296. Palliative resection of primary tumour in incurable colorectal cancer: A case - controlled study as to whether complete or excision

S S117 Background: There was still a controversy as to whether palliative resection of primary tumor in incurable colorectal cancer (ICRC) is beneficial in point of survival prolongation. However, there was a few studies for the extent of palliative resection. Purpose: The aim of this study is to estimate the extent of resection of primary tumor in ICRC by using case controlled study. Methods: A retrospective analysis was performed of 190 patients undergoing palliative surgery for ICRC between 1995 and 2004 in single institution. Variables in relation to patients’ demographics, histopathological characteristics of tumor, surgical procedures, and natural course of the disease were examined. Results: Seventy patients (45.5%) underwent complete resection of primary tumor in ICRC and 84 patients (55.5%) underwent excisional resection. In median months of survival, complete resection group was 22 months and excisional resection group was 12.6 months, and Kaplan-Meier survival curve showed a significant survival benefit in patients undergoing complete resection for primary tumor (p<0.001). Multivariate analysis showed that extra-abdominal metastasis, the excisional resection of primary tumor, and absence of multimodality adjuvant therapy were significantly associated poor survival outcome (p1⁄40.03, 0.034, <0.001, respectively). In survival analysis according to histologic type, low grade tumor had significant survival benefit by complete resection (p<0.001), while high grade tumor had no benefit by complete resection (p1⁄40.786). In high grade tumor, multimodality adjuvant therapy was the single most important factor which was associated with survival. Conclusions: In healthy patients with ICRC, if histology is low grade and there was no extra peritoneal metastasis, complete resection of primary tumor was the option for survival benefit and local control of disease. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.287 297. Multimodal approach to stage IV rectal cancer treatment V. Aliev, Y.U. Barsukov, S. Tyulyandin, S. Tkachev, A. Nikolaev,M. Fedyanin, D. Kuzmichev, Z.Z. Mamedli, S. Gordeev, I. Tataev 1 N.N. Blokhin Russian Cancer Research Center Moscow Russia, Moscow, Russian Federation N.N. Blokhin Russian Cancer Research Center Moscow Russia, Dept. of Colorectal Cancer, Moscow, Russian Federation The aim of this trial was to investigate safety, efficacy of neoadjuvant chemoradiotherapy in metastatic rectal cancer patients and sphincter preservation rate after such treatment. Methods: During 2010-2013 neoadjuvant treatment was performed in 75 patients with synchronous metastatic rectal cancer patients. T3 patients had synchronous liver (n1⁄430, 73,1%), lung (n1⁄45, 12,1%), liver+lung (n1⁄44, 9,6%), ovarian (n1⁄41, 2,4%), peritoneal (n1⁄41, 2,4%) metastases. T4 patients had synchronous liver (n1⁄417, 50%), lung (n1⁄45, 14,7%), liver+lung (n1⁄45, 14,7%), ovarian (n1⁄42, 5,9%), retroperitoneal (n1⁄45, 14,7%) metastases. T3 patients underwent (n1⁄441, 54,7%) 3-4 FOLFOX6 cycles and 5x5 Gy radiotherapy. T4 patients (n1⁄434, 45,3%) underwent 3-4 XELOX cycles and 36-40 Gy radiotherapy in 4 Gy fractions. Control group included 80 patients who had primary tumor resected as the first stage of treatment. Type of surgery, sphincter preservation rate, R0 resection rate, postoperative complications and survival were analyzed. Results: 17,6% patients experienced grade 2-3 diarrhoea, 13,2% vomiting, 10,3% neutropenia, 20,5% proctitis, 2,9% skin toxicity. 60 (80%) patients underwent surgical treatment. 22 (36,7%) had ultralow anterior resection, 15 (25%) e low anterior resection, 12 (20%) e abdominoperineal resection, 7 (11,7%) e Hartmann procedure, 10 (16,7%) patients had combined resections, 3 (5%) e explorative operations. 3 (8,1%) had anastomotic leak, 1 (2,7%) e bowel obstruction, 2 (3,3%) e pelvic abscess, 2 (8,7%) e postoperative bleeding, 1 (2,7%) pleuritis, 2 (3,3%) e bladder atony. 38 (63,3%) patients had sphincter-sparing surgery. R0 resections were performed in 27 (45%) patients, 15 (55,5%) had synchronous resections. Median followup was 11,5 months, 1-year survival was 85% in T3NxM1 patients, 80% in T4NxM1 patients. Patients, who had no neoadjuvant treatment had 60% 1-year survival. Conclusions: Investigated treatment schemes have acceptable toxicity and justify sphincter preservation in this group of patients. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.288 298. Cytoreductive surgery in colorectal cancer patients with synchronous lung metastases V. Aliev, A. Rasulov, Y.U. Barsukov, A. Allakhverdiev, D. Kuzmichev, A. Ovchinnikova, S. Gordeev, H. Djumabaev, V. Kulushev, A. Polynovskiy 1 N.N. Blokhin Russian Cancer Research Center Moscow Russia, Moscow, Russian Federation N.N. Blokhin Russian Cancer Research Center Moscow Russia, Dept. of Colorectal Cancer, Moscow, Russian Federation The aim of this trial was to investigate R0 resection rate in colorectal cancer patients with synchronous lung metastases. Methods: This retrospective study included 94 colorectal cancer patients with synchronous lung metastases, who underwent treatment during 2004-2014. R0 resection rate, methods of surgical and combined treatment and survival were analyzed. Results: 64 patients(68,1%) had synchronous lung and liver metastases, 30 (31,9%) e only lung metastases, 11 (11,7%) had singular lung metastases. Primary tumor was localized in rectum in 51 (54,3%) patients, 13 (25,5%) of them received neoadjuvant chemoradiation. 12 (12,8%) patients received monochemotherapy after surgery, others received XELOX, FOLFOX chemotherapy. 78 (82,3%) patients had primary tumor resected. Among 16 (17,1%) patients with primary tumor, 14 had palliative surgery for bowel obstruction. 34 (66,6%) rectal cancer patients had sphinctersparing surgery. All 11 (100%) patients with singular lung metastases had R0 resection, 8 (72,7%) had thoracoscopic surgery. Median followup was 12,6 months, 2-year survival e 40%. Patients with synchronous lung and liver metastases had 27% 2-year survival, patients with lung-only metastases had 51% 2-year survival. Conclusions: Isolated resectable lung metastases are rarely observed in rectal cancer patients. Patients undergoing R0 resection for metastatic disease have a tendency to improved survival. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.289 299. Management of temporary stoma after elective surgery in an Italian tertiary care referral center for rectal cancer “COMRE Group” S. Scabini, E. Rimini, A. Massobrio, E. Romairone 1 St. Martino Hospital, Emato-Oncology, Genoa, Italy Background: Rectal surgery for cancer often requires the creation of a temporary stoma to protect an anastomosis that can be jeopardized by neoadjuvant therapy. The recanalization can be performed either immediately or several months after surgery (early or delayed). This series reports about the results in the management of the stoma in a tertiary care referral center for rectal surgery. Materials and methods: One hundred ninety-three consecutive patients undergoing surgery for rectal cancer have been included in this report . All patients underwent anterior rectal resection. Overall, a stoma was performed in 139 patients (75.6%) (M: 78; F: 61; average age: 67.6