762 ABSTRACTS

referral centres and eight referring hospitals. Logistic regression analysis

was conducted to examine the effect of hospital of diagnosis on surgery, ad-

justed for gender, age, comorbidity, T stage, histology, tumour location, and

socioeconomic status (SES). Furthermore, the effect of hospital of diagnosis

on overall survivalwas examined usingmultivariateCox regression analysis.

Results: Forty-five percent of patients with resectable esophageal can-

cer underwent resection.

A notable difference in patients proposed for potential curative surgery

was observed, with percentages ranging from 33 to 67% (p¼0.002) be-

tween hospitals of diagnosis. No significant differences regarding to age,

comorbidity, histology and tumour location were observed, however T-

stage and socioeconomic status (SES) were significantly different between

the hospitals. Multivariate logistic analysis showed that patients in two

hospitals were offered significantly less often curative surgery (OR 0.5;

CI 0.2-0.9 and OR 0.4; CI 0.2-0.8). The hospital of diagnosis with the larg-

est proportion of resected patients had an independent significant better

overall survival (HR 0.5; CI 0.3-0.9).

Conclusion: Hospital of diagnosis plays a significant role in offering

potential curative surgery to patients with resectable esophageal cancer,

with an effect on overall survival. This study shows that all patients diag-

nosed with resectable esophageal cancer should be discussed within a re-

gional multidisciplinary panel.

95. Neoadjuvant chemoembolisation of Colorectal Liver Metastases

(CRLM) with Drug Eluting Beads Trans-arterial Chemo-

embolization (DEBIRI-TACE); a Multi-institute phase 2 study in

resectable metastases

S. Staettner1, R. Jones1, V.S. Yip1, N.Misra1, H.Malik1, T. Gr€unberger2,

S. Fenwick1, G. Poston1

1 University Hospital Aintree, General and Hepatobiliary Surgery,

Liverpool, United Kingdom2University Hospital Vienna, General and Hepatobiliary Surgery, Vienna,

Austria

Background: Perioperative chemotherapy confers 3-year progres-

sion free survival advantage following resection of CRLM and good

pathologic response is associated with improved overall survival. How-

ever, systemic neoadjuvant chemotherapy can increase postoperative

morbidity and mortality. TACE using preloaded Irinotecan eluting

beads give sustained delivery of drug directly to tumor, thereby max-

imising response and reducing systemic exposure. This study examined

the feasibility and safety of neoadjuvant DEBIRI-TACE before CRLM

resection.

Methods: Patients with resectable CRLM received single DEBIRI-

TACE (up to 200mg) 1 month pre-hepatectomy. Primary end-point: tumor

resectability, secondary end-points: safety, radiologic response (RECIST)

and pathologic tumor response.

Results: TACE attempted in 49 patients, successful in 40. Reasons for

failed TACE included consent withdrawal (n¼2), bilobar disease (n¼2),

tumour involving gallbladder wall (n¼1), suspected hepatoma (n¼1), arte-

rial access difficulty (n¼2), contrast medium allergy (n¼1). Post-TACE

complications: 1 acute pancreatitis (3%); 4 post-embolization syndromes

(10%).

Imaging at 4 weeks post-TACE (30 patients): complete response 0/40

(0%); partial response 1/40 (3%); stable disease 19/40 (48%); ’progressive’

disease 10/40 (25%).

40 patients proceeded to surgery, 38 underwent hepatectomy (2 perito-

neal disease, resectability rate 95%). 30-day post-operative mortality 5%

(n¼2), neither death TACE related (1 intraoperative pneumomediastinum,

1 aspiration pneumonia).

63 lesions (median 2 per patient) targeted with TACE. Histology: no

residual disease 17%; 1-49% residual disease 59%; >50% residual disease

22%; no response 2%.

Conclusions: Resection after neoadjuvant DEBIRI-TACE for CRLM

is feasible and safe. Single treatment with DEBIRI-TACE resulted in tu-

mor pathologic response similar to that seen after protracted systemic che-

motherapy.

20 September 2012: 15:30 e 16:00

Lifetime achievement award: Developments in surgical oncology

96. Present and future of surgical oncology

Abstract not submitted.

20 September 2012: 16:30 e 18:00

Symposium: Open vs laparoscopic rectal cancer surgery (Joint ESSO/ESCP/ESES)

97. Organs sparing surgery after downstaging of colorectal cancer

B. Teleky1, D. Kandioler1, J. Karner-Hanusch1, A. Stift1, I. Kuehrer1

1Medical University of Vienna, Vienna, Austria

Incidence of colorectal cancer in Central Europe has shown a marked

increase in recent years and colorectal cancer currently ranks second

among cancer entities. Moreover, the strategic approach in rectal cancer

has also been revised and currently either neoadjuvant radiochemotherapy

for 5 weeks with a radiation dose of 50.4 Gy or neoadjuvant radiotherapy

with a radiation dose of 25 Gy over 5 days are used. With long-term ther-

apy, consecutive surgical TME (total mesorectal excision) according to

Heald will be done at a time interval of 5-6 weeks following completion

of radiotherapy.1 With short-term irradiation, surgery has been scheduled

immediately during the week of termination of irradiation. Ultimately, ra-

diotherapy is intended to provide for organ preservation in patients with

rectal carcinoma. As shown by the most recent data this concept confirms

the shift in paradigm. The primary results of the German Working Group

(Sauer et al.) having compared preoperative versus postoperative radio-

chemotherapy for advanced rectal carcinoma show a definite benefit for

the preoperative treatment arm with respect to recurrence rate (12% vs

6%) and also for overall toxicity (27.7% vs 9%).2 The long-term results

after follow-up for 11 years have confirmed these results. Recurrence rate

in the pre- and postoperative arm ranged at 7.1% and 10.1%, respectively.

However, no differences in survival (59.6% vs 59.9%) or in the rate of

distant metastases after 10 years (29.8% vs 29.6%) were observed.3 In

the study of Habr-Gama, neoadjuvant chemoradiotherapy of distal rectal

carcinoma resulted in complete remission in 28% thus increasing the rate

of sphincter preservation. This group of patients were not operated on, but

were followed-up closely.4 Short-term irradiation (25 Gy) was started in

Sweden (Swedish Rectal Cancer Trial) and initially published in 1997 re-

porting a significant reduction of the rate of local recurrence from 27% in

the non-irradiated group to 11% in the irradiated group. An additional no-

table result was the benefit of tumor-specific survival after 9 years with

65% versus 74% following radiotherapy (p<0.002).5 The Dutch publica-

tion (Dutch ColoRectal Cancer Group) comparing prospectively random-

ized resectable rectal carcinoma with irradiation and surgery versus

surgery alone showed a marked advantage in terms of local recurrence

rate for the irradiation group with 2.4% versus 8.2% after 2 years