S34 ABSTRACTS

desmoids would lead to mutilation, functional loss or amputation, TM-ILP

should be considered.

No conflict of interest.

http://dx.doi.org/10.1016/j.ejso.2014.08.062

66. On behalf of the EORTC MG: The interval between primary

melanoma excision and sentinel node biopsy does not affect survival

C.M.C. Oude Ophuis1, D.J. Gr€unhagen1, C. Verhoef1,

A.M.M. Eggermont2, A.C.J. Van Akkooi1

1 Erasmus MC Cancer Institute, Surgery, Rotterdam, Netherlands2 Institut Gustave Roussy, Surgery, Paris, France

Background: Worldwide, sentinel node (SN) biopsy (SNB) is

currently the recommended routine staging procedure for stage I/II mela-

noma patients. Most national melanoma guidelines recommend re-excision

plus SNB within six weeks after primary excision. To date, there is no liter-

ature to support this time-frame. We evaluated the melanoma specific sur-

vival (MSS) for different time intervals between primary excision and SNB

in a SN positive population.

Materials and methods: Between 1993 and 2008, 1,080 patients

(509 women and 571 men) were diagnosed with a positive SN in 9

European Organization for Research and Treatment of Cancer (EORTC)

Melanoma Group Centers. We selected 928 patients (86%) of whom pri-

mary excision date was known. Time until SNB was calculated from pri-

mary excision date until SNB date. Different cut-off values were tested.

Kaplan-Meier estimated MSS was calculated. Cox proportional hazard

multivariate analysis was performed to correct for known prognostic

factors.

Results: Median Breslow thickness was 3.00 mm, 44% were ulcer-

ated. Median follow-up time was 36 months (range 1e162 months). Me-

dian interval between primary excision and SNB was 37 days (5.3

weeks). The interval was eight weeks or more in 26%. Patients undergo-

ing SNB within two weeks had a significantly worse MSS compared to

patients undergoing SNB at two weeks or more: MSS was 66% versus

70% (p¼0.036), Hazard Ratio (HR) 0.74 (95%CI 0.56-0.98). MSS was

also significantly worse for a three week cut-off value: 66% for

SNB within three weeks versus 71% for SNB at three weeks or more

(p ¼ 0.025), HR 0.74 (95%CI0.56e0.96). There were no significant dif-

ferences in MSS for other interval cut-off values, in particular not for

the 6 weeks interval (p¼0.123). Patients operated within three

weeks had a median Breslow thickness of 3.75mm and ulceration was

present in 56%, versus 2.60mm and 39% for patients with a time interval

of three weeks and over. Time interval between primary excision and

SNB was not confirmed as an independent prognostic factor for MSS

on multivariate analysis with Breslow thickness and ulceration as co-

variates.

Conclusions: Patients undergoing SNB within a short interval have a

significantly worse prognosis compared to patients undergoing SNB later.

However, this effect is caused by a selection bias, since patients with

thicker and ulcerated melanomas undergo a SNB within a shorter waiting

period. It is not the consequence of the time interval between primary exci-

sion and SNB.

No conflict of interest.

http://dx.doi.org/10.1016/j.ejso.2014.08.063

67. Salvage gastrectomy after intravenous and intraperitoneal

paclitaxel (PTX) combined with oral tegafur/gimeracil/oteracil

potassium (S-1) for gastric cancer with peritoneal metastasis

J. Kitayama1, H. Ishigami1, H. Yamaguchi1, T. Watanabe1

1 University of Tokyo, Department of Surgical Oncology, Tokyo, Japan

Background: Peritoneal metastasis is the most frequent and life-

threatening types of metastasis in gastric cancer. In spite of recent ad-

vances in chemotherapeutic agents, any regimens, if administrated only

via intravenous (IV) route, cannot satisfactorily control the peritoneal

metastasis in gastric cancer. Although intraperitoneal (IP) chemotherapy

has been proposed as a treatment option, the clinical efficacy of IP chemo-

therapy for peritoneal lesions has not been examined in gastrointestinal

cancer.

Patients and methods: A total of 100 patients with peritoneal metas-

tasis of gastric cancer received combination chemotherapy of S-1 plus

PTX from both IV and IP routes. In particular, 64 patients were clinically

diagnosed as severe peritoneal metastasis (P3 category in Japanese classi-

fication) with apparent malignant ascites. PTX was administered IP at 20

mg/m2 from the subcutaneous implanted peritoneal access ports as well as

IV at 50 mg/m2on days 1 and 8. S-1 was administered at 80 mg/m2/day for

14 consecutive days, followed by 7 days rest. In case of apparent down-

stage, gastrectomy was performed in salvage setting, and then the same

chemotherapy was continued.

Results: The median survival time (MST) of the whole 100 patients was

23.5 months. In all patients, laparoscopy was performed under general anes-

thesia before and after chemotherapy, and the change of peritoneal metasta-

ses was macroscopically evaluated by video-recorded picture. In 60 patients

who showed apparent shrinkage of peritoneal lesions with negative perito-

neal cytology after the median course of 3 (range 2-16), we performed gas-

trectomywith standard nodal dissection and R0 resectionwas achieved in 35

cases. TheMSTand 1 year overall survival (OS) of the 60 patients were 34.5

months and 83%, while those of the other 40 patients without gastrectomy

were 13.0months and 39%, respectively. Pathological examination of the re-

sected stomach and lymph nodes revealed that grade 2 and grade 3 histolog-

ical responses were obtained in 18 (18%) and 1 (1%) case(s), respectively.

Anastomotic leakage and pancreatic fistula developed in 2 cases but no mor-

tality was observed. In 64 patients withmalignant ascites, gastrectomy could

be performed in 34 patients, and their MSTand 1-year OS were 26.4 months

and 82%, respectively.

Conclusions: Combination chemotherapy of S-1 plus IVand IP PTX is

well tolerated and very effective in gastric cancer patients with peritoneal

metastasis. Systemic chemotherapy combined with repeated IP administra-

tion of PTX followed salvage gastrectomy is a promising strategy for perito-

neal carcinomatosis in gastric cancer even in cases with malignant ascites.

No conflict of interest.

http://dx.doi.org/10.1016/j.ejso.2014.08.064

68. Use of personalized abdominal band in stoma hernia and stoma

prolapse prophylaxis - retrospective analysis

S. Tavares1, D. Oliveira1, A. Gomes1, R. Rocha1, C. Carneiro1,

F. Assuda1, M. Sousa1, R. Marinho1, V. Nunes1

1 Hospital Fernando Fonseca Lisbon, Cirurgia B, Amadora, Portugal

Background: Parastomal hernia (PH) and stoma prolapse (SP) are the

most frequent complications post stoma construction. When symptomatic

they represent major morbidity and impaired quality of life. Prophylaxis of

PH and SP is one of the major challenges in intestinal stoma care. Our aim

was to evaluate the role of personalized abdominal band (PAB) in the pro-

phylaxis of SH and SP in our patients.

Methods: Retrospective longitudinal analysis. Adult patients with in-

testinal stoma construction in our hospital between April 2011 and October

2013 were studied with a follow up of at least six months. Demographic

data, comorbidities, surgery and type of stoma were registered. Incidence

of symptomatic PH and SP, were assessed and compared between patients

using daily abdominal band with personalized manufactured hole, for pa-

tient with stoma and patients who don’t. Descriptive analysis, parametric