Prior Resection Research Articles

P0925 Risk of postoperative Crohn’s disease recurrence in patients smoking e-cigarettes and heat-not-burn tobacco products: a multicenter retrospective study

Abstract Background Tobacco is a known risk factor for Crohn’s disease (CD) recurrence after surgery. However, the impact of electronic cigarettes (or vape) and heat-no-burn tobacco products on post-operative recurrence is unknown. Methods We conducted a retrospective study across five centers in Italy. We included consecutive patients with CD who underwent ileocolic resections and endoscopic reassessment within 3 to 12 months after surgery, for whom smoking habit after surgery and before reassessment was known. Endoscopic recurrence was defined as a modified Rutgeerts score of i2b or higher. Recurrence rates were compared with Fisher’s exact test. Results In total 332 patients were retrieved, 65% male and 35% female, with an average age of 44, 55 (16.6%) with a history of other prior intestinal resections. (Table 1) Of these, 64 (19.3%) patients were excluded for uncertain endoscopic outcomes or missing Rutgeerts score. Additionally, because we focused the analysis on the consumption of e-cigarettes, heat-not-burn tobacco products (ie. IQOS), and traditional tobacco cigarettes, 4 patients were excluded due to mixed smoking habits (e-cigarettes and conventional cigarettes), and 1 for smoking cannabis. In the overall population, post-operative endoscopic recurrence was observed in 76% (13/17) of heat-not-burn tobacco smokers, 72% (51/71) of conventional cigarette smokers, 56% (9/16) of e-cigarette smokers, and 52% (82/159) of non-smokers. Figure A To avoid the potential confounding effect of therapy, we restricted the analysis to patients who received immunomodulators, biologics, or advanced small molecules after surgery for prevention of post-op recurrence. In the 208 patients who received prophylaxis, recurrence rates were broadly similar, 80% (12/15), 73% (43/59), 58% (7/12), and 51% (62/122) for the respective groups. Figure B Irrespective of post-operative treatment, recurrence rates were similar for heat-not-burn tobacco and traditional tobacco cigarettes (76% vs 72%, p=0.9; and 80% vs 73% p=0.7) and similar between e-cigarettes and non-smokers (56% vs 52% p=0.8; and 58% vs 51% p=0.7). Instead, as expected, tobacco increased the risk of recurrence compared to non-smoking (both p=0.005). Although not significant, a trend of progressively greater recurrence was observed from non-smoke, vape, tobacco, and heat-not-burning tobacco products. Conclusion In the first study on the impact of novel smoking habits on CD postoperative recurrence, vaping was not associated with higher recurrence rates compared to non-smoking, instead heat-not-burn tobacco products had recurrence rates similar to traditional cigarettes. A larger study is underway to confirm these results.

P1056 Effectiveness and Safety of Upadacitinib Induction Therapy in Real-World Setting for 234 Patients with Crohn’s Disease: A GETAID Multicentre Cohort Study

Abstract Background While upadacitinib has demonstrated its efficacy as an induction treatment for Crohn’s disease (CD) in two phase 3 randomized, placebo-controlled trials1, real-world data remain limited. Methods From September 2022 to September 2024, all consecutive patients with refractory CD treated with once-daily upadacitinib 45 mg in 30 French and Belgian GETAID centres were retrospectively included. The primary endpoint was steroid-free clinical remission (SFCR) at week 12, defined as a Harvey-Bradshaw Index (HBI) score of < 4. Secondary endpoints included clinical response (decrease of ≥ 3 points in the HBI score and/or an HBI score < 4), clinical remission, biological remission (calprotectin ≤ 250 µg/g, or CRP ≤ 5 if calprotectin was unavailable), endoscopic or radiological (IUS and/or MRI) response, and adverse events (AEs). Results 234 patients were included, all of whom had been previously exposed to at least one biologic (median 4, IQR[3-4]), and 125 (53.9%) had undergone prior intestinal resection (Table 1). At week 12, SFCR was observed in 107 patients (n=107/197, 54%), clinical response in 120 (n=120/190, 63%) and clinical remission in 111 (n=111/197, 56%). Ninety-two (n=92/179, 51%) achieved biological remission and endoscopic or radiological response was observed in 19 (n=19/40, 48%) patients (Figure 1). Respectively 28 (n=28/37, 76%) and 20 (n=20/37, 54%) of patients with articular EIMs achieved clinical response and remission. For cutaneous EIM, clinical response was achieved in 10 patients (n=10/11, 91%), and clinical remission was achieved in nine patients (n=9/11, 82%). In multivariate analysis, body mass index < 18.5 kg/m2 (OR=0.09, 95%CI: 0.01-0.33, p=0.002) and HBI > 7 (OR=0.24, 95%CI: 0.12-0.47, p<0.0001) were associated with lower rates of SFCR at W12 while the number of prior biologics did not influence SFCR (OR = 0.72, 95% CI: 0.35-1.48; p = 0.36). At week 12, 35 (15%) patients discontinued upadacitinib (lack of effectiveness, n=31; AEs, n=2 and other, n=2). CD-related hospitalization was needed in 18 (7.7%) patients, and 4 (1.7%) underwent intestinal resection. Sixty-eight AEs occurred in 61 patients (26%), including 19 serious AEs, corresponding to 18 cases of CD exacerbation and one case of colonic EBV-associated lymphoproliferative disorder. Acne was observed in 25 (10.7%), justifying treatment discontinuation in one (0.4%). Conclusion In this real-world cohort of highly refractory CD patients, upadacitinib induction resulted in a clinical response in about two-thirds of patients and SFCR in half of patients.

P0797 Clinical outcomes of dose escalated vedolizumab in Inflammatory Bowel Disease: a retrospective tertiary centre experience

Abstract Background Dose escalation has emerged as a key strategy in optimising the effectiveness of biologic therapies in patients with inflammatory bowel disease (IBD) facing secondary loss of response (SLOR). Emerging data supports dose escalation of anti-tumour necrosis factor α (TNF-α) biologics, with many centres employing the use of therapeutic drug monitoring (TDM) guided by serum drug levels 1. However, titration of vedoluzimab remains challenging due to the lack of available TDM 2. The effectiveness and safety of dose escalated vedolizumab is an area of ongoing interest, particularly, with vedolizumab perhaps being a safer alternative in patients who warrant avoidance of systemic immunosuppression 3. As such, we evaluated clinical outcomes of dose escalated vedolizumab at a large tertiary centre. Methods We performed a retrospective analysis of IBD patients receiving dose escalated vedolizumab from 2016 to 2024 at the Royal Melbourne Hospital. Dose escalation was defined as an increase of dose (>300mg) and/or frequency [every 8 weeks (>Q8W)] and/or received additional induction doses. We reported primary outcomes as treatment persistence, clinical disease status (SCCAI & HBI) and biochemical markers (faecal calprotectin & CRP), at the following intervals: 3-12 months, 12 months, and yearly up to 36 months following escalation. Secondary outcomes include hospitalisation and surgery rates. Results Of the 16 patients (median age 43.5, 56% female) who had previously received dose escalated vedolizumab, 12 had ulcerative colitis (UC) and 4 had Crohn’s disease (CD). Indications for dose escalation included: sonographic features of disease progression on intestinal ultrasound (18.8%), concerning endoscopic findings (6.3%) and clinical loss of response (75%). Dose escalation led to significant improvements in UC activity scores (Simple Clinical Colitis Activity Index (SCCAI): p=0.043), but not CD activity scores (Harvey-Bradshaw Index (HBI): p>0.05), at 3-12 months respectively. Dose escalation did not yield statistically significant reductions in CRP and faecal calprotectin (p > 0.05) at all measured time points. Patients previously exposed to biologics had higher persistence at 36 months compared to biologic naïve patients – at 69% and 50% respectively. Surgery was required in 0% of patients, although 25% of patients (n=4) had prior bowel resections, and 6.25% required hospitalisation (n=1). No serious adverse reactions were reported in any followed up patients. Conclusion Dose escalation of vedolizumab appears to be safe and effective in IBD patients with secondary loss of response. Our study demonstrates that dose escalation prolongs treatment persistence and improves patient quality of life.

P0977 Health-Related Physical Fitness and Its Association with Disease- and Treatment-related Characteristics in Patients with Inflammatory Bowel Disease Versus Healthy Controls

Abstract Background Inflammatory Bowel Disease (IBD) may negatively impact health-related physical fitness components (body composition, cardiorespiratory fitness, muscular strength, muscular endurance, and flexibility) due to sedentary behavior and disease-specific effects. Limited data on health-related physical fitness in IBD hinders the development of targeted physical exercise training interventions to improve disease outcomes and well-being. This study aimed to compare health-related physical fitness between IBD patients and age- and sex-matched healthy controls and to assess associations with disease- and treatment-related characteristics in IBD. Methods This cross-sectional study included 105 IBD patients (in remission or mild-to-moderate clinical disease activity) and 102 age- and sex-matched healthy controls (Table 1). Participants performed validated tests for health-related physical fitness, including four-site skinfold thickness for body fat percentage, the steep ramp test for cardiorespiratory fitness and muscular strength, the 60-second sit-to-stand test and hand-held dynamometry for muscular strength, isokinetic dynamometry for muscular endurance, and the sit-and-reach test for flexibility.1 Fatigue (Checklist Individual Strength) and self-reported physical activity (International Physical Activity Questionnaire Short Form) were also assessed. Clinical data were collected, including body mass index, comorbidities, disease duration, disease activity, extra-intestinal manifestations, medication use, and prior intestinal resections. Results Patients with IBD had a higher body fat percentage (29.5% vs. 26.9%, p=0.012), lower steep ramp test performance (WRpeak 4.2 W/kg vs. 4.8 W/kg, p<0.001), fewer sit-to-stand repetitions (42 vs. 47, p=0.002), and reduced hand-held dynamometry hamstring strength (3.0 N/kg vs. 3.2 N/kg, p=0.011), as compared to healthy controls (Figure 1). Differences persisted after adjusting for age, sex, Charlson comorbidity index, smoking, and educational level. Multivariable linear regression analyses showed associations for increased body fat and reduced cardiorespiratory fitness and muscular strength with older age, female sex, higher body mass index (BMI), fatigue, arthritis, and a higher number of biologicals. No differences were found in muscular endurance or flexibility. Conclusion Patients with IBD have elevated levels of body fat and reduced cardiorespiratory fitness and muscular strength compared to healthy controls, with no observed differences in muscular endurance or flexibility. Targeted exercise interventions, especially for those with higher BMI, fatigue, arthritis, or multiple biologic treatments, may improve deficits in health-related physical fitness and potentially enhance disease outcomes.

Single-step 3D printing aided cranio-orbital reconstruction with patient specific polyetheretherketone implants after resection of benign spheno-orbital tumors

PurposeComputer-aided design (CAD) and computer-aided manufacturing (CAM) techniques have paved the way for single-step resections and cranio-orbital reconstructions with patient specific implants in spheno-orbital tumors. Here, we present our interdisciplinary maxillofacial and neurosurgical workflow and a case series of patients treated with this integrated approach.MethodsPatients, who underwent single-step resection of benign spheno-orbital tumors and cranio-orbital reconstruction with polyetheretherketone (PEEK) patient specific implants (PSI) from 2019 to 2024 in our institution were included. Three dimensional models of the tumor, the skull, the implants and the cutting guides were integrated into intraoperative neuronavigation and 3D printed at the point of care (POC) for surgical planning. Clinical data was retrospectively analyzed, pre- and postoperative Exophthalmic index (EI) was radiologically determined.ResultsEleven patients met inclusion criteria. Meningioma WHO grade 1 was the most common tumor entity (81.8%). In a majority of patients, exophthalmos was the presenting sign (63.6%). Postoperative cranial imaging revealed an optimal position of the PEEK implants with regredient EI in 88.9%. Four (36.4%) patients, of whom two (50%) had undergone prior tumor resections, suffered from surgical complications. The most commonly recorded complication was impaired wound healing (n = 2). Tumor recurrence was observed in one (9.1%) patient at six months follow-up.ConclusionsSingle-step resection and reconstruction in spheno-orbital tumors with PEEK PSIs is feasible and combines surgical expertise, virtual implant design and 3D printing techniques. Favorable aesthetical, visual and oncological outcomes were achieved in this cohort, despite a significant risk for postoperative complications.

Propensity Score-Matched Analysis of Liver Venous Deprivation and Portal Vein Embolization Before Planned Hepatectomy in Patients with Extensive Colorectal Liver Metastases and High-Risk Factors for Inadequate Regeneration.

Liver venous deprivation (LVD) is known to induce better future liver remnant (FLR) hypertrophy than portal vein embolization (PVE). The role of LVD, compared with PVE, in inducing FLR hypertrophy and allowing safe hepatectomy for patients with extensive colorectal liver metastases (CLM) and high-risk factors for inadequate hypertrophy remains unclear. Patients undergoing LVD (n=22) were matched to patients undergoing PVE (n=279) in a 1:3 ratio based on propensity scores, prior to planned hepatectomy for CLM at a single center (1998-2023). The propensity scores accounted for high-risk factors for inadequate hypertrophy, namely pre-procedure standardized FLR (sFLR), body mass index, number of systemic therapy cycles, an extension of PVE to segment IV portal vein branches, prior resection, and chemotherapy-associated liver injury. The matched cohort included 78 patients (LVD, n=22; PVE, n=56). Baseline characteristics were comparable. The number of tumors in the whole liver was similar but more LVD patients had five or more tumors in the left liver (32% vs. 11%; p=0.024). Post-procedure sFLR was similar but LVD patients had a significantly higher degree of hypertrophy (16% vs. 11%; p=0.017) and kinetic growth rate (3.9 vs. 2.4% per week; p=0.006). More LVD patients underwent extended right hepatectomy (93% vs. 55%; p=0.008). Only one patient had postoperative hepatic insufficiency after PVE, and no patients died within 90 days of hepatectomy. In patients with extensive CLM and high-risk factors, LVD is associated with better FLR hypertrophy compared with PVE and allows for safely performing curative-intent extended major hepatectomy.

Colorectal Neoplasia Detection Rates in Lynch Syndrome.

The expected and optimal adenoma detection rate (ADR) is not well characterized in Lynch syndrome (LS). The aim of this study is to determine the ADR, the overall colorectal neoplasia detection rate (CNDR), proximal serrated detection rate (PSDR), and CRC detection rate (CRCDR) in an LS cohort. A retrospective study was performed of individuals with LS who were evaluated at a single tertiary care center from May 2001 to September 2023 (n = 542). Data from procedure and pathology reports were collected along with relevant demographic, clinical history, and family history data. Fisher's exact test and the Kruskal-Wallis test were used to assess factors associated with colorectal neoplasia. Amongst 542 individuals with LS, 352 met the inclusion criteria, and their 1296 colonoscopies/sigmoidoscopies were used for analysis. The cohort was primarily female (64.5%), white (87.5%), and privately insured (76.1%), with a near even distribution across genotypes. CNDR was 27.9%, ADR was 21.4%, PSDR was 7.7%, and CRCDR was 1.5%. Advanced age, Medicare insurance, prior colonic resection, and prior history of non-CRC were significantly associated with an increased CNDR and ADR (p < 0.05). PSDR remained constant with age. There was no association with genotype, biological sex, race, smoking, BMI, aspirin use, nor family history. Despite frequent colonoscopies/sigmoidoscopies, individuals with LS maintain a high rate of colorectal neoplasia, primarily driven by increased detection of adenomas with advancing age. Neoplasia rates may serve as helpful "ballpark rates" for endoscopists performing colonoscopies/sigmoidoscopies in LS. However, further studies need to determine whether neoplasia rates are predictive of CRC risk and outcomes in LS.

A Clinicopathologic Study of 1598 Ultrasound-Guided Needle Prostate Biopsies and Trends in Prostate Cancer Over a 14-Year Period

BackgroundProstate cancer manifests in various forms, ranging from occult and localized to metastatic disease. Analyzing prostate biopsies offers insights into histopathological characteristics, enhancing disease understanding and management. MethodsThis 14-year study reviewed ultrasound-guided needle prostate biopsies, collecting data via questionnaires and medical records, focusing on Gleason group, tumor involvement percentage, and predicted cancer stage. A comparative analysis across 2 distinct 7-year intervals was conducted. Statistical analyses included the Kolmogorov–Smirnov test, chi-square test, Fisher's exact test, and Analysis of Covariance, all performed using SPSS software. ResultsAmong 1,598 biopsies, 624 cases of adenocarcinoma were identified. Malignancy incidence significantly correlated positively with age, prostate-specific antigen (PSA), and PSA density (PSAD), and inversely with prostate volume and the free-to-total PSA ratio (%fPSA). Notably, 30.8% of malignancies were classified as Gleason groups 4 or 5, displaying significantly higher PSA levels. Patients with prior transurethral resection of the prostate exhibited increased malignancy rates and higher Gleason groups. Diagnostic accuracy, measured by Area Under the Curve, was 0.719 for PSA, 0.730 for %fPSA, and 0.817 for PSAD. The later phase of the study showed higher cancer detection, lower PSA levels, and a greater incidence of higher Gleason groups despite a lower predicted stage. ConclusionThe prevalence of higher Gleason groups was similar to other studies. PSAD demonstrated greater diagnostic reliability than PSA alone. Additionally, higher malignancy rates and Gleason groups were observed in patients with prior transurethral resection of the prostate. The increase in cancer detection rates during the second period likely indicates improved biopsy candidate selection.

NIMG-77. MRI PHENOMENON OF PUNCTATE ENHANCING LESIONS IN PATIENTS TREATED WITH IDH INHIBITORS

Abstract BACKGROUND Magnetic Resonance Imaging (MRI) response assessment is essential in isocitrate dehydrogenase (IDH)-mutant gliomas and provides evidence of treatment efficacy. Ivosidenib, a mutant IDH1 inhibitor, and vorasidenib, a pan-mutant IDH inhibitor, may induce imaging stabilization or improvement. We describe an imaging phenomenon of punctate enhancing lesions in patients receiving ivosidenib or vorasidenib. METHODS From October 2020 to December 2023, we identified patients treated with IDH inhibitors who developed punctate enhancing lesions on imaging during their treatment course. We report their clinical and imaging characteristics. RESULTS In our cohort (n=5), patients age range was 29-47 years. Diagnoses included astrocytoma grades 2 (n=2) or 3 (n=1), and oligodendroglioma grades 2 (n=1) or 3 (n=1). Beside all having a prior resection, two had prior radiation therapy and temozolomide, one had prior temozolomide only and two were treatment-naïve. Before initiation of IDH inhibitor, all patients had some evidence of enhancement, albeit small (&amp;lt;1 cm) for most. Four patients received ivosidenib (500mg daily) and one received vorasidenib (40mg daily). The median time to develop punctate lesions from treatment initiation was 16 months (range 1-28 months). All but one lesion was &amp;lt; 1 cm and adjacent to the original tumor locations. Four had FLAIR correlation, and two had high DWI signal without associated restricted diffusion. Punctate lesions resolved on subsequent imaging, within 1-2 months, for all grade 2 tumors. Punctate lesions persisted in the grade 3 tumors, without further progression. Four patients remain on therapy. One discontinued treatment due to this enhancement, which resolved on subsequent imaging. CONCLUSIONS Punctate enhancing lesions may develop in patients on IDH inhibitors. We advocate for close interval imaging monitoring in these cases since they may not universally require treatment discontinuation. Future advanced imaging and tissue evaluations of punctate enhancement, to differentiate between inflammatory response and progression, would be of interest.

CTNI-15. A PERIOPERATIVE STUDY OF SAFUSIDENIB IN PATIENTS WITH IDH1 MUTATED GLIOMA

Abstract BACKGROUND IDH mutations cause aberrant accumulation of (R)-2-hydroxyglutarate (2-HG), an oncometabolite that promotes tumorigenesis through abnormal hypermethylation of histones and DNA as well as suppression of normal cellular differentiation. IDH inhibition significantly improves progression free survival in patients with IDH mutant WHO grade 2 glioma, however most patients progress, and there is a lack of understanding on mechanistic reasons for failure. METHODS We tested Safusidenib, an oral, blood brain barrier penetrant IDH1 R132X enzyme inhibitor in a single arm, open label perioperative study. Patients with IDH1 mutated glioma, treatment naïve to radiation or chemotherapy, received Safusidenib (250 mg BID) for four weeks following surgical biopsy and prior to definitive resection (Part A). After resection patients continued Safusidenib until toxicity or progression (Part B). Translational endpoints include paired whole genome transcriptome sequencing (WGTS), single nuclei RNA sequencing (snRNAseq), spatial transcriptomics and spatial metabolomics as well as longitudinal sampling of blood and CSF for circulating tumour DNA (ctDNA). Here we are reporting Part A of the study. RESULTS As of May/27/2024 10 patients (mean age 37, 40% female) have been enrolled: seven with astrocytoma, three with oligodendroglioma; six had prior surgical resection. Pharmacokinetic sampling showed a mean tumor concentration 2457 ng/mL (range 957.0 – 4810) with tumor:plasma ratio 0.33. Consistent with mechanism, tumor 2-HG reduced 86% from biopsy (mean 75.0μM, range 7.8-203) to surgery (10.3μM, range 2.3 – 30.8), as well as identification of novel biomarkers of response. Paired tumour snRNAseq reveals transcriptional shift with changing cell-to-cell communication, and increased immune infiltration post-treatment, validated by spatial transcriptomics. Additionally, we find reduced heterogeneity consistent with a more differentiated tumour state. Treatment was well tolerated with ongoing follow-up. CONCLUSIONS This innovative trial facilitates intra-patient comparisons and confirmation of the on-target effects of Safusidenib, enhancing understanding of the mechanisms of response and resistance. The approach serves as a proof of concept for advancing drug development in glioma through perioperative trials.

INNV-37. REAL-WORLD OUTCOMES AMONG HIGH GRADE IDH1-MUTANT GLIOMA PATIENTS TREATED WITH AN IDH INHIBITOR

Abstract BACKGROUND Isocitrate dehydrogenase (IDH) inhibitors are transforming the treatment of patients with non-enhancing grade 2 IDH-mutant gliomas. Uncertainty remains on the utility of IDH-inhibitors in high-grade IDH-mutant glioma patients that had prior therapies and have progressive disease. METHODS From October 2020 to December 2023, we identified high-grade IDH1-mutant patients treated with off-label ivosidenib, a mutant IDH1 inhibitor. We report their clinical and imaging characteristics. RESULTS In our cohort (n=18), the patient age range was 29-68 years with male predominance (n=11). Diagnoses included astrocytoma grades 3 (n=9) or 4 (n=2), and oligodendroglioma grade 3 (n=7). The median number of progressions prior to ivosidenib initiation was 2 (range 1-7). Fifteen patients had prior surgical resection, three had biopsy. Prior treatment exposures included radiation therapy (n=15), temozolomide (n=18), lomustine (n=5), bevacizumab (n=3), etoposide (n=1), optune (n=1) and a clinical trial (n=1). Mean time from diagnosis to ivosidenib treatment was 9.6 years (95% CI, 6.7 to 16.4 years). Karnofsky performance-status score upon initiation was 80 (n=6) or 90 (n=12). Thirteen patients had &amp;gt;1 cm enhancing disease, five had non-enhancing disease. Ivosidenib was initiated due to enhancing disease progression (n=11), non-enhancing disease progression (n=4), a combination of both (n=2) or temozolomide intolerance (n=1). Best radiographic responses per RANO criteria were partial response (n=2), minor response (n=3), stable disease (n=7), and progressive disease (n=6). Nine patients continue ivosidenib without disease progression, with a median treatment duration of 27.5 months (95% CI, 18.0 to 33.0 months). All had FLAIR stabilization/improvement and 45% (n=4) had improved enhancing disease. Nine patients discontinued ivosidenib due to progression, with a median treatment duration of 7 months (95% CI, 3 to 9 months). CONCLUSIONS These data suggest that treatment with an IDH inhibitor can provide disease control for some high-grade IDH-mutant glioma patients who had prior therapies and progressive disease. Future studies are needed to investigate this patients population.

Factors Contributing to Early Recovery of Urinary Continence Following Radical Prostatectomy: A Narrative Review.

Stress urinary incontinence (SUI) is a common condition in patients following radical prostatectomy (RP), which has a significant impact on all aspects of quality of life and is associated with significant social stigma. The factors that improve urinary incontinence in patients following surgery remain controversial. The aim of our narrative review was to identify and synthesise the latest evidence on pre-, intra- and post-operative factors and predictors that contribute to early continence recovery after RP. In this narrative review, primary resources were identified by searching PubMed, EMBASE and Medline, and secondary resources were collected by cross-referencing citations in the relevant articles. We started our review by searching for systematic reviews of factors and predictors that contribute to early recovery of urinary continence after RP. We then reviewed societal guidelines such as the American Urological Association and European Urological Association guidelines on male urinary incontinence. This review focuses on the pre-, intra and postoperative factors that influence postoperative SUI after RP, as well as highlighting modifications in surgical techniques that lead to early continence recovery. Increasing age, higher BMI, shorter membranous urethral length (MUL), and larger PV are independent prognostic factors for SUI within 3 months after RP. Factors such as modified surgical technique preservation of anatomical structure lead to influence postoperative early continence recovery. SUI after RP is influenced by various factors. These factors include not only anatomical landmarks and patient-related factors such as age, BMI, length of MUL and prostate volume, but also prior transurethral resection or laser enucleation of the prostate, the surgeon's expertise, the surgical approach and NS technique.

12215 Techniques for Hysteroscopic Myomectomy of Type 2-3 Fibroid after Prior Incomplete Resection

12215 Techniques for Hysteroscopic Myomectomy of Type 2-3 Fibroid after Prior Incomplete Resection

Efficacy and Low Toxicity of Normo-Fractionated Re-Irradiation with Combined Chemotherapy for Recurrent Glioblastoma-An Analysis of Treatment Response and Failure.

Glioblastoma is the most common malignant brain tumor in adults. Even after maximal safe resection and adjuvant chemoradiotherapy, patients normally relapse after a few years or even months. Standard treatment for recurrent glioblastoma is not yet defined, with re-resection, re-irradiation, and systemic therapy playing key roles. Usually, re-irradiation is combined with concurrent chemotherapy, harnessing the radiosensitizing effects of alkylating agents. A retrospective analysis of 101 patients with recurrent glioblastoma treated with re-irradiation was conducted, evaluating the survival impact of concurrent chemotherapy regimens, as well as prior resection. Patients were subcategorized according to concurrent chemotherapy (temozolomide vs. CCNU vs. combination of both vs. none) and details are given regarding treatment toxicity and patterns of relapse after first- and second-line treatment. Patients were treated with normo-fractionated re-irradiation (with prescription dose of ~40 Gy to the PTV), resulting in a moderate cumulative EQD2 (~100 Gy). The mean overall survival was 11.3 months (33.5 months from initial diagnosis) and mean progression free survival was 9.5 months. Prior resection resulted in increased survival (p < 0.001), especially when gross total resection was achieved. Patients who received concurrent chemotherapy had significantly longer survival vs. no chemotherapy (p < 0.01), with the combination of CCNU and TMZ achieving the best results. Overall survival was significantly better in patients who received the CCNU + TMZ combination at any time during treatment (first or second line) vs. monotherapy only. The treatment of larger volumes (mean PTV size = 112.7 cm3) was safe and did not result in worse prognosis or increased demand for corticosteroids. Overall, the incidence of high-grade toxicity or sequential radionecrosis (5%) was reasonably low and treatment was tolerated well. While second-line chemotherapy did not seem to influence patterns of relapse, patients who received TMZ + CCNU as first-line treatment had a tendency towards better local control with more out-field recurrence. Normo-fractionated re-irradiation appears to be safe and is accompanied by good survival outcomes, even when applied to larger treatment volumes. Patients amenable to undergo re-resection and achieving concurrent systemic therapy with alkylating agents had better OS, especially when gross total resection was possible. Based on existing data and experiences reflected in this analysis, we advocate for a multimodal approach to recurrent glioblastoma with maximal safe re-resection and adjuvant second chemoradiation. The combination of TMZ and CCNU for patients with methylated MGMT promoter yielded the best results in the primary and recurrent situation (together with re-RT). Normo-fractionated RT enables the use of more generous margins and is tolerated well.

Effect of Prior Transurethral Prostate Resection (TURP) or Laser Enucleation (ThuLEP) on Radiotherapy-Induced Toxicity and Quality of Life in Prostate Cancer Patients Undergoing Definitive Radiotherapy.

In our study, the post-radiotherapy quality of life of prostate cancer patients who previously underwent transurethral resection of the prostate (TURP) is compared to those who had thulium laser enucleation of the prostate (ThuLEP) and those who had no prior surgery. It also aims to identify and assess risk factors affecting therapy tolerance in this patient group. We analyzed 132 patients with localized prostate cancer treated with definitive radiotherapy (RT), including 23 who had prior TURP and 19 who previously underwent ThuLEP. A total of 62% of patients underwent irradiation within 12 months after surgery. We included only patients treated with radiotherapy using the IMRT technique. Changes in patient-reported urinary toxicity were evaluated using the International Prostate Syndrome Score (IPSS) and the quality of life index of the World Health Organization (QoL/WHO-PSS) over a three-year post-radiotherapy period. Patients with prior TURP experienced significant deterioration in QoL and IPSS immediately after irradiation (p < 0.001), whereas those without previous surgery showed both less significant differences in IPSS and QoL scores. In conclusion, patients with previous TURP/ThuLEP differ from those without previous surgery in urinary quality of life and acute and chronic urinary symptom profiles after RT. The surgical technique (ThuLEP vs. TURP) and the time interval to irradiation are crucial factors affecting RT tolerance in acute and late settings. The previously operated patient group reported a significantly longer period of increased symptom burden.

6424 From Hyperparathyroidism To Neurologic Crisis: A Tale Of Brown Tumor And Spinal Cord Compression

Abstract Disclosure: A. Kormanis: None. M. Anderson: None. M. McKnight: None. H. Darapu: None. Background/Objective: In this case, we present a rare and severe consequence of secondary hyperparathyroidism, a Brown tumor leading to spinal cord compression, in a young adult with end-stage renal disease. Case Report: A 26-year-old male with a medical history of polycystic kidney disease and IgA Nephropathy complicated by ESRD, history of brown cell tumors (s/p surgery) was admitted for hospitalization due to hypocalcemia after presenting to the Emergency Department with right lower extremity weakness. Examination revealed right hip flexor weakness and right foot clonus. Lab results showed serum calcium of 10.4 mg/dL . MRI displayed a 2.5cm X 3.7 cm soft tissue mass with circumferential encroachment of the epidural space leading to severe spinal canal stenosis of T4-T5 at the site of prior Brown tumor resection. Ultimately, the patient underwent subtotal parathyroidectomy with left cervical thymectomy, leading to an intra-operative PTH drop from &amp;gt;3500 to 247 pg/mL. Discussion: In the context of treating vertebral brown tumors, the consensus suggests that parathyroidectomy plays a crucial role in achieving both clinical and radiographical amelioration of the tumor. However, in cases like ours where paresis is present, surgical decompression of the tumor becomes imperative. Conclusion: The development of Brown tumors is a severe and rare long-term complication for hyperparathyroidism, and the location of a Brown tumor in the thoracic spine causing symptomatic cord compression is even more rare. Presentation: 6/2/2024

DSA Quantitative Analysis and Predictive Modeling of Obliteration in Cerebral AVM following Stereotactic Radiosurgery.

Stereotactic radiosurgery is a key treatment modality for cerebral AVMs, particularly for small lesions and those located in eloquent brain regions. Predicting obliteration remains challenging due to evolving treatment paradigms and complex AVM presentations. With digital subtraction angiography (DSA) being the gold standard for outcome evaluation, radiomic approaches offer potential for more objective and detailed analysis. We aimed to develop machine learning modeling using DSA quantitative features for post-SRS obliteration prediction. A prospective registry of patients with cerebral AVMs was screened to include patients with digital prestereotactic radiosurgery DSA. Anterior-posterior and lateral views were retrieved and manually segmented. Quantitative features were computed from the lesion ROI. Following feature selection, machine learning models were developed to predict unsuccessful 2-year total obliteration using processed radiomics features in comparison with clinical and radiosurgical features. When we evaluated through area under the receiver operating characteristic curve (AUROC), accuracy, area under the precision-recall curve F1, recall, and precision, the best performing model predictions on the test set were interpreted using the Shapley additive explanations approach. DSA images of 100 included patients were retrieved and analyzed. The best-performing clinical radiosurgical model was a gradient boosting classifier with an AUROC of 68% and a recall of 67%. When we used radiomics variables as input, the AdaBoost classifier had the best evaluation metrics with an AUROC of 79% and a recall of 75%. The most important clinico-radiosurgical features, ranked by model contribution, were lesion volume, patient age, treatment dose rate, the presence of seizure at presentation, and prior resection. The most important ranked radiomics features were the following: gray-level size zone matrix, gray-level nonuniformity, kurtosis, sphericity, skewness, and gray-level dependence matrix dependence nonuniformity. The combination of radiomics with machine learning is a promising approach for predicting cerebral AVM obliteration status following stereotactic radiosurgery. DSA could enhance prognostication of stereotactic radiosurgery-treated AVMs due to its high spatial resolution. Model interpretation is essential for building transparent models and establishing clinically valid radiomic signatures.

Alopecia as an uncommon side effect of single postoperative instillation of gemcitabine in patients with non-muscle-invasive urothelial carcinoma of the bladder.

274 Background: Single-dose administration of intravesical gemcitabine is a common part of clinical practice following transurethral resection (TURBT) of non-muscle invasive bladder cancer (NMIBC). Although the side effect profile for gemcitabine is well characterized in systemic and local therapy, rare side effects continue to be identified with ongoing use. Here we identify several cases of treatment-related alopecia with adjuvant single dose intravesical administration for NMIBC after TURBT. Methods: Using our single-institutional IRB-approved Cysview registry database, we identified patients who underwent TURBT for NMIBC and received a single dose of intravesical gemcitabine post-TURBT between January 2020 and June 2023 at Keck Hospital of USC. Patients with a history of low grade NMIBC or those undergoing their first TURBT received 2g of gemcitabine dissolved in 100 cc of saline 1h after tumor resection. We reviewed patient-reported adverse events and included patients who reported alopecia following gemcitabine instillation. Patients were questioned on the degree and length of hair loss and information was collected from patient charts. Results: Overall, 9 patients (2 male, 7 female) reported hair loss following single dose intravesical gemcitabine after the TURBT. One patient had an autoimmune disease. The hair loss started within a few days of gemcitabine instillation and resolved spontaneously. The table shows the clinicopathologic characteristics of this cohort in detail. Three patients experienced severe hair loss. The resection extent during TURBT was classified as small (&lt;2 cm), medium (2-5 cm), or large (&gt;5 cm). Three patients had a large resection, 2 patients a medium one and 3 patients a small resection. None of the patients had previous intravesical gemcitabine; however, 2 patients had a history of intravesical BCG and 1 had intravesical mitomycin before. Conclusions: This study demonstrates that hair loss is a rare but possible adverse effect of intravesical gemcitabine after TURBT. Prior to surgery, patients should be counseled regarding this potential side-effect. Additional research and multicenter studies are required to describe the occurrence and cause of this adverse event. Demographic, clinical, and pathologic characteristics of patients. Patient ID Age Sex History of other IVT Pathology of TURBT Number of prior TURBT Resection extent Severity of hair loss Prior UBC 1 73 M None LGTa 1 large moderate LGTa 2 88 M MMC LGTa multiple large severe LGTa 3 76 F BCG CIS multiple small moderate HGT1 in upper tract,HGTa &amp; LGTa in bladder 4 56 F BCG HGTa multiple large severe LG+HGTa 5 66 F None HGTa none small moderate None 6 84 F None LGTa none small severe None 7 62 F None LGTa 1 medium moderate LGTa 8 68 F None HGTa multiple medium mild LGTa 9 64 F None LGTa none medium severe None LG= Low Grade, HG = High Grade.

Application of bevacizumab in the management of meningiomas: a systematic review and meta-analysis.

Meningiomas are the most common intracranial lesions and constitute one-third of diagnoses. Surgical resection is the gold-standard treatment option. In case of treatment failure, therapeutic options are limited. Bevacizumab is a vascular endothelial growth factor ligand-binding monoclonal antibody that prevents angiogenesis. This study aims to investigate the efficacy and feasibility of bevacizumab in meningiomas On December 30, 2023, a systematic search was conducted according to PRISMA guidelines using the PubMed, Scopus, Web of Science, and Embase databases. This study is conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart. Our study included 12 studies, comprising 243 individuals and 310 tumors. Most of the studies were retrospective (80%). Most of the patients were male (47.9%). The bevacizumab was mostly administered intravenously at 10mg/kg every two weeks (77.8%). The mean progression-free survival (PFS) and overall survival (OS) were 19.1 ± 4.7 and 23.9 ± 8.4 months, respectively. The response rate was 0.33 (95%CI: 0.14-0.60). The PFS-6, PFS-12, and PFS-24 were 0.80 (95% CI: 0.64-0.89), 0.66 (95%CI: 0.46-0.82), and 25% (95%CI: 0.16-0.37), respectively. The OS-6, OS-12, and OS-24 were 0.89 (95% CI: 0.80-0.96), 0.86 (95%CI: 0.65-0.95), and 0.48 (95%CI: 0.16-0.82), respectively. The meta-regression identified the total number of individuals, number of tumors, gender, WHO II/III, and prior resection as a possible source of heterogeneity for outcomes. This study highlights the effectiveness of bevacizumab in meningiomas, especially in refractory, high-grade, or neurofibromatosis patients.

Pancreatoduodenectomy after Ivor-Lewis Santi oesophagectomy with gastric tube reconstruction. An European multicentre experience

BackgroundPancreaticoduodenectomy (PD) is the standard surgery to treat tumors and other conditions affecting the head of the pancreas. PD involves the division of the gastroduodenal artery (GDA) and its branches, to allow for complete dissection of lymph nodes. However, PD in patients with prior esophageal resection presents challenges due to altered anatomy and risks compromising gastric tube vascularization. GDA preservation becomes crucial to avoid ischemia, although this may pose oncological risks by potentially leaving behind regional lymph nodes. This article reviews European surgical center experiences and techniques for PD in patients with prior esophageal surgery, focusing on short-term outcomes. MethodsWe have collected all the experiences carried out in European surgical centers and evaluated the techniques applied for PD in patients who had prior esophageal surgery while analyzing short-term outcomes. ResultsEight patients from 5 European centers were identified. Six patients were diagnosed with pancreatic adenocarcinoma, including one borderline case. Intraoperatively, the gastroduodenal artery (GDA) was preserved in all cases, with portal vein reconstruction required in only one instance due to tumor invasion. No ischemia or venous congestion of the gastric tube was observed during the surgical procedure. Post-operative complications that occurred included POPF type C in 1 (12.5 %), PPH type C in 1 (12.5 %). The median number of harvested lymph nodes was 21 [14–24]. with a median of 1.5 positive lymph nodes. R1 resection was present in 62.5 % of cases. ConclusionPerforming pancreaticoduodenectomy subsequent to Ivor Lewis esophagectomy is a technical challenge, but seems feasiable and safe in selected patients. GDA-preserving pancreaticoduodenectomy emerges as a valuable and time-efficient variation of the conventional procedure, it can be considered oncologically appropriate, but studies confirming its long-term impact on radicality are still needed.