Minimally invasive pyloroplasty provides excellent outcomes for patients with gastroparesis and should be considered as a primary treatment along with diet and medications as it is effective and does not eliminate the option for additional surgical options in the future for refractory disease. With technological advancements, a totally endoscopic pyloroplasty may be a less invasive option.

Results. There were 212 patients included. Seventynine percent of patients who underwent PC had a clini-

Introduction. Preoperative chemotherapy (PC) for operable breast cancer has shown significant benefits in prospective trials. Many patients are treated in the community setting and some may question the applicability of PC outside the university setting.Methods. Retrospective review was performed of stage II and IIIA breast cancer patients treated from January 2002 to July 2009. Fifty-three of 57 patients who underwent PC were matched based on age, tumor size, and hormone receptor status with 53 patients who did not undergo PC. Differences in patient compliance with physician recommendations for all types of adjuvant therapy were evaluated. Crude odds ratios and adjusted odds ratios derived from conditional logistic regression models were calculated.Results. There were 106 patients included. Patient compliance with chemotherapy was better in the PC group than in the adjuvant chemotherapy (AC) group (100% versus 70%; p ‫؍‬ .0001). Similarly, more patients

In our SICU, early, empiric broad-spectrum VAP therapy followed by de-escalation to pathogen-specific agents did not alter antimicrobial resistance and is a valid practice. Further, our compliance with de-escalation practices was higher than published rates.

e11594 Background: The benefits of preoperative chemotherapy (PC) for operable breast cancer have been demonstrated in prospective clinical trials. For palpable breast cancers, however, operative intervention remains the most common initial treatment. The benefits of PC for operable breast cancer were examined in a community hospital. Methods: Maricopa Medical Center is the safety net hospital in Arizona. A retrospective review was performed of all breast cancer patients from 2004 to 2008. All patients who were stage IIA - IIIA breast cancer patients were included. Outcomes of breast cancer were evaluated based on whether the patient underwent PC or adjuvant chemotherapy (AC). All patients in the PC group received anthracyclines and a taxane in their treatment. The Fisher's exact test and the Chi-square test were used to determine differences between the two populations. Unpaired t-test was used to compare means of the two populations. Results: During this period, 145 patients were treated. In the PC group, the clinical response rate was 81% and the pathologic complete response rate was 26%. Patients in the PC group underwent lumpectomy more often for T2 (73% vs. 40%, P = 0.01) and for T3 tumors (73% vs. 37%, P = 0.06). The positive margin rate was lower (14% vs.37%, P = 0.02) and the lumpectomy volume was smaller in the PC group compared to the AC group (132 cm3 vs. 245 cm3, P < 0.01). Despite similar demographics, compliance with chemotherapy was improved in the PC group (100% vs. 71%, P < 0.01). In addition, compliance was also improved for adjuvant radiation (97% vs. 70%, P < 0.01) and hormone therapy (100% vs. 76%, P = 0.01) in the PC group. Conclusions: Preoperative chemotherapy improved compliance with chemotherapy. This could represent a significant benefit over AC in populations where compliance with chemotherapy recommendations is not ideal. Improvements in surgical outcomes were also seen in patients who received preoperative chemotherapy in the community hospital setting. No significant financial relationships to disclose.