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ANZMOSS - ANZGOSA 2020 Virtual Conference
ANZMOSS – ANZGOSA 2020 Virtual Conference
ANZMOSS - ANZGOSA 2020 Virtual Conference
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ANZGOSA Plenary 2 - Improving outcomes, new pathways

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Session Description
This session will address new patient management paradigms, in particular, Enhanced recovery after surgery and its role in the Australasian setting. 
Another presentation will cover the rapidly emerging concepts of sarcopaenia in oesophago-gastric malignancy and whether it is ready to be incorporated into routine clinical staging systems. 
The ANZGOSA free paper abstract scored highest will also be featured.
Session Program
12:45 pm
BACKGROUND
Leaks post sleeve gastrectomy remain morbid and resource-consuming. Incidence, treatments and outcomes are variable, representing heterogeneity of the problem. A predictive tool available at presentation would aid management and predict outcomes. we aimed to develop and validate a classification of sleeve gastrectomy leaks able to reliably predict outcomes, from protocolised CT findings and readily available variables.
 
METHODS
From a prospective database (2009-2018) we reviewed patients with staple line leaks. A Delphi process was undertaken on candidate variables (80 to 20).  Correlations were performed to stratify 4 groupings based on outcomes (salvage resection, length of stay, and complications) and predictor variables. Training and validation cohorts were established by block randomization. 
 
RESULTS
A 4-tiered classification was developed based on CT appearance and duration post-surgery. Inter-observer agreement was high (κ=0.85, p<0.001). There were 59 patients, (training:30, validation:29). Age 42.5±10.8 vs. 38.9±10.0 years (p=0.187); female 65.5%vs.80.0% (p=0.211), weight 127.4±31.3 vs. 141.0±47.9kg, (p=0.203). In the training group, there was a trend towards longer hospital stays as grading increased (I=10.5days; II=24days: III=66.5days; IV=72 days; p= 0.005). Risk of salvage resection increased (risk ratio grade4=9; p=0.043) as did complication severity (p=0.027).  Findings were reproduced in the validation group: risk of salvage resection (p=0.007), hospital stay (p=0.001), complications (p=0.016). 
 
CONCLUSION
We have developed and validated a classification system, based on protocolised CT imaging that predicts a step-wise increased risk of salvage resection, complication severity and increased hospital stay. The system should aid patient management and facilitate comparisons of outcomes and efficacy of interventions. 
12:55 pm
AUTHORS
YATES M(1)^, CABALAG CS(1)^, CORRALES BENITEZ M(1), YEH P(1,4), WONG SQ(1,4), CHONG L(2, 3), HII M(2, 3), DAWSON SJ(1,4,5), PHILLIPS WA(1), CLEMONS NJ(1), DUONG CP(1)
 
^Authors contributed equally to this work
1-Peter MacCallum Cancer Centre, Melbourne VIC
2-Department of Upper GI and Hepatobiliary surgery, St. Vincent’s Hospital, Melbourne VIC
3-Department of Surgery, St Vincent’s Hospital, University of Melbourne 
4-Sir Peter MacCallum Department of Oncology, University of Melbourne
5-Centre for Cancer Research, University of Melbourne

PURPOSE
Circulating tumour DNA (ctDNA) has clinical utility in monitoring treatment response and in the detection of disease recurrence in breast and colorectal cancer.  The aim of this study was to explore the role of ctDNA in the management of patients with oesophageal cancer (OC).  
 
METHODOLOGY
Blood samples and tumour biopsies were collected from 52 patients after diagnosis of OC.  In patients planned for surgery, blood samples were taken before and after neoadjuvant treatment, and during the surveillance period.  Blood samples were analysed for the same mutations present on pre-treatment tumour biopsy using a custom targeted amplicon-based approach to cover mutational foci across 9 of the most commonly mutated genes in OC.
 
RESULTS
Somatic mutations in treatment-naïve OC tumour biopsies were detected in 45 out of 51 (88%) patients.  Out of these 45 cases, 19 (42%) had detectable tumour-informed ctDNA in their plasma.  The majority (79%) of patients who were ctDNA positive had either locally advanced or metastatic disease.  In locally advanced nodal negative patients who were ctDNA positive, there was a trend towards inferior disease specific survival.  After treatment, the emergence of new somatic mutations in serial surveillance blood samples was associated with recurrent disease (p = 0.038).  
 
CONCLUSIONS
This study demonstrates that ctDNA may have clinically utility in the management of patients with OC by providing additional prognostic information.  Assessment of ctDNA in post treatment blood samples may lead to the detection of early recurrent disease.
1:05 pm
Radiological assessment of low skeletal muscle mass (myopenia) and density (myosteatosis) have been identified as potential predictors of postoperative complications, recovery and survival after oesophago-gastric cancer surgery. This presentation will provide a summary of the relevant evidence to date, pros and cons of available tools to assess muscularity and future direction of incorporating these measures into preoperative risk stratification tools.  
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