Su1634

Surgical Myotomy Should Be Considered As Primary Treatment in ElderlyPatients With AchalasiaDonald E. Low, Artur M. Bodnar, Sheraz R. Markar

Introduction: Achalasia is a rare disease which predominantly affects patients between 25and 55 years. Older patients are often not considered for endoscopic management due tothe perception that they are at higher risk for surgical therapy. Methods: All patientsundergoing surgical treatment for achalasia between 2001 and 2012 were entered into anIRB-approved database. Presenting characteristics and perioperative outcomeswere comparedin patients younger and older than 70 years. Results: 99 patients underwent surgical treatmentfor achalasia during the study period. 6 patients (1 .70, 5,70) underwent esophagealresection and were excluded. 92 patients underwent Heller myotomy and either Toupet orDor fundoplication. 17 patients .70 years of age, mean age was 76.5, range 70-92 years,were compared to 75 patients ,70 years. Pre-operative weight loss was similar (mean 15.6lbs .70 versus 18.7 lbs ,70). Patients in the .70 group had higher ASA scores (2.58versus 2.14, p=0.01) and were more likely to undergo previous endoscopic therapy (65%versus 60%). Patients in the .70 group were less likely to undergo laparoscopic surgery(35% versus 79%). Length of operation and blood loss was similar between study groups.Intraoperative complications were more common in patients ,70, conversions (3 versus0), intraoperative mucosal injury (3 versus 0). Perioperative complications occurred in 13%of patients ,70 and 23.5% of patients .70. Complications in the .70 group includedtransient delirium 2, C. diff colitis 1 and fall 1. Median length of stay was 2 days in patients,70 (lap 2 versus open 4.5 days) and 4 days in patients .70 (lap 2 versus open 4 days).There was no mortality in either group. Readmissions were required in one patient in eachcohort. At mean objective follow-up of 3.8 months, 94% of patients .70 reported excellent(normal swallowing) or good (occasional dysphagia but no regurgitation) results. Followupwas available in 12 patients .70 years at mean 29.1 months. 83% reported they ate acompletely normal diet. Residual symptoms included occasional dysphagia 34%, occasionalregurgitation 8%, and periodic heartburn 42%. No patient had required additional surgicalor endoscopic therapy and all patients indicated they would have the operation again.Conclusions: Elderly patients with achalasia can undergo surgical myotomy and partialfundoplication safely and with excellent results comparable to younger patients. These olderpatients should be given the opportunity to discuss surgical treatment with an experiencedsurgeon at the time of their initial presentation.

Su1635

Surgical Treatment for Achalasia: A NSQIP AnalysisStephanie G. Wood, Edward J. Hannoush, Andrew Duffy, Robert Bell, Kurt E. Roberts

Introduction: There are multiple surgical treatment options for Achalasia, with the laparos-copic approach increasingly considered the treatment of choice. We review the largestnumber of reported cases of laparoscopic Heller myotomies to date, from the NSQIP database,and compare alternative surgical treatments. Methods: Using the American College of Sur-geons National Surgical Quality Improvement Program (NSQIP) participant use files from2005-2010, patients diagnosed with Achalasia (ICD-9 530.0) who underwent a surgicalHeller myotomy, including open abdominal (CPT 43330), laparoscopic (CPT 43279), openthoracic (CPT 43331), and thoracoscopic (CPT 32665) approaches. As the CPT code forlaparoscopic Heller myotomy was created in 2009, there are none reported before this time.Results: A total of 978 patients diagnosed with Achalasia were identified, of which 663patients received a laparocopic Heller, 239 open Heller, 16 open thoracic, and 60 thoracos-copic myotomies. Overall, 56.8% were male and mean age is 52 years (SD ± 16.3). Therewas no significant difference in age between groups. There was a significant difference intotal length of stay between open and laparoscopy Heller myotomy groups only, 3.45 vs2.48 days, p= 0.015. Operative time was significantly different between the open andlaparoscopy Heller myotomy groups only, 146.0 vs 136.27min (SD ± 54.9), p 0.018. Thereonly significant difference in postoperative complications was in superficial site infections,with 3 in open heller and 1 in thoracoscopic groups, p= 0.025. There were no deathsreported. Conclusion: While there is no significant difference in serious post-operativecomplications, laparoscopic Heller myotomy has improved length of stay and operativetimes compared to open, and thoracic approaches.

Su1636

Difference in Outcomes Between Right and Left Hepatectomy in PatientsUndergoing Hepatic ResectionMashaal Dhir, Lynette M. Smith, George Dittrick, Quan P. Ly, Aaron R. Sasson,Chandrakanth Are

Background: Several studies have documented the safety of liver resections. Although righthepatectomy is felt to be associated with higher mortality and morbidity, data on thedifference in outcomes between right and left hepatectomy is scarce. The aim of the currentstudy is to analyze the difference in outcomes between right and left hepatectomy in patientsundergoing hepatic resection. Methodology: All patients undergoing right (primary CPTcode 47130) and left hepatectomy (primary CPT code 47125) were extracted from theNational Surgical Quality Improvement Program (NSQIP) database (2005-2010). Benignand malignant diagnoses (ICD-9 155.0, 155.1, 155.2 and 197.7) were determined from thedatabase. The data was analyzed to determine differences in outcomes between right andleft hepatectomy by using the chi square test or Fisher's exact test as appropriate. Results:A total of 2311 patients who underwent right or left hepatectomy were identified of whom1680 patients were noted to have a malignant diagnosis. (Table 1) Patients that underwentright hepatectomy were noted to be have a higher mortality rate when compared to lefthepatectomy (all patients: right vs left - 4.24% vs 1%, P , 0.001 and for patients withmalignancy: right vs left - 4.52% vs 1.09%, P , 0.001). Right hepatectomy was alsoassociated with significantly higher incidence of several other complications such as organspace infections, pneumonia, unplanned re-intubation, pulmonary embolism, failure to weanoff the ventilator, renal insufficiency, urinary tract infection, blood transfusion, deep venous

S-1079 SSAT Abstracts

thrombosis and sepsis (P value , 0.05). Conclusion: The results of our study demonstratethat mortality and morbidity after right hepatectomy remains significantly higher thanleft hepatectomy.

Su1639

Modified FOLFOX6 and Bevacizumab As Neoadjuvant Chemotherapy forPatients With Potentially Curable Bilobar Liver Metastases From ColorectalCancerAtsuyuki Maeda, Masatoshi Isogai, Yuji Kaneoka

Objective: Even though patients with colorectal cancer (CRC) and liver metastases have apoor prognosis, they can benefit from perioperative chemotherapy and complete extirpationof the disease. Oxaliplatin based chemotherapy with bevacizumab has been widely reportedto improve outcomes with metastatic CRC. However, its impact on surgical complicationsand survival benefit after liver resection remains to be determined. Patients and Methods:Nineteen patients with potentially curable bilobar metastases from CRC were eligible forthis single-center, nonrandomized trial during a period between September 2008 and August2012 (NAC group). The study group consisted of 13 men and 6 women, with median ageof 63 (range 52 to 79) years. Eligible criteria included synchronous liver metastases andmetastatic liver disease developed within one year after resection of the primary lesions.Patients received biweekly oxaliplatin, 5-fluorouracil, and folic acid (FOLFOX6) plus bevaci-zumab therapy. The sixth cycle of neoadjuvant chemotherapy (NAC) did not include bevaci-zumab, resulting in 4 weeks window-time between the last administration of bevacizumaband hepatectomy. Over all survival (OS) and progression free survival (PFS) were comparedwith 27 patients who underwent hepateictomies for bilober metastasis during 2002 and2008 (non NAC group). Results: Synchronous liver diseases were observed in 14 (73%).Although objective response to NAC was achieved in 6 patients (32%), 16 patients (84%)underwent liver resection. The liver surgery included 4 hemihepatecitomies, 5 sectorectomies,and 7 partial resections of the liver with median operative time of 186 minutes and medianblood loss of 340 mL without blood transfusion. Any postoperative morbidity or morbiditywas observed. One- and three-year OS of the NAC group were 100% and 56% (MST 43months), and those of the non-NAC group were 93% and 49% (MST 31 months), respectively(P=0.47). DFS of the two groups were not different (P=0.50). Among the hepatectomizedof NAC group, 10 patients (60%) developed recurrence with median relapse free time of16.6 months. Initial recurrent deposits were observed in remaining liver in 4 patients, lungin 3, lymph nodes in 3, and peritoneum in 1 (redundant included). Conclusion: Our datasuggest that FOLFOX6 and bevacizumab can be safely administered until 4 weeks beforeliver resection in patients with liver metastases from CRC without increasing perioperativecomplications. Although no contributions to OS and DFS were observed, control of liverrecurrence may be achieved. Adjuvant therapies and further study is needed to define thesurvival benefit of NAC with FOLFOX6 plus bevacizumab in patients with potentially curablebilobar metastases from CRC.

Su1640

Hepatectomy for Liver Metastases From Gastric and Esophageal Cancer:Tumor Biology and Surgical Results Define OutcomeAndreas Andreou, Luca Viganò, Giuseppe Zimmitti, Martin Dreyer, Jean-Nicolas Vauthey,Peter Neuhaus, Daniel Seehofer, Lorenzo Capussotti, Sven-Christian Schmidt

Background: The role of hepatectomy for patients with liver metastases from gastric andesophageal cancer (GELM) is not well defined. The present study examined the morbidity,mortality and long-term survival after liver resection for GELM. Patients and Methods:Clinicopathological data of patients who underwent hepatectomy for GELM between 1987and 2012 at two European high-volume hepatobiliary centers were assessed and predictorsof overall survival were identified. Results: Fourty-six patients underwent liver resection forGELM. The primary tumor was located in the stomach and in distal esophagus in 40 and6 cases, respectively. GELM were synchronous to primary tumor in 33 patients and multiplein 18 patients. In 13 cases, major hepatectomy (resection ≥ 3 liver segments) was performed.Thirty-day postoperative morbidity and mortality rates were 33% and 2%, respectively. Aftera median follow-up time of 76 months (range 1-135), 1, 3 and 5 year overall survival rateswere 70%, 40% and 27%, respectively. Outcomes were comparable between the two centers.At univariate analysis, primary tumor invasion of other organs (T4) (P = 0.004), poorly

SS

AT

Ab

stra

cts