Section on colon & rectal surgery. (Abstracts of Scientific Posters).

CO1-E. EMERGENCY PRESENTATIONS OF COLORECTAL CANCER IN PATIENTS AGED LESS THAN FORTY YEARS. Reza F. Saidi, MD, Parvin Mirbod, MD, and Shahriar Aghakhani, MD. Knoxville, TN.

There is little known about emergency presentation of colorectal cancer in young adults and its clinicopathologic features. Retrospective analysis of colorectal cancer in patients aged less than 40 years with emergency presentation, treated at Cancer Institute of Tehran University of Medical Sciences, Tehran, Iran (1978 to 1997) was performed. Of 1,056 patients treated for colorectal cancer, 227 (21.5%) were younger than 40 years old. Twenty-four patients (10.6%) had emergency presentation: 14 ( 58.3%) with obstruction, 8 (33.3%) with perforation, and 2 (8.3%) with massive bleeding. Female to male ratio was 1.4 (14:10). Tumors were at advanced stages (60% stages C and D). Tumor were infiltrative in 58.3% of cases and polypoid in 41.7%. Obstructing tumors were mostly located in the rectosigmoid (41.7%) and transverse colon (50%). The most common site for perforation was the cecum. The two patients who presented with massive bleeding had cancer in the sigmoid colon. The average tumor size was 6 cm. Most of the tumors were poorly differentiated, and there was a high incidence of signet cell adenocarcinoma. Colorectal cancer in young adult patients can present as acute surgical abdomen, and it is associated with advanced disease.

Reza F. Saidi, MD, and Paul D. Dudrick. University of Tennessee Medical Center, Knoxville, TN

CO2-E. COLORECTAL SURGERY IN RENAL TRANSPLANT PATIENTS: EXPERIENCE AT UNIVERSITY OF TENNESSEE MEDICAL CENTER KNOXVILLE.

Over 16 years (1985-2001), 5 patients out of 556 renal transplant recipients (0.9%) needed colorectal surgery. Three patients (0.5%) had colon cancer and two (0.4%) had diverticulitis. All patients were male, with mean age of 63 years. The mean elapsed time from transplantation to symptoms was 11 years (10 for diverticulitis and 12 for cancer). All were taking prednisone and additional immunosuppressive agents (mycophenolate mofetil , cyclophosphamide, or cyclosporine). Both patients with diverticulitis underwent laparascopic sigmoid colectomy for recurrent episodes of acute diverticulitis without any postoperative complications. There were no cases of perforation, abscess, or obstruction. The patients with colorectal cancer underwent resection with primary anastomosis (2 underwent sigmoid colectomy for sigmoid cancer, and one underwent low anterior resection for rectal cancer). All had uneventful postoperative courses, and no anastomosis leak occurred. One patient was found to have liver metastasis at the ti me of operation. The other one had stage U disease at the time of operation, but developed liver lesions 6 months later. However, the primary source for the liver metastases was not specifically identified, as he had a history of lung and prostate cancer. The third one had stage I disease. According to our data, renal transplant patients rarely require colorectal surgery. Mortality and morbidity of operation were low in these patients. Although two of the three patients with colorectal cancer presented with advanced disease, no specific conclusions regarding the behavior of colorectal cancer in renal transplant patients can be made from these data and further evaluation is needed.