Specialized Cancer Centers Research Articles

Patient and Caregiver Experience of Diagnosis, Treatment, and Living With Recurrent Oropharyngeal Cancer

The management of recurrent oropharyngeal cancer (rOPC) is complex. Curative options carry considerable risk of morbidity with overall poor prognosis. Little data exist on function and quality of life (QoL) outcomes for noncurative treatments. Even less is known about patient and carer experiences of function and QoL change over time when undergoing curative or noncurative treatment(s) for rOPC. To investigate the patient and caregiver experience of diagnosis, treatment, and living with recurrent oropharyngeal cancer and changes to function/QoL. A longitudinal prospective and retrospective qualitative study was carried out at a specialist cancer center in the United Kingdom. Participants with a biopsy proven diagnosis of recurrent OPC and their caregivers were included. Participants were recruited between December 2022 and November 2023. Concurrent data analysis took took place between November 2023 and January 2024. Curative salvage surgery or noncurative immunotherapy, chemotherapy, or clinical trials of investigational agents. A framework-approach thematic analysis of semistructured, in-depth interviews. Twenty-two patients and 7 caregivers were recruited. Demographic data was collected via medical record review. The longitudinal sample included 8 male and 2 female individuals, and the median age was 62 (range, 47-77) years. The retrospective sample included 11 male individuals and 1 female individual, and the median age was 64 (range, 59-70) years. Eleven participants (50%) underwent curative treatment, and 11 (50%) noncurative treatment.Treatments included salvage surgery, immunotherapy, chemotherapy, or clinical trials. Patients and their caregivers contextualize their experience of recurrent disease in their past experience of primary disease diagnosis and treatment. Patients want to survive and when the options to choose between are cure or functional outcomes impacting health-related QoL, cure appears to be favored. However, when cure is not an option, patients appear to want to survive as long as possible. However, as the prognosis gets shorter there appears to be a shift in priorities where function/QoL take precedence over survival. This qualitative study found that treatment decision-making is extremely complex in the setting of rOPC. Quite often, decisions are made based on what is perceived by health care professionals to be functionally "too morbid" with salvage surgery, or "kinder" with life-prolonging noncurative treatments. However, patients are not always fully involved in these decisions and so shared decision-making does not always happen. To facilitate shared decision-making and informed consent, patients need to be given clear and accurate information on survival and function/QoL outcomes for the various treatment modalities for rOPC.

Radiation-Induced Breast Angiosarcoma-A Single-Institution Experience.

Introduction: Radiation-induced breast angiosarcoma (RIBAS) is a rare adverse event associated with postoperative breast irradiation. The data from the literature indicate that RIBAS occurs in less than 0.3% of patients treated with adjuvant radiotherapy for breast cancer. Given the rarity, diverse clinical presentation, poor prognosis, and lack of consensus on the management, this study aimed to present experiences of our specialized cancer center with RIBAS, in terms of the incidence, presentation, management, and outcomes. Methods: We reviewed the medical records of 10,834 breast cancer patients treated at the Institute for Oncology and Radiology of Serbia between January 2013 and June 2024 to detect patients that had breast-conserving surgery, followed by postoperative irradiation, and developed angiosarcoma in the irradiated area at least 3 years after radiotherapy, without distant metastases. The incidence, latency period, management, and treatment outcomes were analyzed. Results: A total of nine female patients with RIBAS were identified and included in this study. The median age at RIBAS diagnosis was 64 years (range: 36-68), with a median latency of 64 months (95% CI > 57) from irradiation to diagnosis. The mean tumor size was 55 mm (SD 32.78). Patients were followed for a median of 30 months (range: 7-40) after initial RIBAS surgery. Local recurrence occurred in seven patients (77.8%), with five undergoing re-do surgery with curative intent. Three patients developed distant metastases during follow-up. The median overall survival (OS) was 31 months (95% CI > 30), with a 3-year survival rate of 15.2% (95% CI 2.5-91.6%). The median local recurrence-free interval was 10 months (95% CI > 3). Median OS after RIBAS local recurrence and after breast cancer treatment was 17 months (95% CI > 15) and 108 months (95% CI > 88), respectively. Conclusions: RIBAS is a rare but increasingly prevalent adverse event associated with BC irradiation, marked by an aggressive disease course and high relapse rates. Awareness, prompt diagnosis, and a radical surgical approach with wide clear margins are critical for improving patients' outcomes.

The impact of continuous lenalidomide maintenance treatment on people living with multiple myeloma—a single-centre, qualitative service evaluation study

PurposeContinuous lenalidomide maintenance treatment after autologous stem cell transplantation delivers improvement in progression free and overall survival among newly diagnosed multiple myeloma patients and has been the standard of care in the UK since March 2021. However, there is scant information about its impact on patients’ day-to-day lives. This service evaluation aimed to qualitatively assess patients receiving lenalidomide treatment at a cancer centre in London, in order that the service might better align with needs and expectations of patients.MethodsWe conducted 20 semi-structured interviews among myeloma patients who were on continuous lenalidomide maintenance treatment at a specialist cancer centre in London. Members of the clinical team identified potentially eligible participants to take part, and convenience sampling was used to select 10 male and 10 female patients, median age of 58 (range, 45–71). The median treatment duration was 11 months (range, 1–60 months). Participants were qualitatively interviewed following the same semi-structured interview guide, which was designed to explore patient experience and insights of lenalidomide. Reflexive thematic analysis was used for data analysis.ResultsFour overarching themes were as follows: (i) lenalidomide: understanding its role and rationale; (ii) reframing the loss of a treatment-free period to a return to normal life; (iii) the reality of being on lenalidomide: balancing hopes with hurdles; (iv) gratitude and grievances: exploring mixed perceptions of care and communication. Results will be used to enhance clinical services by tailoring communication to better meet patients’ preferences when making treatment decisions.ConclusionThis study highlights that most patients feel gratitude for being offered continuous lenalidomide and perceive it as alleviating some fears concerning relapse. It reveals variations in side effects in different age groups; younger patients reported no/negligible side effects, whilst several older patients with comorbidities described significant symptom burden, occasionally leading to treatment discontinuation which caused distress at the perceived loss of prolonged remission. Future research should prioritise understanding the unique needs of younger patients living with multiple myeloma.

Examining how early experiences in oncology settings influence nurses' career decisions.

The transition from nursing student to newly registered nurse is a complex process, and subsequent recruitment to cancer nursing posts can be challenging. This article details a service evaluation that aimed to describe the experiences of nursing students on placement and newly registered nurses or nursing associates working in a specialist cancer centre, and how these experiences might influence their future career aspirations. To gather data, the authors undertook a focus group with nursing students ( n= 8) and interviewed newly registered nurses or nursing associates ( n= 19). The data revealed four themes: navigating the nursing student experience; motivation to work in oncology; transition to staff nurse; and looking ahead. The service evaluation identified that education providers often lack awareness of cancer-specific content and career pathways. It also found that some aspects of cancer care, such as gaining specialist skills in systemic anticancer therapy, require particular attention since they were often anxiety-provoking for newly registered nurses.

Rectal cancer: Demographics and healthcare outcomes in a minority-rich community hospital.

e13735 Background: Rectal cancer (RC) has seen a decreasing incidence and mortality due to national screening guidelines, innovative therapies and new technology. In recent years, however, we have noted shifts in its demographics pertaining to variation in stage at diagnosis and mortality rates amongst various ethnic groups. Minority populations, namely Hispanic (H) and Black (B) patients (pts), continue to see higher incidence, diagnosis at more advanced stages and poorer survival than White (W) pts. In B pts, mortality rates are higher with an increased likelihood of distant-stage RC creating a significant survival disparity. Current studies involving H and Asians(A) show similar disparities. Compared to other malignancies, RC has improved survival for pts when diagnosed in a timely fashion and therefore, we seek to identify potential patterns within the diverse population we care for. Methods: Trinitas Medical Center RWJBH is an urban, community hospital that predominantly treats a minority population. With institutional IRB approval, we completed a retrospective chart review of 59 pts diagnosed with Stage I-IV RC from 2017- 2023. Pts were treated at our cancer center. We assessed age and stage at diagnosis and demographics such as age, sex and ethnicity. Results: We reviewed 59 pts with the following ethnic distribution: 22 H, 21 W, 11 B and 5 A pts. The median age at diagnosis with RC was 57 in H, 64 in B, 71 in W 71. More males were diagnosed in all groups except A pts. B pts were found to be diagnosed with more advanced disease: 36% at Stage III, 45% at Stage IV. W pts also saw a similar trend with 33% at Stage III and 24% at Stage IV. Our H pts had comparatively fewer distant stage diagnoses: 23% at Stage III, 18% at Stage IV. Common sites of metastasis in B: liver 27%, lung 27%, locoregional lymph nodes 9%. In W pts: liver 24%, locoregional lymph nodes 24%, lung 10% and brain 5%. In H pts, 10 of 22(45%) were diagnosed without metastatic disease, though of the 10 who did, 2 had brain involvement. Mortality was highest in B pts at 55%, 33% for W, 20% for A and 18% for H pts. Conclusions: In our study, we note H pts being diagnosed at an earlier median age, at earlier stages of disease, with higher survival rates. Our B pts were diagnosed younger than W pts, at later stages of disease, with higher mortality rates. Brain involvement, which usually is rare, was seen in both H and W upon recurrence. Despite having a multi specialized cancer center, we note limitations in our access to screening resources and the availability of colorectal surgical expertise to enhance care for our underserved population. The challenge of disentangling disparities within RC will benefit from improved healthcare access and availability of multimodality resources in this disease state where cure is the ultimate goal.

Assessing the benefits of repeated esophagogastroduodenoscopy at a specialized center before gastric and esophageal cancer surgery.

The surgical treatment of gastric and esophageal cancer in Denmark is centralized in four specialized esophagogastric cancer (EGC) centers. Patients are referred after an esophagogastroduodenoscopy (EGD) at a secondary healthcare facility. The EGD is repeated at the specialized EGC center before determining a surgical treatment strategy. This multicenter retrospective study aimed to investigate the quality of EGDs performed at a secondary healthcare facility and evaluate the clinical value of repeated EGD at a specialized center when determining the surgical treatment strategy. Patients from three of the four centers, who underwent esophagectomy or gastrectomy with curative intent from 1 June 2016 to 1 May 2021, were included. EGD reports from the referral facilities and EGC centers were compared based on a predefined checklist. Furthermore, endoscopist experience, the time between examinations, and histology were registered. Finally, it was assessed whether the specialized EGD led to any substantial changes in surgical treatment. Baseline characteristics and differences in EGD reports were described and McNemar's chi-square test was performed. A logistic regression analysis was conducted to identify risk factors for a change in surgical strategy. The study included 953 patients who underwent both an initial EGD and EGD at referral to a specialized center. In 644 cases (68%), the information from the initial EGD was considered insufficient concerning preoperative tumor information. In 113 (12%) cases, the findings in the specialized EGD would lead to a significant alteration in the surgical strategy compared with the primary EGD. The findings suggest that repeated EGD at a specialized center is of clinical value and helps ensure proper surgical treatment for patients undergoing curative surgery for gastroesophageal cancer.

Expandable endoprostheses in skeletally immature patients: Where we are

Approximately 45 percent of malignant bone tumors are seen under the age of 16 and one of the important results of growth plate sacrification in patients with immature skeletons is limb inequality. Until the early 1990s, the treatment options for these patients were rotationplasty or amputation. Multimodal approaches that combine imaging, chemotherapy, and surgical techniques have enabled the development of limb-preserving methods with satisfactory results. In order to overcome inequality problems, expandable prostheses have been developed in the 1980s. Extendable endoprosthesis replacements have been improved over the years and are now an established and safe alternative. Noninvasive prostheses appear to be advantageous compared to minimally invasive expandable prostheses that require multiple surgical procedures, but the complication rate remains high. Therefore, although expandable prostheses are not the definitive answer to the treatment of bone sarcomas in skeletally immature children, they are still a suitable interim choice until full adulthood is achieved. Due to reported high complication rates, the procedures require significant experience and are recommended for use only in specialized cancer centers.

The epidemiology of the most frequent cancers in Poland in 2015–2021 and the impact of the COVID-19 pandemic on cancer incidence

BackgroundThe late diagnosis, despite the improving availability and accessibility of diagnostic procedures during the last decade in Poland and cooperation between specialist cancer centres, remains an unsolved problem. Moreover, the accessibility to healthcare resources and diagnostic procedures has been drastically reduced because of the COVID-19 pandemic in 2019–2020. The study aimed to present the epidemiology of the most frequent cancers diagnosed in Poland as well as the impact of the COVID-19 pandemic on cancers’ incidence.MethodsDepersonalized, epidemiological data was obtained from the National Health Fund of Poland. In this retrospective study, the epidemiological analysis was performed and divided into subregions, according to patients’ domicile. For each of the subregions, we have calculated the incidence rate per 100,000 standardized to the European Standard Population 2013. The time points of providing the first healthcare service were considered as the time of cancer diagnosis.ResultsIn the 2015–2019 period, before the COVID-19 pandemic occurred, the nationwide incidence of analysed cancers remained stable or slightly decreased (as the lung cancer). Simultaneusly, during the same period the prevalence of the prostate cancer has increased and the large differences between subregions with the least and the highest incidence were observed. Subsequently, the incidences of all analyzed cancers decreased in 2020, compared to the period before the COVID-19 pandemic occurred. Then, in 2021 a disproportionate increase in cancers’ incidence rates was noted.ConclusionsOur results show a significant decrease in the incidence rate of the most frequent cancers diagnosed in Poland in 2020 compared to 2019. Subsequently, in 2021 the increase of the incidence ratios was noted, most likely due to the gradual reduction of epidemic restrictions.

Abstract SY15-02: Health insurance and outcome disparities in adolescents and young adults with cancer

Abstract SY15-02: Health insurance and outcome disparities in adolescents and young adults with cancer

Incidence, Risk Factors, and Consequences of Acute Kidney Injury in Patients Undergoing Esophageal Cancer Surgery: A Historical Cohort

Background: Limited data exist on postoperative acute kidney injury (AKI) in patients who have undergone esophageal cancer surgery. The purpose of this study was to evaluate the incidence, risk factors, and consequences of postoperative acute kidney after esophagectomy. Methods: This was a retrospective cohort study. The study was conducted in a tertiary specialized cancer center in Italy. All patients undergoing elective esophageal cancer surgery between 2016 and 2021 were included in the study. AKI was defined according to Kidney Disease Improving Global Outcomes criteria (both serum creatinine and urine output), within 48 h after surgery. Preoperative and intraoperative data were registered. We also collected data concerning progression of AKI, need for renal replacement therapy, mortality, and medical (pulmonary, cardiovascular, septic) and surgical complications within 30 days from surgery, as well as length of hospital stay. Results: Incidence of postoperative AKI was 32%. The independent risk factors were body mass index and the use of an invasive surgical approach. Persistent AKI accounted for 15% of the cases and it was associated with increased risk of major cardiovascular events (odds ratio 4.14, 95% CI 1.05–15.8, p-value 0.036), pulmonary complications (OR 3.67, 95% CI 1.04–14.9, p-value 0.050), and increased length of hospital stay (AME 7.2, 0.5–13.9, p-value 0.035). Conclusions: Postoperative AKI is common after esophageal cancer surgery. BMI and a totally invasive surgical approach are independent risk factors. Persistent AKI lasting more than 48 h increased the risk for any cardiovascular or pulmonary complications, with prolonged length of hospital stay.

Knowledge and practice of infection control measures among nurses in Jordan

Background/Aims Healthcare-associated infections are a global concern, with effective infection control measures being crucial in hospital settings. Nurses' knowledge and practice of infection control measures play a crucial role in ensuring patient safety. This study aimed to assess the knowledge and practice of infection control measures among nurses in Jordan. Methods A non-experimental, descriptive cross-sectional design was used in a not-for-profit, specialised cancer centre and two private hospitals in Jordan. A self-reported questionnaire was completed by 267 nurses. The questionnaire was divided into three parts. The first part collected sociodemographic data. The second part consisted of 17 multiple-choice questions assessing knowledge of infection control measures, with a score range of 0–17. The third part comprised 16 questions on a 5-point Likert scale (1=strongly disagree; 5=strongly agree), with a higher mean score indicating better self-reported infection control practice. Responses were analysed using standard statistical methods, with a P value of 0.05 indicating statistical significance. Results The majority of the sample were women (65.2%), with a mean age of 26.7±2.1 years. The mean total knowledge score was 13.81 out of 17.00 and the mean practice score was 4.02 out of 5.00. Significant differences were found across groups depending on hospital type (private vs not for profit), area of practice, years of experience, level of education and whether respondents had received specific training. Conclusions Level of education, training and specific workplace factors may all affect nurses' knowledge and practice of infection control measures. This study highlights the need for strategic educational and training programmes for nurses to improve patient safety.

Web-based cognitive rehabilitation intervention for cancer-related cognitive impairment following chemotherapy for aggressive lymphoma: protocol for a randomised pilot trial

IntroductionCancer-related cognitive impairment is common among people diagnosed with and treated for cancer. This can be a distressing and disabling side effect for impacted individuals. Interventions to mitigate cognitive dysfunction...

Receipt of Guideline-Concordant Care Is Associated With Improved Survival in Patients With Osteosarcoma in California: A Population-Based Analysis.

To examine the relationship between guideline-concordant care (GCC) on the basis of national clinical practice guidelines and survival in children (0-14 years), adolescents and young adults (AYAs, 15-39 years), and adults (40 years and older) with osteosarcoma, and to identify sociodemographic and clinical factors associated with receipt of GCC and survival. We used data from the California Cancer Registry (CCR) on patients diagnosed with osteosarcoma during 2004-2019, with detailed treatment information extracted from the CCR text fields, including chemotherapy regimens. Multivariable logistic and Cox proportional hazard regression were used for statistical analyses. Of 1,716 patients, only 47% received GCC, with variation by age at diagnosis: 67% of children, 43% of AYAs, and 30% of adults. In multivariable models, patients who received part or all care (v none) at specialized cancer centers were more likely to receive GCC. AYAs and adults were less likely to receive GCC than children (odds ratio [OR], 0.38 [95% CI, 0.30 to 0.50] and OR, 0.40 [95% CI, 0.28 to 0.56], respectively). In a model excluding adults, patients treated by pediatric (v medical) oncologists were more likely to receive GCC (OR, 3.44 [95% CI, 2.40 to 4.94]). Patients with metastatic osteosarcoma at diagnosis who did not receive GCC had a greater hazard of death (hazard ratio [HR], 2.02 [95% CI, 1.55 to 2.63]) but no statistical differences were found in those diagnosed at earlier stages (HR, 1.15 [95% CI, 0.92 to 1.43]). GCC was associated with improved survival in patients with metastatic osteosarcoma in California. However, we found disparities in the delivery of GCC, highlighting the need for target interventions to improve delivery of GCC in this patient population.

Development of clinically meaningful quality indicators for contemporary lung cancer care, and piloting and evaluation in a retrospective cohort; experiences of the Embedding Research (and Evidence) in Cancer Healthcare (EnRICH) Program

ObjectivesLung cancer continues to be the most common cause of cancer-related death and the leading cause of morbidity and burden of disease across Australia. There is an ongoing need to...

Interval breast cancer: radiological surveillance in screening Egyptian population

BackgroundInterval cancers might be divided into true negative interval cancer where a new lesion is detected that no sign of disease could be detected on previous screening mammogram. For false-negative interval cancers, those missed for overt symptoms and those missed for mild or undetectable ones, this includes interpretive error as benign interval cancer (benign mimics), subtle changes, masked carcinoma or slowly growing or patient factors, such as the dense breast parenchyma. Technical failure interval cancer hampered the reader to discover the abnormality. The aim of this study was to relate the risk factors for the development of the interval breast cancer such as breast density, positive family history of breast cancer in Egyptian population. Highlight the causes of missed breast cancer in order to overcome it in the future radiological interpretation.MethodsA total of 74,546 screening mammographic examinations were performed in the radiology department at specialized breast cancer center in the period between 2015 and 2021 with about 844 pathologically proved malignant cases. Out of the 844 pathologically proven breast cancer cases, 185 breast cancer patients were interval breast cancer having reported normal examination in the previous year, 88 were true interval breast cancer and 97 were missed on mammography and detected later on. The cases were subjected to full-field digital mammogram (FFDM), complementary ultrasound, contrast-enhanced digital mammography (CEDM) and magnetic resonance imaging (MRI) in some cases, and all cases were histopathologically proven by either fine needle aspiration, core needle biopsy (CNB) or open biopsy.ResultsThe mean age of the patients was 53.5 years (range 36–83 years). The overall breast cancer detection rate was 11 per 1000 women. The 185 interval cancers were present at a rate of 3.8 per 1000 women. True negative interval breast cancers where 88 cancers were not present in retrospect on screening mammograms, 17 cases present with benign findings (benign mimics mass or calcifications) and 80 cancers were missed cancers. Analysis of the cause of missed carcinoma revealed patient-related, tumor-related, or provider-related factors. Tumor factors were the most commonly encountered, accounting for 49.5% (48 cases), then provider factors in 25.8% (25 cases) while the patient factors were the least commonly encountered in 24.7% (24 cases). Recorded positive family history found in about 35% (31cases) of the true interval breast cancers.ConclusionsAlthough mammography is the standard for detecting early breast cancer, some cancers can be missed due to various causes. Mammographic interpretation must meet high standards to reduce missed cancers. Radiologists should carefully assess screening views and order additional imaging if needed. Palpable lesions and clinical data should be further examined with ultrasound and contrast imaging if necessary. Always compare current images with previous examinations to check for any changes in lesion size. When one pathology is found, search for additional lesions.

Barreiras de adesão medicamentosa por cuidadores de crianças com leucemia: um estudo observacional

ABSTRACT Objective: To identify barriers to adherence to home oral maintenance chemotherapy in children with leukemia treated at a specialized cancer center. Methods: We used the Brief Medication Questionnaire (BMQ) as a tool for screening barriers to adherence. The level of adherence was calculated considering at least one positive response in each BMQ domain, defined as Regimen Screen, Belief Screen, and Recall Screen. A positive screening for belief barriers (PSB) indicates that the caregiver reports not understanding the medication's mechanism of action and adverse effects. Results: Three important barriers to adherence were identified: beliefs, number of children of the caregiver, and age of the caregiver. The primary caregivers included 32 mothers (80%), four fathers (10%), three grandmothers (7.5%), and one unrelated caregiver (2.5 %). Most caregivers with a PSB were mothers. A PSB indicates that the caregiver reports not understanding the medication's mechanism of action and adverse effects. Caregivers with two or more children (median, three) had more barriers to adherence. Caregivers with potential non-adherence tended to be older than those with potential adherence, although without statistical significance (p=0.079, Mann-Whitney U test). Conclusions: The main barriers to adherence to home oral maintenance chemotherapy in children with leukemia identified through interviews with their caregivers, most often mothers, were lack of understanding of the treatment regimen, a greater number of children, and older age.

A RARE UTERINE TUMOR: DISSEMINATED PERITONEAL LEIOMYOMATOSIS. CLINICAL OBSERVATIONS.

Disseminated peritoneal leiomyomatosis (DPL) is an extremely rare benign disease characterized by widespread lesions of the abdominal cavity, pelvis, and retroperitoneal space with tumor nodules of varying size and number, which are benign neoplasms consisting of smooth muscle fibers in their histological structure. To analyze clinical cases of DPL with a concise review of the current state of the DPL diagnosis and treatment. We analyzed 5 clinical cases of DPL of female patients aged 39-50 years (mean age 46.2 years) who underwent surgical treatment at the National Cancer Institute from 2010 to 2021. In all 5 patients, the diagnosis of DPL (8898/1) was verified according to pathological (using routine hematoxylin/eosin staining) and immunohistochemical (IHC) studies. All patients underwent surgical treatment with a laparotomy approach, the extent and radicality of which depended on the location and number of tumor lesions. At the time of follow-up, all 5 patients were alive and did not receive any special oncological treatment. DPL is characterized by a variety of clinical manifestations from polyserositis to acute abdomen, depending on the location and size of the main tumor focus. IHC analysis is the criterion for the final diagnosis, and radical removal of all tumor foci provides the best therapeutic prognosis. The treatment should be carried out in highly specialized cancer centers where surgeons have gained sufficient experience in performing cytoreductive surgery.

Nonoperative management of the primary tumor in patients with unresectable stage IV colon cancer treated with systemic chemotherapy: Higher complication rates for left-sided colon tumors

IntroductionTreatment of the primary tumor in asymptomatic patients with unresectable colorectal metastases remains controversial. MethodsData from patients with synchronous stage IV colon cancer and an untreated primary tumor who started treatment aimed at metastatic disease at a specialized cancer center between 2014 and 2018 were analyzed retrospectively. Main outcome was primary tumor-related complications comparing left-sided and right-sided colon cancer. A competing-risk regression model was used to identify predictors of complications. ResultsOf 523 patients with metastatic colon cancer at presentation, 221 started treatment aimed at metastatic disease; these patients constituted the study cohort. The primary tumor was left-sided in 109 patients (49%) and right-sided in 112 patients (51%). In total, 46 patients (21%) developed a complication that required invasive intervention. Complications occurred more frequently in patients with left-sided tumors than in patients with right-sided tumors (29% vs 13%, P = 0.003). Eighteen patients (8%) underwent non-surgical intervention. Six patients (33%) failed non-surgical management and underwent surgery. Of 34 patients (15%) who underwent surgical intervention, 20 underwent an emergency colectomy and 14 underwent diversion with a permanent stoma. Overall, 10% of patients ended up with a permanent stoma. In competing-risk analysis, only left-sided primary tumor (hazard ratio 2.62; 95% CI 1.40–4.89; P = 0.003) was significantly associated with primary tumor-related complications requiring invasive intervention. ConclusionsPatients with asymptomatic metastatic left-sided tumors have a higher risk for primary tumor-related complications than patients with right-sided tumors. Close monitoring and early surgical rescue should be considered for patients with left-sided colon cancer who are managed nonoperatively.

HPB P20 Radical Single Stage Liver Resection of Bilobar Colorectal Liver Metastases

Abstract Background Surgical resection of Colorectal Liver Metastases (CRLM) offers the best long-term patient survival with current 5-year survival rates of 50%. However, bilobar CRLM often require an individualised patient approach with the primary goals being oncological resection of metastases and adequate future liver remnant. A number of surgical approaches can be used for bilobar CRLM including resection ± ablation, two stage hepatectomy ± portal vein embolization, associating liver partition and portal vein ligation for staged hepatectomy (ALPSS), or extended hepatectomy. We describe our approach of single stage parenchymal preserving (SSPP) liver resection for bilobar CRLM. Methods All patients with bilobar CRLM that underwent liver resection in a single, tertiary, specialist cancer centre in the UK between April 2018 to December 2021 were included. All liver resections were carried out using an open approach and 6-8 weeks after the cessation of chemotherapy. Pringle was used in all patients. We assessed peri-operative and oncological outcomes as well as disease-free (DFS) and overall (OS) patient survival. Results A total of n=42 patients underwent SSPP surgery during the study period. Median age was 54 years (range 36-71) and 93% were performance status=0. Pre-operative chemotherapy was administered in n=39 patients. A median of 4 lesions were resected (range 3-12). Median blood loss was 450mls (range 115-2500mls). R0 resection rate was 95%, with no post-operative liver failure and no peri-operative mortality. Bile leak rate was 10% and n=1 required massive blood transfusion. Median DFS was 13 months, and n=26 patients recurred by the end of the study period. Of these, n=14 were suitable for further treatment. Five-year OS was 77%. Conclusions SSPP liver resection for bilobar CRLM is associated with low peri-operative complications and good oncological outcomes. Early recurrence is noted but patients remain eligible for further liver- directed therapies or systemic treatment allowing for good overall patient survival.

OGC P04 Total Gastrectomy is associated with greater Overall Survival than Subtotal Gastrectomy in Stage III Gastric Adenocarcinoma with Signet Rings

Abstract Background Presence of signet rings is a poor prognostic factor in advanced gastric adenocarcinoma (GAc), and is associated with lower chemo(radio)sensitivity, higher locoregional and distant recurrence rates, and lower overall survival (O.S) rates than non-signet ring gastric Ac. Incidence of signet ring GAc is increasing in Europe, Asia and USA, accounting for 35-45% of new cases of GAc. D2 lymphadenectomy and perioperative chemo(immuno)therapy enable better locoregional and systemic disease control, and reduced rate of cancer-related death in GAc. We hypothesise that total gastrectomy is associated with greater O.S than subtotal gastrectomy in signet ring positive GAc. Methods All patients who underwent elective gastrectomy for signet ring positive GAc from October 2013 - February 2023 at a single, tertiary, specialist cancer centre in the UK were included in this study. Demographic details including age, BMI, tumour staging (TNM classification), Charlson co-morbidity score, and use of neo(adjuvant) chemo(immuno)therapy were collected. Post-operative histopathology including tumour differentiation, lymphovascular invasion, lymph node yield, recurrence and survival time since surgery were collected. Statistical analyses were performed on matched data subsets using the Datatab platform, including Chi-squared, Student’s T-test and Fisher’s exact tests. Log-rank tests were performed on survival data. Results A total of 51 patients (32 male, 19 female) underwent elective total or subtotal gastrectomy for GAc with signet rings (27 total, 24 subtotal gastrectomy). There was no significant difference in mean age, BMI, tumour differentiation, nodal (N) or metastasis (M) stage between these two cohorts. A total of 14/24 (58.3%) patients underwent neoadjuvant chemo(immuno)therapy before subtotal gastrectomy, compared to 21/27 (77.8%) of patients who underwent total gastrectomy (p=0.135). Overall survival was greater among patients that underwent subtotal gastrectomy for stage I cancer (p=0.08), whereas total gastrectomy led to better survival in stage III disease (p=0.131). Conclusions This study demonstrates a trend towards greater O.S with total gastrectomy for stage III signet ring positive gastric adenocarcinoma. We suggest total gastrectomy enables better locoregional disease control in advanced cases which have higher risk of lymph node spread. The potential oncological and survival benefits of this methodology need to be weighed up against the increased morbidity and quality of life implications of total gastrectomy.