Annals Of Surgical Oncology Research Articles

Putting the "M" in Breastfeeding Medicine.

Putting the "M" in Breastfeeding Medicine.

PRIMARY CARDIAC ANGIOSARCOMA INVADING BIOPROSTHETIC MITRAL VALVE

SESSION TITLE: Tuesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM INTRODUCTION: Primary cardiac tumors have an occurrence rate of 0.0001% - 0.03% on large autopsy series. The angiosarcoma variety are locally aggressive, however there are no previous reports of invasion of a bioprosthetic mitral valve. This may be partially due to the predisposition of malignant cardiac tumors to be right sided. CASE PRESENTATION: We present a 52-year-old female with a past medical history of rheumatic heart disease that came to the hospital for worsening shortness of breath and chest pain. She had undergone a surgical mitral valve replacement 5 years prior. To evaluate for possible endocarditis a trans-esophageal echocardiogram was performed which showed a large mass overlying the mitral annulus and significant bioprosthetic stenosis. This mass protruded across the mitral valve and extended into the left atrial appendage. During removal of the compromised bioprosthetic mitral valve a significant amount of foreign material was noted in and around the valve and a large tumor-like mass involving part of the interatrial septum was resected. A 27 mm Perimount Magna Mitral Ease valve was seated in the supra-annular position. The interatrial septum was reconstructed using a 2 cm bovine pericardium patch. Initial pathology of the mass revealed foci of high-grade malignant neoplasm, organizing thrombi and mesenchymal tissue. Final pathology was consistent with a high-grade epithelioid angiosarcoma. This patient is currently undergoing chemotherapy and radiation therapy. DISCUSSION: Overall survival of patients with primary cardiac angiosarcoma is approximately 1 year. Patients that undergo surgical resection of the tumor have a greater survival than those treated with chemotherapy and radiation alone. Surgical resection is technically difficult due to proximity to important vascular structures. Improvement in overall survival rates has been difficult due to the rarity of the condition. CONCLUSIONS: Primary cardiac angiosarcoma is a rare condition with very poor outcomes. Surgical resection is the cornerstone of treatment, however survival is poor regardless. Reference #1: Lam KY, Dickens P, Chan AC. Tumors of the heart. A 20-year experience with a review of 12,485 consecutive autopsies. Arch Pathol Lab Med. 1993;117(10):1027-31. Reference #2: Patel SD, Peterson A, Bartczak A, et al. Primary cardiac angiosarcoma - a review. Med Sci Monit. 2014;20:103-9. Published 2014 Jan 23. https://doi.org/10.12659/MSM.889875 Reference #3: Look hong NJ, Pandalai PK, Hornick JL, et al. Cardiac angiosarcoma management and outcomes: 20-year single-institution experience. Ann Surg Oncol. 2012;19(8):2707-15. DISCLOSURES: No relevant relationships by Raul Alonso, source=Web Response No relevant relationships by Daryoosh Derakhshan, source=Web Response No relevant relationships by Christopher Foth, source=Web Response No relevant relationships by Marc Iskandar, source=Web Response No relevant relationships by Vy Nguyen, source=Web Response No relevant relationships by Josue Rizo, source=Web Response

WS05.06 Relevance of Lymphadenectomy in Carcinoma of the Esophagus and of the Esophagogastric Junction

WS05.06 Relevance of Lymphadenectomy in Carcinoma of the Esophagus and of the Esophagogastric Junction

Mind the Gap: Gendered Publication Trends in Academic Oncology

Women now comprise the majority of medical school matriculants (51.6% in 2018), and an increasing number of women are seeking careers in oncology and academic medicine. Yet, men still outrank and outnumber women in academic oncology. Given that scientific publications remain an important metric of academic productivity and expertise, we assessed the gender gap in authorship with three metrics: role in publication, degree credentials, and citation count. We hypothesized women would have lower publication metrics but that the gender gap would decrease over time. This study is a bibliometric analysis of 5 major oncology journals (Cancer, Annals of Surgical Oncology, JAMA Oncology, Journal of Clinical Oncology, and International Journal of Radiation Oncology, Biology, Physics [IJROBP]) for 1990, 2000, 2010, and 2017 using the Web of Science. Full name, credentials, article citation metrics, article type, publication year and journal impact factor were collected. First names were used to identify author gender; ambiguous names were categorized via Google web and image search. In total, 9189 journal articles were identified. Overall, women represented 28.4% of first and 20.7% of senior authors. Across all journals, female representation rose between 1990 and 2017, with first authors increasing from 17.7% in 1990 to 36.6% in 2017 and female senior authors increasing from 11.7% in 1990 to 28.5% in 2017. With male senior authors, the first author was more likely to be male (71.4% male; 25.0% female); with female senior authors, first authors were 50.2% male and 47.6% female. IJROBP had the lowest female representation amongst first (25.1%) and senior (16.7%) authors. Women first-authored 30.5% of reviews, 29.9% of articles, 27.3% of editorials, and 22.3% of letters and notes. Credentials could be identified for 71% of authors. Female authors had more MD/Masters degrees than men, who held more MDs and MD/PhDs; this was more pronounced for senior authors (women: 47.9% MD, 11.6% MD/PhD, 9.6% MD/Masters; men: 61.9% MD, 18.7% MD/PhD, and 4.1% MD/Masters). For the 50 most cited articles per year in each journal, female authors comprised a smaller percent of first (26.5%) and senior (19.9%) authors compared to all articles. Average article citation counts were higher for male first (44.8) and senior (47.1) authors compared to female first (39.7) and senior (44.1) authors. Although female oncologists have made significant strides in closing the gender gap in academic publishing, substantial gendered differences remain. Including more women in oncology research will benefit academic diversity, productivity, and recruitment efforts, especially in technical fields such as radiation oncology. Since our work shows female senior authors play a significant role in mentoring or collaborating with other women academics, it is important to foster the advancement of women in leadership.

Analysis of Authorship in Hepatopancreaticobiliary Surgery: Women Remain Underrepresented

IntroductionGiven the need to increase female representation in hepatopancreatobiliary (HPB) surgery, as well as the need to increase the academic pipeline of women in this subspecialty, we sought to characterize the prevalence of female authorship in the HPB literature. In particular, the objective of the current study was to determine the proportion of women who published HPB research articles as first, second, or last author over the last decade. MethodsAll articles pertaining to hepatopancreaticobiliary (HPB) surgery appearing in seven surgical journals (Annals of Surgery, British Journal of Surgery, JAMA Surgery, Annals of Surgical Oncology, HPB (Oxford), Surgery, and Journal of Gastrointestinal Surgery) were reviewed for the years 2008 and 2018. Information on sex of author, country of author’s institution, and article type was collected and entered into a computerized database. ResultsAmong the 1473 index articles included in the final analytic cohort, 414 (28%) publications had a woman as the first or last author, while the vast majority (n = 1,059, 72%) had a man as the first or last author. The number of female first authors increased from 15.6% (n = 92/591) in 2008 to 25.7% (n = 227/882) in 2018 (p < 0.001). There were no differences in the proportion of second (n = 123/536, 23.0% vs n = 214/869, 24.6%, p = 0.47) or last (n = 44/564, 7.8% vs n = 88/875, 10.1%, p = 0.15) authors. Women were more likely to publish papers appearing in medium-impact journals (OR 1.40, 95% CI 1.04–1.88) and articles with a female author were more likely to be from a North American institution (referent: North America, Asia OR 0.43, 95% CI 0.31–0.59 vs Europe OR 0.67, 95% CI 0.51–0.87). ConclusionWomen first/last authors in HPB research articles have increased over the past 10 years from 22 to 32%. Women as last authors remain low, however, as only 1 in 10 papers had a senior woman author. These data should prompt HPB leaders to find solutions to the gap in female authorship including mentorship of young female researchers and surgeons.

Reconstruction of Complex Hemipelvectomy Defects: A 17-year Single-institutional Experience With Lower Extremity Free and Pedicled Fillet Flaps

PURPOSE: Hemipelvectomy procedures result in massive soft tissue defects.1,2 The standard reconstructive approach is to reconstruct the defect with anterior or posterior hemipelvectomy flaps; however, certain oncologic situations can preclude the use of local tissue flaps.3,4 In such cases, a suitable alternative to provide sufficient soft tissue coverage is the use of fillet flaps, which are defined as pedicled or free flaps harvested from amputated parts.5 The purpose of this study is to present our institution’s experience with using both pedicled and free fillet flaps to reconstruct hemipelvectomy soft tissue defects. METHODS: The authors performed a retrospective chart review of patients who underwent hemipelvectomy followed by fillet flap reconstruction from 2001 to 2018. Patient demographics, clinical and surgical characteristics, postoperative outcomes, and complications were reviewed. RESULTS: Ten patients were identified and included. Mean age was 51 ± SD 12.4 years. Six patients (60%) underwent standard external hemipelvectomy, and 4 patients (40%) extended external hemipelvectomy. Seven (70%) lower extremity fillet flaps were performed as free tissue transfers, and 3 (30%) were pedicled flaps. Mean flap size was 1,153 ± SD 1,137 cm2. Mean follow-up was 5 months (range, 1–24 months). Five patients developed postoperative complications; none of them required operative intervention. There were no partial or total flap losses postoperatively. CONCLUSION: Reconstruction with either pedicled or free lower extremity fillet flaps is a valuable reconstructive modality for managing acquired soft tissue defects following hemipelvectomy. This useful technique mitigates donor site morbidity, while simultaneously delivering adequate soft tissue coverage with an acceptable complication profile. REFERENCES: 1. Senchenkov A, Moran SL, Petty PM, et al. Soft-tissue reconstruction of external hemipelvectomy defects. Plast Reconstr Surg. 2009;124:144–155. 2. Tashiro K, Arikawa M, Fukunaga Y, et al. Free latissimus dorsi musculocutaneous flap for external hemipelvectomy reconstruction. Microsurgery. 2019;39:138–143. 3. Senchenkov A, Moran SL, Petty PM, et al. Predictors of complications and outcomes of external hemipelvectomy wounds: account of 160 consecutive cases. Ann Surg Oncol. 2008;15:355–363. 4. Houdek MT, Andrews K, Kralovec ME, et al. Functional outcome measures of patients following hemipelvectomy. Prosthet Orthot Int. 2016;40:566–572. 5. Bibbo C, Newman AS, Lackman RD, et al. A simplified approach to reconstruction of hemipelvectomy defects with lower extremity free fillet flaps to minimize ischemia time. J Plast Reconstr Aesthet Surg. 2015;68:1750–1754.

Abstract SY23-01: Blood-borne tumor cell dissemination in cancer patients

Abstract SY23-01: Blood-borne tumor cell dissemination in cancer patients

Impact of the partnership between Japanese Society of Gastroenterological Surgery, Society of Surgical Oncology, and Annals of Surgical Oncology.

The Society of Surgical Oncology (SSO) and its official journal, Annals of Surgical Oncology, have had a very important and successful partnership with the Japanese Society of Gastroenterological Surgery (JSGS). This partnership has advanced our missions of promoting high‐quality surgical science focused on improving patient outcomes.

Cells to Surgery Quiz: May 2019

Cells to Surgery Quiz: May 2019

MON-384 The Dynamic Genetics of Recurrent Paragangliomas: The Importance of Surveillance

BACKGROUND: Paraganglioma (PGL) are tumors that arise from the ganglia of the sympathetic nervous system, and comprise 10% of all sympathetic nervous system tumors. There are at least 16 germline mutations that have been associated with increased risk of PGL. CASE PRESENTATION: A 32 year-old female with a history of PGL status-post resection presented with elevated plasma metanephrines during surveillance follow-up. She was diagnosed with PGL 7 years ago. Plasma free normetanephrine were elevated at 607 pg/ml (ref ≤ 148 pg/ml) and an MRI abdomen demonstrated a 6.6 x 4.5 x 7.8 cm para-aortic retroperitoneal mass. An MIBG scan showed no abnormal activity. She underwent resection of PGL. Postoperative labs showed normal plasma and urine metanephrines. Genetic testing was negative for known related mutations. She reported dizziness and palpitations six years later. Labs revealed elevated free normetanephrine 213 pg/ml and total metanephrine 238 pg/ml (ref ≤ 205 pg/ml). Repeat plasma and urine tests remained elevated, but an MRI abdomen/pelvis and two MIBG scans were unremarkable. The patient remained symptomatic. Six months later, CT abdomen/pelvis showed a retroperitoneal 2.5 x 1.8 x 1.7 cm necrotic mass and an 3.2 x 2.6 x 2.5 cm adnexal cystic lesion concerning for recurrent PGL. Repeat testing confirmed elevated plasma free normetanephrine 511 pg/ml and undetectable free metanephrine. PET/CT abdomen/pelvis demonstrated the retroperitoneal necrotic mass, two lesions anterior to the L3 and L4-L5 vertebral bodies, and a lytic lesion in the right iliac crest. The patient underwent surgical resection of three PGL, all with vascular and capsular invasion. Six months later, plasma and urinary levels were all normal. PET Ga-68 DOTATATE scan demonstrated uptake near the surgical bed and in the aorto-caval groove, suspicious for residual tumors, and several foci of somatostatin receptor positive osseous lesions, suspicious for skeletal metastases. An updated genetic test showed a variant of uncertain significance (VUS) of the SDHA gene. She is currently undergoing treatment with lanreotide. CONCLUSION: This case highlights the importance of continuous surveillance, as well as the swift advancements in genetics associated with paragangliomas and pheochromocytomas. REFERENCES: Fishbein, L.,et al. (2013). Inherited Mutations in Pheochromocytoma and Paraganglioma: Why All Patients Should Be Offered Genetic Testing. Annals of Surgical Oncology, 20(5),1444-1450.

Abstract P3-10-22: BluePrint molecular subtyping versus HER2 assessment by immunohistochemistry and FISH in the real-world diagnostic setting

Abstract Background: Both the Aphinity and ExteNET trials for anti-HER2 targeted agents were challenged in showing significant benefit of added HER2-targeted treatment. The findings suggested biological heterogeneity in HER2+ cancers, not entirely identified by IHC/FISH, requiring more nuanced biomarkers to clearly identify patient subsets who may derive benefit from new HER2-targeted agents. We have previously shown that BluePrint (80-gene) molecular subtyping reclassifies nearly half of HER2+/ER+ patients to Luminal-type with differential neoadjuvant treatment response (Whitworth, Ann Surg Oncol 2014; Whitworth, ASCO 2018). Here, we evaluated the reclassification rate in the real-world diagnostic setting. Methods: Physicians regularly provide pathology reports to Agendia, Inc for samples which are processed for MammaPrint (70-gene signature) and BluePrint molecular assays as part of routine diagnostic care. For this analysis, 4986 sequentially available pathology reports (submitted between October 2016 to October 2017) were reviewed; HER2 and ER IHC results were captured. The molecular subtype was compared to IHC/FISH status. Results: HER2 IHC/FISH results were available for 1568 samples. Of those, 85% (1330/1568) were HER2-nonamplified, 10% (153/1568) were HER2-equivocal, and 5% (85/1568) were HER2-amplified by IHC/FISH. Of the HER2-nonamplified tumors, BluePrint reclassified 0.1% (2/1330) as HER2-type. Of the HER2-equivocal tumors, none were HER2-type by BluePrint; 91% (139/153) were Luminal-type and 9% (14/153) were Basal-type. Of the HER2-amplified tumors, 15% (13/85) were dominant HER2-type, 79% (67/85) were dominant Luminal-type, and 6% (5/85) were Basal-type. Conclusions: In this set of tumors identified as HER2-amplified by IHC/FISH, BluePrint reclassified 85% of tumors to non-HER2 molecular subtypes, mostly Luminal-type for ER-positive tumors and Basal-type for ER-negative tumors. Moreover, BluePrint gave clarity where IHC/FISH could not, classifying all HER2-equivocal tumors to non-HER2 subtypes. Additional therapeutic options should be explored for HER2+/ER+ BluePrint Luminal-type patients who have observed much lower pCR rates versus BluePrint HER2-type patients (12% vs. 51%, respectively; Lee, AACR 2018). HER2 IHC/FISH vs BluePrint SubtypeHER2 IHC/FISH StatusHER2-type Luminal-type Basal-type Total IHC ER-IHC ER+IHC ER-IHC ER+IHC ER-IHC ER+ Nonamplified (ER-Unknown, n=28)118120353361330Equivocal (ER-Unknown, n=6) 2131104153Amplified (ER-Unknown, n=2)112 664 85Total21310140067401568 Citation Format: Treece T, Audeh W, Navarro F, Wei J. BluePrint molecular subtyping versus HER2 assessment by immunohistochemistry and FISH in the real-world diagnostic setting [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-10-22.

Operative choice for colon and rectal cancer: what matters?

Thearticle entitled “ Long - term outcomes of robot - assisted surgeryin patients with colorectal cancer ”, published in the Annals of SurgicalOncology , is a timely analysis of oncologic outcomes comparing robotic andconventional laparoscopic techniques (1). Several other studies have demonstratedequivalent short-term outcomes between robotic and laparoscopic groups,including postoperative complications and hospital length of stay (2-5).However, long-term oncologic outcomes for the robotic approach have not yetbeen well evaluated.

A RARE CASE OF SOLITARY FIBROUS TUMOR OF THE LUNG PRESENTING WITH CAVITARY LESION AND THROMBOEMBOLISM

SESSION TITLE: Lung Cancer 2 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Solitary fibrous tumors (SFT) are fibroblastic mesenchymal tumors that most commonly develop in lungs and pleura. The majority are benign and do not invade or metastasize. CASE PRESENTATION: A 60-year-old male was admitted with cough, sputum production, night sweats, and progressive right leg edema and erythema of 14 days duration. Patient denied fever, chills, anorexia or weight loss. At admission, vital signs were stable. Patient had leukocytosis, normocytic normochromic anemia, normal LDH and haptoglobin, thrombocytosis with 619K platelets. He had elevated PTT 33.6, normal PT/INR. FOBT was negative. Chest x-ray showed right lung apical cavitary lesion which was not present on CXR done three years ago. Patient was a heavy smoker. He denied history of incarceration, sick contacts, recent surgery, immobilization, long flights or car rides. Lower extremity venous doppler showed right popliteal and femoral DVT. CT angiography was negative for PE but showed an irregular cavitary lesion in the right upper lobe with surrounding nonspecific opacities and bilateral hyperinflation. CT abdomen was negative for masses or hepatosplenomegaly. Blood cultures, three acid-fast smears, quantiferon TB, West Nile virus, HIV, hepatitis B and C were negative. Bronchoscopy and broncho-alveolar lavage (BAL) showed 400 WBCs, mainly lymphocytes. Two BAL cultures were negative for bacterial or fungal growth and cytology was negative for malignancy. CT-guided biopsy of the right upper lobe was consistent with SFT: immunoperoxidase stains for pancytokeratin, CK5/6, calretinin, CD34, WT1 and CD99 showed dense fibroblastic proliferation, scattered cytokeratin positive cells, maturity subset stromal and spindle cells without malignant features. Patient was planned for surgical resection of the tumor. DISCUSSION: Patients with SFTs are either asymptomatic or present with non-specific symptoms such as cough, chest pain, dyspnea, and rarely hemoptysis and mass effect. Paraneoplastic symptoms, specifically hypoglycemia, digital clubbing, and hypertrophic pulmonary osteoarthropathy can develop. SFTs typically present as homogeneous masses on CT scans, but cystic masses have been reported. Reports of cavitary SFT as we described in our patient are extremely rare. To our knowledge, there are no reports of SFT cases with paraneoplastic hypercoagulability syndromes. Since regardless of the histologic type the behavior of these tumors is often unpredictable and approximately 10-20% recur or metastasize, surgical resection is recommended. CONCLUSIONS: We presented a case report of a patient who developed cavitary pulmonary SFT accompanied by thrombocytosis and paraneoplastic hypercoagulability syndrome leading to DVT. Clinicians should consider the diagnosis of SFT in patients with similar unusual presentations and plan for early surgical removal of the tumor to reduce the likelihood of recurrence and metastases. Reference #1: Chick, J.F.B., Chauhan, N.R. and Madan, R., 2013. Solitary fibrous tumors of the thorax: nomenclature, epidemiology, radiologic and pathologic findings, differential diagnoses, and management. American Journal of Roentgenology, 200(3), pp.W238-W248. Reference #2: van Houdt, W.J., Westerveld, C.M., Vrijenhoek, J.E., van Gorp, J., van Coevorden, F., Verhoef, C. and van Dalen, T., 2013. Prognosis of solitary fibrous tumors: a multicenter study. Annals of surgical oncology, 20(13), pp.4090-4095. Reference #3: Tay, C.K.J., Teoh, H.L. and Su, S., 2015. A common problem in the elderly with an uncommon cause: hypoglycaemia secondary to the Doege-Potter syndrome. BMJ case reports, 2015, p.bcr2014207995. DISCLOSURES: No relevant relationships by Alexander Goldstein, source=Web Response No relevant relationships by ASM ISLAM, source=Web Response No relevant relationships by Phyo Kyaw, source=Web Response No relevant relationships by Lusine Nahapetyan, source=Web Response No relevant relationships by AHMED TAHA, source=Web Response

PC03.08 Adjuvant Chemotherapy for Thymic Carcinoma - NO

PC03.08 Adjuvant Chemotherapy for Thymic Carcinoma - NO

PC04.03 Adjuvant Targeted Therapy for PTS with Genomic Alterations - Yes

PC04.03 Adjuvant Targeted Therapy for PTS with Genomic Alterations - Yes

Editorial introductions

Editorial introductions

PS02.194: THE GENERATION &amp; VALIDATION OF FOUR NEW ESOPHAGEAL CANCER CELL LINES WITH MATCHED PATIENT-DERIVED TUMOR XENOGRAFTS

Abstract Background Research into esophageal cancer, in particular adenocarcinoma, has been hampered by a paucity of relevant pre-clinical models. To date, only 13 bona fide adenocarcinoma cell lines have been published, with only six being derived from patients with confirmed Barrett's esophagus. Having so few available cell lines makes it difficult to model the genetic diversity observed in esophageal adenocarcinoma. In addition, only one of these lines has been shown to be reproducibly metastatic in xenograft models. This is in distinct contrast to the disease in the human, which is almost universally metastatic when left untreated. Methods Using our previously published intramuscular xenografting technique1, patient derived tumour xenografts (PDTX) were generated from endoscopic biopsies of treatment naïve esophageal adenocarcinoma and SCC biopsies. Following successful engraftment, PDTX tissue was digested in order to generate small explant pieces. Explants were then plated with media and cultured for extended periods until a dominant clone was cultured. One cell line was directly obtained from the malignant ascites of a mouse that was harboring a PDTX that had metastasized. Established cell lines then underwent validation, which consisted of short tandem repeat (STR) analysis, targeted oncogene assessment using the Illumina TruSeq cancer panel, tumorigenic assay, immunohistochemical (IHC) analysis for both adenocarcinoma and SCC markers as well as FACS analysis for both epithelial and human markers. Results Matched PDTX and xenograft derived cell lines were generated from two separate SCCs in addition to two separate adenocarcinomas. From one of the adenocarcinoma lines, two separate cell lines were generated, with one clone demonstrating a reproducibly metastatic phenotype, while the other remained non-metastatic. STR analysis confirmed all of the PDTXs and cell lines were derived from their respective patients and IHC analysis confirmed that they expressed the appropriate epithelial markers. Conclusion We have successfully generated and validated four additional esophageal cancer cell lines (two adenocarcinoma and two SCC) with matched PDTXs. The combination of both models creates a powerful tool, given the ability of PDTXs to recapitulate the heterogeneity and stromal elements of the original tumour, and the versatility of cell lines for mechanistic studies. 1. Read, M., et al. Annals of surgical oncology 2015. Disclosure All authors have declared no conflicts of interest.

Influences of clinical experience in the quantification of morphometric sarcopaenia: a cohort study.

Influences of clinical experience in the quantification of morphometric sarcopaenia: a cohort study.

Abstract ES7-1: Challenges in the management of locoregional recurrence

Abstract The increasing trend toward tailoring treatment of the primary breast cancer with limited surgery of both the breast and axilla has increased the challenge of managing locoregional recurrence (LRR). In the era when patients uniformly had axillary dissection, the appropriateness of repeat sentinel node biopsy was not a question. Similarly, the dogma that all ipsilateral breast tumor recurrences must be treated with mastectomy if the breast has been previously irradiated is also being challenged. LRR events are infrequent with modern multi-modality therapy, and there are no randomized trials to address these questions. Re-operative sentinel node (SN) biopsy after breast conserving surgery therapy (BCT) has been shown to be feasible, with the likelihood of identifying additional SNs related to the number of nodes excised at the time of initial SN biopsy. The accuracy of SN biopsy after mastectomy is less clear. However, the impact of identification of nodal disease on management of LRR is controversial. In a study of 12 patients with isolated chest wall recurrence post mastectomy, 10/12 had successful mapping and 7/10 had an axillary SN. The absence of nodal metastases was an indication to avoid supraclavicular RT (Johnson J. Ann Surg Oncol 2016;23:715). In a study of 83 patients with in breast (n=79) or chest wall recurrence who were clinically node negative, 47 had axillary surgery and 36 did not. At a median of 4.2 years after LR, rates of axillary and non-axillary local recurrence, distant metastases, and death did not differ significantly between groups (Ugras S. Ann Surg Oncol 2016). With the findings of the CALOR trial that systemic chemotherapy is beneficial in the management of LRR, the finding of axillary metastases is less likely to influence systemic therapy than in the past and repeat axillary staging could potentially be avoided. In the untreated breast, drainage to the contralateral axilla is very rare and contralateral axillary metastases classify a patient as Stage IV. After initial axillary dissection, between 4% and 33% of patients with local recurrence will have contralateral axillary drainage. In a systemic review of 48 cases of contralateral nodal recurrence without other distant metastatic disease, at a mean follow-up of 50.3 months disease free survival was 65% and overall survival 83% after treatment that included both local and systemic therapy (Moossdorff M. Eur J Surg Oncol 2015;41:1128). These findings raise the possibility that in the setting of LR, contralateral axillary metastases should be treated aggressively for cure after excluding distant metastases. Citation Format: Morrow M. Challenges in the management of locoregional recurrence [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr ES7-1.

The impact of preoperative dexamethasone on long-term survival following surgery for colorectal cancer.

644 Background: Steroids given at the induction of anaesthesia are associated with a reduction in the magnitude of the postoperative systemic inflammatory response and fewer complications following elective surgery for colorectal cancer (McSorley et al. Ann Surg Oncol 2017;24(8):2104-2112). The present study examined their impact on survival. Methods: Patients who underwent elective surgery, with curative intent, for stage I-III colorectal cancer at a single centre between 2008 and 2016 were included. Data on preoperative dexamethasone was obtained from anaesthetic records, and its impact on cancer specific (CSS) and overall survival (OS) assessed using Cox regression in an unmatched (n=556) and a propensity score matched cohort (n=276) (Table 1). Results: After excluding postoperative mortalities (n=3), there were 98 deaths (18%), with 57 (10%) due to cancer. Of those alive at censoring, the median follow up was 47 months (range 16-110). In the unmatched cohort, there was no significant association between dexamethasone and CSS (HR 0.90, 95% CI 0.52-1.53, p=0.688) or OS (HR 0.95, 95% CI 0.63-1.43, p=0.804). In the propensity score matched cohort, there was no significant association between dexamethasone and CSS (HR 1.18, 95% CI 0.55-2.53, p=0.668) or OS (HR 1.21, 95% CI 0.67-2.17), p=0.532). Conclusions: These results suggest that whilst preoperative steroids are associated with improved short term outcomes following surgery for colorectal cancer, they have no negative effect on long term outcomes. [Table: see text]