2000 to 2004, using the World Standard Population. The age specific relative risks (RR) and the overall comparison of two standardized rates (SRR) were estimated with 95% confidence intervals to determine relative differences among the study groups, during the same period of time, using the Poisson regression model and PR as reference. Results: Overall, in PR during the years 2000–2004, the ASI rates (x 100,000 persons) for all EC were 16.8; among male 36.1 and among females 11.6. The risk of developing any histology type of EC in PR was higher than NHW for both sexes (SRRmales: 1.14, 95%CI: 1.02–1.28; SRRfemales: 1.27, 95%CI: 1.06–1.51) and USH (SRRmales: 1.45, 95%CI: 1.21–1.76; SRRfemales: 2.39, 95%CI: 1.74–3.35). PR also showed 2 to 3 times the risks of developing esophageal squamous cell carcinomas (ESCC) compared to NHW and USH for both sexes (p Conclusions: Differences in EC incidence rates exist overall and by histology type among Puerto Ricans, NHW, NHB, and USH. Future research is warranted to elucidate the effect of the different risk factors and genetic predisposition for each histology type of EC in PR and among US racial/ethnic populations. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B82.