P1. Surgery for locally recurrent rectal cancer

S S269 Poster abstracts for the BASO w The Association for Cancer Surgery and the RSM e Section of Surgery Scientific Conference e 2 and 3 November 2015 P1. Surgery for locally recurrent rectal cancer AntonioChiappa, EmilioBertani, AndrewZbar,MarcoVenturino, Marco Tulli, Mariagiulia Zampino, Carlo Ferrari, Roberto Biffi 1 University of Milan, Milan, Lombardy, Italy 2 European Institute of Oncology e Unit of Surgical Innovative Techniques, Milan, Lombardy, Italy 3 European Institute of Oncology e Division of Epatobiliary Surgery, Milan, Lombardy, Italy 4 Sheba Medical Center, Tel Aviv, Israel 5 European Institute of Oncology e Intensive Care Unit, Milan, Lombardy, Italy 6 European Institute of Oncology e Division of Medical Oncology, Milan, Lombardy, Italy 7 European Institute of Oncology e Division of Abdomino-Pelvic Surgery, Milan, Lombardy, Italy Background: Local recurrence still remains a major problem after radical resection of rectum for cancer with TME. At the same time the poor evidence due to lack of randomized trials enrolling patients with local recurrence has led to a wide spectrum of treatments for such patients, who are often managed in multidisciplinary framework programs. Methods: Between January 2004 and July 2014, 577 patients were treated with TME for rectal cancer (within 12 cm of the anal verge). All these patients underwent a strict follow-up program comprising instrumental and clinical controls every 6 months for at least 5 years. With a median follow-up of 50 mouths (range 9e120 months), 56 local recurrences were diagnosed. In all but 8 patients recurrence was asymptomatic. The local recurrence rates registered were 7%, 9% and 10% respectively at 2, 3 and 5 years. Seven patients (12.5%) with distant recurrence at the same time were excluded from the following, analysis, for a total of 49 patients examined with local recurrence only. Results: Among the remaining 49 patients, 30(61%) underwent surgery comprising Miles operation in 14 cases (29%), Hartmann procedure in 7(14%), repeated low anterior resection with colo-anal anastomosis in other 3 cases(6%) and palliative colostomy or other palliative procedure in 6 cases (12. Eight patients (16%) were excluded from surgery and underwent some form of CT or associated RT-CT, whilst 11 patients (23%) were addressed to palliative treatment. Overall survival (OS) rates were 48%, 29% and 22% respectively at 2, 3 and 5 years. On univariate analysis, resection of recurrent diseasewas the only significant factor associatedwith prognosiswith a 5 years OSof30%vs22%for resectedandnon-resectedcases respectively (p1⁄4 0.04). Conclusions: Despite early diagnosis due to an intensive follow-up program after TME for rectal cancer, only a half of patients are amenable for re-resection. Surgical resection still remains the mainstay of treatment for locally recurrent rectal cancer. http://dx.doi.org/10.1016/j.ejso.2015.08.106 P2. Gelatinase expression in colorectal cancer pathology and survival Liz Baker, Norma Robinson, Mohamed Tabaqchali, David Leaper 1 University Hospital of North Tees, Stockton on Tees, UK University of Huddersfield, Huddersfield, UK Introduction:Matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) are responsible for tissue breakdown and remodelling in both normal and pathological processes, including tumour invasion andmetastasis. The most extensively studied MMPs in cancer are the gelatinases (MMP-2 andMMP-9). This study determined gelatinase tissue expression in colorectal cancer and correlated this with tumour pathology and 10 year survival status. Methods: Paired tumour and normal mucosal tissue from 101 colorectal cancer patients were analysed by ELISAs (ng/mg protein) and gelatin zymography for MMP-2 and MMP-9 expression. TIMP-1 and TIMP-2 expression were also determined by ELISA. Tissue levels were then correlated with tumour pathology (P< 0.05, Spearman’s correlation) and ten year survival analysis was performed (p< 0.05 Kaplan Meier). The study had ethics approval. Results: Latent and active gelatinases and TIMP-1 levels were all significantly greater in colorectal tumour tissue samples than normal tissue e.g. total MMP-9 levels (median (range)); tumour, 17.4(0.3e217.3) and normal, 2.8(0.2e35.3)ng/mg protein. Tumour levels of some gelatinase forms correlated with the tumour pathology including Dukes’ stage and lymphatic invasion. The proportion of active MMP-2 and MMP-9 in tumour tissue significantly correlated with disease free and overall survival, with higher tissue levels associated with poorer survival. Conclusions: Gelatinase expression is up-regulated in colorectal tumour tissue compared to normal mucosa. Gelatinase levels correlated with both tumour pathology and with disease-free and overall ten year survival in patients with colorectal cancer. http://dx.doi.org/10.1016/j.ejso.2015.08.107 P3. Mammaglobin-A, VEGFR3 and Ki67 in human breast cancer pathology and 5-year survival Liz Baker, NaomiWhiteoak, DeborahWilson, LouiseHall, PudBhaskar University Hospital of North Tees, Stockton on Tees, UK Introduction: Human mammaglobin-A is specifically expressed in breast tissue, over-expressed in some breast cancers and has been associated with less aggressive phenotypes. Vascular endothelial growth factor receptor 3 (VEGFR3) is a marker for angiogenesis and lymph-angiogenesis, and Ki67 is a marker for cell proliferation. It is currently unknown how mammaglobin-A relates to these markers of tumour growth and or disease free survival. Methods: A total of 80 patients who have undergone breast surgery for either breast cancer or benign disease were randomly selected after stratification for tumour grade. Tissue sections were analysed by immunohistochemistry for mammaglobin-A, VEGFR3 and Ki67 expression. Expression was compared with tumour histopathology including receptor status (where available) and five year survival analysis was performed (Chisquared). The study had ethics approval. Results: There was no association found between either, VEGFR3 and mammaglobin (P1⁄4 0.925) or Ki67 and mammaglobin expression (P1⁄4 0.768) however there was a significant association between Ki67 and VEGFR3 (P1⁄4 0.037). Significant associations were also found between Ki67 and tumour grade (P< 0.001), Ki67 and metastasis (P1⁄4 0.045), and between VEGFR3 and tumour grade (P1⁄4 0.002). No