S28 ABSTRACTS

partial ureteral resection in 13 patients and nephrectomy in one patient.

Partial cystectomy was performed in 21 patients, and complete cystectomy

with urinary diversion according to Bricker in 3 patients. At a median

follow-up of 26.7 months, 160 patients (60%) were alive. The overall me-

dian survival was 32.0 months. There was no significant difference in

overall survival following CRS+HIPEC between patients with and without

involvement of the urological tract (median survival: 26.9 versus 32.1

months, P ¼ 0.29). In patients with an urological procedure during

CRS+HIPEC, severe complications (grade�3) occurred in 18 patients

(47%), compared to 20% in patients without urological resection (OR

3.58, 95%-CI: 1.75 e 7.31, P < 0.001). In patients with an urological pro-

cedure, the most frequent complications were gastrointestinal leakage

(n¼9) or intra-abdominal abscess formation (n¼5). In univariate analysis

the following variables were significantly correlated to severe postopera-

tive complications: regional PC score (OR 1.22, 95%-CI: 1.00 e 1.48,

P ¼ 0.05), intraoperative blood loss (OR 1.36, 95%-CI: 1.05 e 1.78, P

¼ 0.02), operating time (OR 1.45, 95%-CI: 1.20 e 1.76, P < 0.001)

and urological procedures (OR 3.58, 95%-CI: 1.75 e 7.31, P <0.001).

In multivariate analysis, operating time (OR 1.38, 95%-CI: 1.08 e 1.77,

P ¼ 0.01) and an urological procedure (OR 2.66, 95%-CI: 1.16-6.11, P

¼ 0.021) were significantly correlated to severe postoperative

complications.

Conclusions: Urological resections during cytoreduction and HIPEC in

patients with peritoneal carcinomatosis of colorectal origin are feasible and

effective. Severe complications are prevalent in these patients, mainly due to

the more extensive visceral resections, but the overall and disease-free sur-

vival are comparable to patients without involvement of the urinary system.

No conflict of interest.

http://dx.doi.org/10.1016/j.ejso.2014.08.046

50. Cytoreductive surgery and HIPEC in treatment of colorectal

peritoneal carcinomatosis: Experimental or standard care? A survey

of surgical oncologists and medical oncologists

H. Braam1, D. Boerma1, M.J. Wiezer1, B. Van Ramshorst1

1 St. Antonius Hospital, Surgery, Nieuwegein, Netherlands

Background: Cytoreductive surgery (CRS) combined with hyperther-

mic intraperitoneal chemotherapy (HIPEC) is increasing applied in pa-

tients with peritoneal metastasis of colorectal carcinoma. Although the

treatment in recommended in the Dutch guideline, in current daily practice

there still appears to be controversy regarding its indication and effective-

ness. The goal of the current study was to evaluate the opinion about this

treatment among Dutch gastroenterological surgeons and medical

oncologists.

Methods: An online survey, with 10 general questions and 6 cases, was

sent to all known Dutch oncologic or gastroenterological surgeons

(N¼459) and medical oncologists (N¼363) located in 84 hospitals. The

questions concerned effectiveness of HIPEC, risk of complications, and

patient selection. A comparison was made between surgeons and medical

oncologists.

Results: In total we received 185 eligible responses of 71 hospitals,

resulting in an overall response rate of 23% and a response rate of 85%

of the hospitals. Overall, 65% of respondents regarded CRS+HIPEC as

effective with sufficient evidence for its effect. 29% responded that

CRS+HIPEC is probably effective without sufficient evidence, and 7%

of respondents regards HIPEC as probably ineffective with insufficient

evidence of effect. Medical oncologists were significantly less convinced

of the effect of CRS+HIPEC compared to surgeons (51%, 41%, 9%, vs.

74%, 21%, 6%, P ¼ 0.006). In our study, 68% of respondents indicated

that they regard CRS+HIPEC as standard treatment in patients with peri-

toneal dissemination of colorectal carcinoma (77% of surgeons vs. 54%

of medical oncologists, P ¼ 0.001). Additionally, a quantification of the

effect of HIPEC was asked, overall 68% of respondents regards

CRS+HIPEC as potentially curative. Again surgeons were more in

favour of this treatment compared to medical oncologists (77% versus

54%, P ¼ 0.001)

Conclusions: Although CRS+HIPEC is currently advised in the Dutch

guideline in patients with peritoneal dissemination of colorectal cancer,

approximately 30% of physicians, who treat colorectal carcinoma, does

not regards this treatment as standard care. Surgeons appear significantly

more in favour of this treatment compared to medical oncologists. This

study shows that there is a need for a widely accepted consensus regarding

the position of this treatment in patients with peritoneal dissemination of

colorectal cancer.

No conflict of interest.

http://dx.doi.org/10.1016/j.ejso.2014.08.047

51. Infrared thermography monitoring in closed hyperthermic

intraperitoneal chemotherapy: A novel technique to maintain

therapeutic intraperitoneal temperature distribution

T. Jager1, A. Dinnewitzer1, C. Augsch€oll1, C. Rabl1, D. Neureiter2,S. Stattner1, D. Ofner1

1 Paracelsus Medical University, Surgery, Salzburg, Austria2 Paracelsus Medical University, Pathology, Salzburg, Austria

Background: Primary and secondary peritoneal malignancies have an

extremely poor prognosis. There is a growing body of evidence that cyto-

reductive surgery (CRS) combined with hyperthermic intraperitoneal

chemotherapy (HIPEC) is the optimal treatment for selected patients

with peritoneal surface malignancies. There are basically two methods to

deliver the heated chemotherapy: the open-abdomen and the closed-

abdomen technique. Due to growing concern about toxic side effects of

chemotherapeutic agents on medical staff during open-abdomen HIPEC,

the closed technique is increasingly used. The main drawback of the closed

technique is the loss of manual temperature control within the peritoneal

cavity with a possible insufficient intraperitoneal temperature distribution

during the HIPEC procedure. We present a novel new technique to visu-

alize and maintain a constant and therapeutic intraperitoneal temperature

distribution during closed HIPEC.

Methods and materials: An infrared thermography camera was used

to measure and display the superficial thermal distribution on the abdom-

inal wall during closed HIPEC procedure. The live on-screen visualized

mapping was directly correlated with the intraperitoneal temperature

measured by three intraabdominal, one inflow and one outflow tempera-

ture probes. In case of low correlation the ’shake and bake’ method was

applied to maintain an equally distributed intraperitoneal heated

chemotherapy.

Results: From April 2013 to April 2014 this novel technique was used

during 10 closed HIPEC procedures. Colorectal cancer n¼4, gynecological

tumor n¼2, mesothelioma n ¼ 3, gastric cancer n ¼ 1 and pseudomyxoma

peritonei n¼1. On the basis of our preliminary results, both qualitative, as

well as quantitative statements could be obtained regarding the distribution

of the intra-abdominal temperature during closed HIPEC.

Conclusion: Infrared thermography temperature control of the abdominal

surface during closedHIPEC is a novel and feasible method. Its use provides a

better control for constant therapeutic intraperitoneal temperature distribution

of the heated chemotherapy, and gives the surgeon the ability to react immedi-

ately and targeted to avoid severe acute or late systemic side effects.

No conflict of interest.

http://dx.doi.org/10.1016/j.ejso.2014.08.048