ABSTRACTS 751

restrictions were accepted then less than 10% of patients with liver only

disease would come to hepatectomy. As a result, barely 3% of all patients

with stage 4 disease were alive 5 years after diagnosis. The current defini-

tion of resectability is metastatic disease in the liver (even in the presence

of resectable extra-hepatic disease) which can be resected while preserving

25-30% of viable disease free liver with a vascular inflow and vasculo-bil-

iary outflow. As such, more than 20% of these patients are now considered

resectable at presentation. The only barrier to such surgery is now anaes-

thetic fitness to undergo the liver surgery (2).

Furthermore, more patients can now be brought physically to liver re-

section by using a number of techniques including:

� Portal vein embolisation to increase the size of the future remnant liver

� Two stage hepatectomy

� Combination of surgery with ablation (3)

� Employing techniques from liver transplantation

As such, a further 10% of patients become surgical candidates without

recourse to the use of induction chemotherapy.

It has been clear for some time that there are patients with liver-limited

but unresectable disease who can be converted to resectability following

induction chemotherapy, either on intention to treat or following a dramatic

response, even when thought initially not feasible (the ‘accidental’ hepa-

tectomy). Combining cytotoxic chemotherapy with biologics (especially

the EGF-receptor antibody cetuximab in patients whose tumours are kras

wild-type) might now bring up to 40% of patients with unresectable

liver-limited disease to liver surgery with potentially curative intent (4).

Using chemotherapy and biologics to bring patients to such surgery

must only be employed within the setting of a highly specialised hepato-

biliary multi-disciplinary team (5). Injudicious and excessive use of these

agents leads to liver parenchymal damage, so causing increased morbidity

and mortality after liver surgery, and also runs the risk of making the le-

sions morphologically disappear, so becoming undetectable at surgery,

while remaining pathologically viable.

1. Morris E et al. Brit J Surgery 2010; 97: 1110-8

2. Adam R et al. Brit J Surg 2010; 97: 366-376

3. Ruers T et al. Ann Oncol 2012 in press

4. Folprecht G et al. Lancet Oncology 2010; 1: 38-47

5. National Institute of Health and Clinical Excellence. Technology

Appraisal 176, August 2009

20 September 2012: 09:00 e 10:30

Symposium: How I do: Intraoperative decision-making and problem-solving

in surgical oncology

63. Gastric cancer surgery: The unexpected positive oesophageal

margin/direct invasion into colon or pancreas

M. Pera1

1 Hospital Universitario del Mar, Section of Gastrointestinal Surgery,

Barcelona, Spain

UGI surgeons must be aware before the operation of those gastric

cancer patients with a greater risk of having positive oesophageal mar-

gins after total gastrectomy. It has been shown that patients with larger

tumour size, deeper wall penetration, more extensive gastric involve-

ment, greater nodal involvement, higher stage and diffuse histology be-

long to this group at risk. In those cases, and once the pathologist

confirms intraoperatively the oesophageal margin involvement, the sur-

geon should balance the potential benefit of achieving a negative margin

against the risks of performing a more extensive resection. Physiological

status of the patient and the stage of the disease, especially the extension

of lymph node involvement, should be taken into account in these cir-

cumstances. Several studies have confirmed that a positive margin is as-

sociated with a worse outcome in patients with node-negative disease or

early stages. All efforts should therefore be made to clear the oesopha-

geal margin in these patients. In patients with more advance disease and

extensive lymph node involvement, a more conservative approach should

be taken.

The value of extended organ resection for advanced gastric cancer

has been debated for many years. Different studies have shown that

additional organ resection is associated with an increase in morbidity

and mortality. However, long-term survival following this kind of ex-

tended resection is possible. In these cases, similar to what happen

with the issue of positive oesophageal margins, depth of invasion

and the extent of lymph node metastasis will finally have the most de-

terminant impact on survival after additional organ resection and a R0

resection.

64. Hepatic cancer surgery: Surgical decision-making regarding the

future liver remnant

S. Lopez-Ben1, M.T. Albiol Quer1, A. Codina Barreras1,

L. Falgueras Verdaguer1, E. Castro Gutierrez1, J. Figueras Felip1

1 Hospital Dr Josep Trueta, Secci�on de Cirug�ıa Hepatobiliar y Pancre�atica,

Girona, Spain

In the last years resectability criteria has been changing in liver neo-

plasm from data based on what has to be removed (namely, size and num-

ber of lesions, wide surgical margin, time from diagnosis,..) towards

features of what we plan to be preserved.

This is more true when we speak about colorectal liver metastases

where the unique criteria of unresectability is the impossibility to preserve

enough functioning liver after the surgical resection of the lesions.

This pursuit of the "as large as possible" liver remnant is nowadays

our main goal in liver surgical oncology and the different surgical options

will be discussed, focusing in portal occlusion techniques, pharmacolog-

ical adjuvant strategies and the different modalities of two-stage hepatec-

tomies.

65. Pancreatic cancer surgery: The unexpected venous or arterial

involvement

Abstract not submitted.

20 September 2012: 09:00 e 10:30

Symposium: Breast cancer e Tailoring mastectomy

66. Tailoring breast cancer reconstruction

Abstract not submitted.

67. Radiation therapy and breast reconstruction

P. Poortmans1

1 Institute Verbeeten, Radiation Therapy, Tilburg, The Netherlands