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3524 Background: Resection of colorectal cancer (CRC) liver or lung metastases is an established therapeutic strategy. However, controversies exist when metastases are found concomitantly in both t...

Background Alpha Fetoprotein (AFP) is a major tumor marker in patients with hepatocellular carcinoma (HCC). Our aim was to assess the prognostic value of AFP measured within the 3-months following partial hepatectomy for HCC on cirrhosis. Methods All patients treated for HCC on cirrhosis by partial hepatectomy with intention to treat between January 1990 and December 2010 and presenting an elevation of AFP (>15ng/ml) at diagnosis were included in the study. The AFP value within the 90 postoperative days was retrospectively collected and analyzed as a dichotomized variable (normalization or absence of normalization). Performed on the whole study population, Cox proportional hazards models were utilized to assess the impact of postresection AFP normalization on overall survival (OS). Results Among 271 patients treated for HCC on cirrhosis by liver resection, 145 (53%) patients presented an elevation of AFP level (>15ng/ml). The AFP value was available within the 90 postoperative days in 96 patients (66%). Missing data were related to the 7 post-operative deaths, the 22 patients lost from follow up, and the 20 patients for which the first post-operative AFP measurement was performed beyond the 90 postoperative days. 5 years-OS after liver resection and median survival were 45% and 54 months in the group with post-resection AFP normalization versus 24% and 23 months in the group without postresection AFP normalization, respectively (P = 0,02). There was a significant decline of disease-free survival in the group without postresection AFP normalization experiencing median survival of 6 months versus 19 months (P Conclusion This study emphasizes the role of AFP in the 3-months period following HCC resection on cirrhotic livers, which should be considered more systematically to help postresection management. Disclosure All authors have declared no conflicts of interest.

e14674 Background: Two-stage hepatectomy (TSH) is the present standard for multiple bilobar colorectal liver metastases (CLM). Its main drawback is the drop-out risk (25-40% of patients fail to com...

Malnutrition is an independent risk factor of postoperative morbidity and mortality and it’s observed in 20 to 50% of surgical patients. Preoperative interventions to optimize the nutritional status, reduce postoperative complications and enteral nutrition has proven to be superior to the parenteral one. Moreover, regardless of the nutritional status of the patient, surgery impairs the immunological response, thus increasing the risk of postoperative sepsis. Immunonutrition has been developed to improve the immunometabolic host response in perioperative period and it has been proven to reduce significantly postoperative infectious complications and length of hospital stay in patients undergoing elective gastrointestinal surgery for tumors. We hypothesize that a preoperative oral immunonutrition (ORAL IMPACT®) can reduce postoperative morbidity in liver resection for cancer. Prospective multicenter randomized placebo-controlled double-blind phase IV trial with two parallel treatment groups receiving either study product (ORAL IMPACT®) or control supplement (isocaloric isonitrogenous supplement - IMPACT CONTROL®) for 7 days before liver resection for cancer. A total of 400 patients will be enrolled. Patients will be stratified according to the type of hepatectomy, the presence of chronic liver disease and the investigator center. The main end-point is to evaluate in intention-to-treat analysis the overall 30-day morbidity. Secondary end-points are to assess the 30-day infectious and non-infectious morbidity, length of antibiotic treatment and hospital stay, modifications on total food intake, compliance to treatment, side-effects of immunonutrition, impact on liver regeneration and sarcopenia, and to perform a medico-economic analysis. The overall morbidity rate after liver resection is 22% to 42%. Infectious post-operative complications (12% to 23%) increase the length of hospital stay and costs and are responsible for a quarter of 30-day mortality. Various methods have been advocated to decrease the rate of postoperative complications but there is no evidence to support or refute the use of any treatment and further trials are required. The effects of preoperative oral immunonutrition in non-cirrhotic patients undergoing liver resection for cancer are unknown. The present trial is designed to evaluate whether the administration of a short-term preoperative oral immunonutrition can reduce postoperative morbidity in non-cirrhotic patients undergoing liver resection for cancer. Clinicaltrial.gov: NCT02041871 .