e16223 Background: Multiple gastrointestinal malignancies have the potential to metastasize in the peritoneal cavity. Peritoneal carcinomatosis (PC) is often associated with disease progression and poor prognosis. However, there has been limited data on the impact of tumor origin on the survival outcomes in patients with PC. We sought to examine the differences in the cancer-specific survival of gastrointestinal malignancies with PC. Methods: We performed a retrospective study of patients ≥18 years of age diagnosed with gastrointestinal malignancies (stomach, colorectal, small intestine, appendix) with PC between 2010-2016 using data extracted from the United States Surveillance, Epidemiology, and End Results (SEER) database. The study endpoint was cancer-specific mortality (CSM). We used the Kaplan-Meier method to evaluate the cancer-specific survival for each primary tumor. Cox proportional hazard regression analysis was used to examine the association between CSM and other patient characteristics. The effects were expressed as hazard ratios (HR) and 95% confidence intervals (CI). Results: We identified 7374 patients who met the inclusion criteria; 2797 (37.9%) with stomach cancer, 3274 (44.4%) with colorectal cancer, 703 (9.5%) with small intestine cancer, and 600 (8.1%) with appendiceal cancer. The median age at diagnosis was 64 (Interquartile Range (IQR), 53-75). Median follow-up was 11 months (IQR 3-22). 3709 patients (50.3%) were female. The majority was White (76.2%). 3942 (53.5%) were married. 5679 (77.0%) were insured. 4343 (58.9%) received chemotherapy and 3682 (49.9%) received surgery. Compared to PC of appendiceal cancer primary, stomach cancer primary had an increased risk of CSM (HR = 4.89; 95% CI 4.23-5.65), followed by colorectal cancer (HR = 2.78, 95% CI 2.41-3.21), and small intestine (HR = 1.17; 95% CI 0.98-1.41). Across all patients, surgery and chemotherapy were associated with a lower risk of CSM. Conclusions: Primary tumor origin significantly affects outcomes of gastrointestinal malignancies with PC. Surgery and chemotherapy were associated with decreased CSM. [Table: see text]

e15514 Background: Appendiceal cancer (AC) survival rates have improved over the last decade. The risk of second primary malignancy (SPM) in AC survivors has become an important concern. Therefore, this study aimed to estimate the risk of SPM in patients with primary AC. Methods: We performed a retrospective cohort study of patients ≥18 years of age diagnosed with AC between 2000-2016 using data extracted from the United States Surveillance, Epidemiology, and End Results (SEER) database. The study endpoint was the occurrence of SPM diagnosed after two months of the index AC. We calculated the standardized incidence ratio (SIR) with 95% confidence intervals (CI) for SPM in AC survivors by using the SEER software. Results: Of 9578 patients with AC, 598 (6.2%) developed a SPM. The overall risk of SPM for all sites was significantly increased in AC patients (SIR = 1.46, 95% CI 1.34-1.58). The highest risk of developing a SPM was seen in ages < 60 years, females, and Asian/Pacific Islanders, respectively (SIR = 1.84, 95% CI 1.64-2.07; SIR = 1.55, 95% CI 1.38-1.74; SIR = 1.72, 95% CI 1.12-2.52). The SPM sites associated with increased incidences included the small intestine, followed by the appendix, splenic flexure of the colon, and peritoneum/omentum/mesentery. There was an increased risk of developing non-Hodgkin lymphoma, but no elevated risk with developing second leukemias. Surgery and chemotherapy were associated with an increased incidence risk of SPM, respectively (SIR = 1.45, 95% CI 1.33-1.57; SIR = 1.47, 95% CI 1.25-1.71). Conclusions: AC survivors have an increased incidence of developing SPM, most notably in the small intestine, which suggests a pathophysiological process affecting derivatives of similar embryological origin. Long-term surveillance for SPM is recommended for AC survivors, especially those at high risk.[Table: see text]

INTRODUCTION:Laryngospasm is a sudden involuntary muscular spasm of the vocal cords, it can lead to cardiac arrest due to hypoxia if not timely treated. Negative pressure flash pulmonary edema (NPPE) is a rare complication secondary to laryngospasm in adults after the acute treatment, which results from forceful inspiration against blocked airways and the resulting high negative pressure in alveoli, causing fluids to flux to the interstitial and alveolar spaces. Healthy individuals are more prone for NPPE due to the strength to induce higher intrathoracic negative pressure to challenge an obstruction. This case illustrates a young adult developed postoperative laryngospasm resulting in a flash NPPE. CASE PRESENTATION:A 40 year-old male, with a history of type 1 diabetes and recent mild COVID-19 Pneumonia was admitted for minor surgery. Pre-operative assessment concluded with ASA class 2, and moderate functional status. He has no history of anesthetic complications. Surgery was done under general anesthesia with a laryngeal mask (LMA). During Recovery after the LMA was removed, he started to desaturate, with audible stridor, cyanosis and retractions. High flow oxygen mask and IV Succinylcholine were given with no response. He was immediately intubated, ET tube suctioning showed large amounts of frothy pink secretions, his saturation had improved immediately to 100% with manual positive pressure ventilation. Sustained closure of the vocal cords was observed during intubation. However, his oxygen requirement didn't improve during the first day, and he failed a spontaneous breathing trial(SBT). Chest radiograph showed diffuse haziness suggestive of pulmonary edema. Chest CT showed pulmonary edema more significant in the dependent areas with atelectasis, it also showed diffuse ground glass opacities of recent COVID-19 pneumonia. He was started on parenteral furosemide, negative fluid balance of five liters was achieved in 24 hours. Surprisingly, his breathing effort was significantly improving with fluid elimination, oxygen requirements was weaned to minimum, passed SBT on CPAP mode, and later extubated. Patient was discharged with no evidence persistent airways pathology.DISCUSSION: Laryngospasm is less common in adults, usually it results from physical manipulation of the airways. Forceful inspiration against obstructed airways results in negative intrathoracic pressure above physiological limit, which disrupts the balance of hydrostatic pressures of alveoli, interstitium and the capillaries, leading to fluid accumulation in the alveolar space, it manifest clinically with desaturation, and diffuse opacities on imaging. High negative pressure increases the permeability as well, which drive the RBCs to extravasate and manifest as bloody mucous secretions.CONCLUSIONS: Fortunately, if NPPE gets timely recognized, patients respond magically to treatment with higher positive pressure ventilation and diuretics.

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