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Aim Epidemiological studies have shown that the incidence and mortality rates of colorectal cancer (CRC) vary over 10-fold worldwide where within Westernized societies lower rates are observed amongst populations living within the Mediterranean basin, suggesting a significant influence of environment and dietary style in CRC carcinogenesis. Interpretation of the data concerning the benefits of mediterranean (MD) diet is difficult in vivo because of the variability of alimentary regimens used, the differing compliance with dietary supplementation and because of the non-uniform duration of patient cohort observation. Therefore, the aim of this review is to evaluate the in-vitro effects on colorectal cancer cell lines. Methods the literature concerning the in-vitro effects of 4 of the principal components symbolizing the MD such as olive oil (polyphenol), red chili (capsaicin), tomato (lycopene) and red grapes (resveratrol) have been systematically reviewed. Results Several studies have demonstrated that polyphenols form olive oil, lycopene, resveratrol and capsaicin have multiple anticancer properties affecting several metabolic pathways involved in cancerogenesis, apoptosis, and metastasis in CRC cell lines. Conclusion This review summarizes some of the most recent data potentially supportive of the use of MD in CRC chemoprevention, analyzing the in vitro effects of individual components of the MD on CRC cell development, progression, metastasis and apoptosis.

Purpose We present our use of magnetic resonance (MR) measurement to determine the amount of residual breast tissue (RBT) following total mastectomy with reconstruction. Methods Breast MR images of 45 women who underwent surgery between January and November 2011 were reviewed. The cohort included therapeutic and prophylactic mastectomies. RBT was evaluated at four points with a digital caliper assessing T2-weighted and T1-weighted images. Results Patients undergoing mastectomy for carcinoma tended to have less RBT than in prophylactic surgery. Greater age and recent surgery both correlated with larger RBT. Conclusions Variable thickness of RBT is demonstrable following mastectomy and implant reconstruction using MR imaging.

Colorectal cancer (CRC) caused nearly 204,000 deaths in Europe in 2004. Despite recent advances in the treatment of advanced disease, which include the incorporation of two new cytotoxic agents irinotecan and oxaliplatin into first-line regimens, the concept of planned sequential therapy involving three active agents during the course of a patient's treatment and the integrated use of targeted monoclonal antibodies, the 5-year survival rates for patients with advanced CRC remain unacceptably low. For patients with colorectal liver metastases, liver resection offers the only potential for cure. This review, based on the outcomes of a meeting of European experts (surgeons and medical oncologists), considers the current treatment strategies available to patients with CRC liver metastases, the criteria for the selection of those patients most likely to benefit and suggests where future progress may occur.

Purpose Assessing the risk and predicting the outcome of surgery, trauma, and surgical intensive care is an important aspect of perioperative practice. There have been attempts to devise and validate many scoring systems to predict the prognosis of patients having a similar severity of illness. This article reviews some of the commonly used systems with respect to their development, strengths, and limitations. Sources Published literature describing risk assessment scores and physiologic scoring systems for preoperative assessment, trauma, and surgical intensive care patients. Principal findings Risk scores used in preoperative evaluation assist the clinician in optimizing the patient before, during, and after surgery. Scoring systems applied in intensive care units are useful as guidelines rather than accurate predictors of prognosis for individual patient. Many models are used for audit purposes, and some are used as performance measures and quality indicators of a unit; however, both utilities are controversial because of poor adjustment of these systems to case-mixtures. Conclusions Risk assessment scores may assist in the perioperative risk evaluation with respect to organ systems. Prognostication of critically ill patients belonging to a category of illness may be done using physiological scoring systems taking into account the difference in the case-mix of the particular unit.

Although cancer in the elderly is extremely common, few health professionals in oncology are familiar with caring for series of oncogeriatric patients. Surgery is at present the first choice, but is frequently delivered suboptimally: under-treatment is justified by concerns about unsustainable toxicity, whilst over-treatment is explained by the lack of knowledge in optimising preoperative risk assessment. This article summarises the point of view of the Surgical Task Force @ SIOG (International Society for Geriatric Oncology), pointing out differences from, and similarities to, the younger cohorts of cancer patients, and highlighting the latest updates and trends specifically related to senior cancer patients.

In this study we measured serum and urinary c-erbB-2 levels in 63 patients with colorectal cancer and 29 healthy controls, assessing their role in cancer-specific survival and the effects of resectional surgery. Serum and urinary c-erbB-2 levels were measured by an enzyme-linked immunosorbent assay, preoperatively and 7 days following tumor resection. Preoperative serum c-erbB-2 concentrations were significantly higher in the cancer patients and correlated with disease stage and the presence of liver metastases. Urinary c-erbB-2 was detected more often in cancer patients, although levels did not differ from controls and there was no association with any clinicopathological variable. Serum c-erbB-2 levels decreased significantly in those patients resected for cure and were an independent prognostic factor for cancer-specific survival with higher preoperative concentrations correlating with worse overall survival. These findings suggest that serum assessment of c-erbB-2 concentration may be valuable in defining colorectal cancer prognosis.

The serum concentrations of the cell adhesion molecules E-selectin, intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) were investigated in 63 patients with colorectal cancer and in 51 controls by an enzyme-linked immunosorbent assay (ELISA). Their relationship to clinicopathological variables and patient survival and changes in their levels after surgery were examined. Colorectal cancer patients showed significantly higher serum levels of E-selectin, ICAM-1 and VCAM-1 compared with healthy controls. There was a significant association between the serum levels of these molecules, disease stage and the presence of both lymph node and distant metastases. Both ICAM-1 and VCAM-1 levels correlated with serum E-selectin and carcinoembryonic antigen (CEA) levels. Serum levels of all three molecules decreased significantly after radical resection of the tumour. Elevated pre-operative E-selectin, ICAM-1 and VCAM-1 levels were significant prognostic factors, although not independent of stage, for patient survival. These findings suggest that serum concentrations of E-selectin, ICAM-1 and VCAM-1 may reflect tumour progression and metastasis. Since these markers are linked to CEA levels, it is uncertain whether their measurement will prove cost-effective in colorectal cancer management.

Aims Prognostic analysis of hepatocellular carcinoma (HCC) in the cirrhotic patient undergoing hepatic resection is necessary in order to determine the clinical effect of hepatectomy on prognosis. Patients and methods: Univariate and multivariate retrospective analyses were performed in 51 cirrhotic patients (38 men, 13 women; mean age 65 years, range 43–81 years) with supervening HCC undergoing hepatic resection between January 1993 and December 1997. Results Segmental liver resection was performed in 39 patients (76%) with non-anatomical (wedge) resections in the remainder of cases. The post-operative mortality rate was 8%. The tumours recurred in 23 patients (45%), with 12 patients (52% of recurrences) recurring within 1 year of surgery and 22 patients (96% of recurrences) within 3 years. Recurrent disease was most frequently intrahepatic (22 patients). Significant risk factors for recurrence were micro/macro vascular invasion, and symptoms. Conclusions: The recurrence rate of hepatocellular carcinoma in patients with cirrhosis undergoing surgical resection alone is high and actuarial survival at 4 years is low. Other approaches to the treatment of hepatocellular carcinoma in patients with cirrhosis require consideration.

Background. β-Endorphin is an endogenous opioid involved in the regulation of food intake and obesity as well as in insulin metabolism. In this study, we investigated glucose-induced β-endorphin, insulin, and glucose responsiveness in morbidly obese patients and the effect of surgically induced weight loss. Methods. Thirty-two healthy, nondiabetic, morbidly obese patients (body mass index over 40 kg/m 2 ) and 32 normal-weight controls were studied. Serum levels of β-endorphin, insulin, and glucose were measured under basal conditions and during an oral glucose tolerance test (OGTT) before and 12 months following vertical banded gastroplasty. Results. Preoperative basal levels of β-endorphin, insulin, and glucose and their responses during OGTT in obese patients were significantly higher compared with those of controls. After surgery, basal β-endorphin, insulin, and glucose levels decreased significantly compared with preoperative values. Postoperative basal insulin and glucose levels were similar to those in controls, while β-endorphin levels remained significantly higher than those of controls. A significant reduction in total responses of β-endorphin, insulin, and glucose during OGTT was also observed; however, postoperative β-endorphin and insulin responses remained significantly higher than in controls. Conclusion. Morbidly obese patients have an increased glucose-stimulated response of β-endorphin, insulin, and glucose which is partially corrected with weight loss following vertical banded gastroplasty.

S S269 Poster abstracts for the BASO w The Association for Cancer Surgery and the RSM e Section of Surgery Scientific Conference e 2 and 3 November 2015 P1. Surgery for locally recurrent rectal cancer AntonioChiappa, EmilioBertani, AndrewZbar,MarcoVenturino, Marco Tulli, Mariagiulia Zampino, Carlo Ferrari, Roberto Biffi 1 University of Milan, Milan, Lombardy, Italy 2 European Institute of Oncology e Unit of Surgical Innovative Techniques, Milan, Lombardy, Italy 3 European Institute of Oncology e Division of Epatobiliary Surgery, Milan, Lombardy, Italy 4 Sheba Medical Center, Tel Aviv, Israel 5 European Institute of Oncology e Intensive Care Unit, Milan, Lombardy, Italy 6 European Institute of Oncology e Division of Medical Oncology, Milan, Lombardy, Italy 7 European Institute of Oncology e Division of Abdomino-Pelvic Surgery, Milan, Lombardy, Italy Background: Local recurrence still remains a major problem after radical resection of rectum for cancer with TME. At the same time the poor evidence due to lack of randomized trials enrolling patients with local recurrence has led to a wide spectrum of treatments for such patients, who are often managed in multidisciplinary framework programs. Methods: Between January 2004 and July 2014, 577 patients were treated with TME for rectal cancer (within 12 cm of the anal verge). All these patients underwent a strict follow-up program comprising instrumental and clinical controls every 6 months for at least 5 years. With a median follow-up of 50 mouths (range 9e120 months), 56 local recurrences were diagnosed. In all but 8 patients recurrence was asymptomatic. The local recurrence rates registered were 7%, 9% and 10% respectively at 2, 3 and 5 years. Seven patients (12.5%) with distant recurrence at the same time were excluded from the following, analysis, for a total of 49 patients examined with local recurrence only. Results: Among the remaining 49 patients, 30(61%) underwent surgery comprising Miles operation in 14 cases (29%), Hartmann procedure in 7(14%), repeated low anterior resection with colo-anal anastomosis in other 3 cases(6%) and palliative colostomy or other palliative procedure in 6 cases (12. Eight patients (16%) were excluded from surgery and underwent some form of CT or associated RT-CT, whilst 11 patients (23%) were addressed to palliative treatment. Overall survival (OS) rates were 48%, 29% and 22% respectively at 2, 3 and 5 years. On univariate analysis, resection of recurrent diseasewas the only significant factor associatedwith prognosiswith a 5 years OSof30%vs22%for resectedandnon-resectedcases respectively (p1⁄4 0.04). Conclusions: Despite early diagnosis due to an intensive follow-up program after TME for rectal cancer, only a half of patients are amenable for re-resection. Surgical resection still remains the mainstay of treatment for locally recurrent rectal cancer. http://dx.doi.org/10.1016/j.ejso.2015.08.106 P2. Gelatinase expression in colorectal cancer pathology and survival Liz Baker, Norma Robinson, Mohamed Tabaqchali, David Leaper 1 University Hospital of North Tees, Stockton on Tees, UK University of Huddersfield, Huddersfield, UK Introduction:Matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) are responsible for tissue breakdown and remodelling in both normal and pathological processes, including tumour invasion andmetastasis. The most extensively studied MMPs in cancer are the gelatinases (MMP-2 andMMP-9). This study determined gelatinase tissue expression in colorectal cancer and correlated this with tumour pathology and 10 year survival status. Methods: Paired tumour and normal mucosal tissue from 101 colorectal cancer patients were analysed by ELISAs (ng/mg protein) and gelatin zymography for MMP-2 and MMP-9 expression. TIMP-1 and TIMP-2 expression were also determined by ELISA. Tissue levels were then correlated with tumour pathology (P< 0.05, Spearman’s correlation) and ten year survival analysis was performed (p< 0.05 Kaplan Meier). The study had ethics approval. Results: Latent and active gelatinases and TIMP-1 levels were all significantly greater in colorectal tumour tissue samples than normal tissue e.g. total MMP-9 levels (median (range)); tumour, 17.4(0.3e217.3) and normal, 2.8(0.2e35.3)ng/mg protein. Tumour levels of some gelatinase forms correlated with the tumour pathology including Dukes’ stage and lymphatic invasion. The proportion of active MMP-2 and MMP-9 in tumour tissue significantly correlated with disease free and overall survival, with higher tissue levels associated with poorer survival. Conclusions: Gelatinase expression is up-regulated in colorectal tumour tissue compared to normal mucosa. Gelatinase levels correlated with both tumour pathology and with disease-free and overall ten year survival in patients with colorectal cancer. http://dx.doi.org/10.1016/j.ejso.2015.08.107 P3. Mammaglobin-A, VEGFR3 and Ki67 in human breast cancer pathology and 5-year survival Liz Baker, NaomiWhiteoak, DeborahWilson, LouiseHall, PudBhaskar University Hospital of North Tees, Stockton on Tees, UK Introduction: Human mammaglobin-A is specifically expressed in breast tissue, over-expressed in some breast cancers and has been associated with less aggressive phenotypes. Vascular endothelial growth factor receptor 3 (VEGFR3) is a marker for angiogenesis and lymph-angiogenesis, and Ki67 is a marker for cell proliferation. It is currently unknown how mammaglobin-A relates to these markers of tumour growth and or disease free survival. Methods: A total of 80 patients who have undergone breast surgery for either breast cancer or benign disease were randomly selected after stratification for tumour grade. Tissue sections were analysed by immunohistochemistry for mammaglobin-A, VEGFR3 and Ki67 expression. Expression was compared with tumour histopathology including receptor status (where available) and five year survival analysis was performed (Chisquared). The study had ethics approval. Results: There was no association found between either, VEGFR3 and mammaglobin (P1⁄4 0.925) or Ki67 and mammaglobin expression (P1⁄4 0.768) however there was a significant association between Ki67 and VEGFR3 (P1⁄4 0.037). Significant associations were also found between Ki67 and tumour grade (P< 0.001), Ki67 and metastasis (P1⁄4 0.045), and between VEGFR3 and tumour grade (P1⁄4 0.002). No

We present a case of ureteral obstruction secondary to pelvic actinomycosis. Despite stenting, prolonged antibiotic therapy, and debridement, the patient required ureteral resection and reconstruction. This condition may simulate advanced malignancy, and diagnostic suspicion lessens the need for radical extirpative surgery.