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Laparoscopic double derivation for palliation of advanced pancreatic cancer
Electronic Poster Abstracts
EP02C-075 OUTCOMES OF PATIENTS WITH PANCREATIC CARCINOMA RESECTED IN A SINGLE BRAZILIAN CENTER M. C. Marques, H. S. C. Ribeiro, W. L. Costa Jr., A. L. Diniz, A. L. Godoy, I. C. Farias, A. M. Cury Filho and F. J. F. Coimbra Department of Abdominal Surgery, A.C. Camargo Cancer Center, Brazil Introduction: Pancreatic adenocarcinoma is an aggressive disease with a high rate of relapse following curative resection. In this study, we analyzed early and long term outcomes of patients with resected pancreatic carcinoma. Methods: A retrospective analyzes in the medical charts of patients who underwent pancreatic resection for pancreatic adenocarcinoma from 1998 to 2014 was performed. Results: Eighty-five patients underwent pancreatic resection for pancreatic carcinoma in the study period, 40 a pylorus-preserving duodenopancreatectomy, 27 a gastroduodenopancreatectomy, 1 a total pancreatectomy and 17 distal pancreatectomy. Median age was 62 years old (40e87). Gender distribution was similar and most patients were ASA I (58.8%) and III (27.1%). Median operative time was 540 minutes (180e1080). Blood transfusion was necessary in 33 patients. Postoperative morbidity was frequent (98.8%) most of then minor complications (64.7%). Mortality rate was 8.2%. Median diameter of the tumor was 3.3 cm (0e9), extrapancreatic extension was frequent (68.2%) and 41.2% of the patients had node positive disease. Complete resections (R0) corresponded to 81.2%. Neo-adjuvant treatment was administered in 15 patients. Median estimated overall survival (OS) and disease free survival (DFS) were respectively 39 and 21 months. Five year OS was 34.4% and DFS 22.6%. No variable was predictor of OS in this cohort. The only independent predictor of DFS was node positive disease (HR = 2.1, p = 0.012, 95% CI 1.1e4.0). Conclusion: Long-term outcomes for patients with resected pancreatic carcinoma are poor and node positive disease was a predictor of survival this cohort.
EP02C-076 LAPAROSCOPIC DOUBLE DERIVATION FOR PALLIATION OF ADVANCED PANCREATIC CANCER G. Kohan, N. Sanchez, R. Klappenbach, O. Ditulio and A. Faerberg Surgery, University of Buenos Aires, Argentina Introduction: Over 75% of patients with pancreatic cancer have unresectable disease at the time of diagnosis. So palliation of symptoms is an important aspect that the pancreatic surgeon must resolve. The objective of this study is to show that although endoscopic treatment is the standard palliation, surgical laparoscopic treatment is both feasible and effective for these patients. Materials and methods: All patients were studied with dynamic contrast-enhanced computed tomography scans for preoperative evaluation. Endoscopic or percutaneous HPB 2016, 18 (S1), e1ee384
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palliation was the first choice for patients with metastatic disease and for patients with locally advanced pancreatic cancer with bad performance status. Laparoscopic palliation was indicated for patients with jaundice and locally advanced pancreatic cancer (elective palliation) and for patients with jaundice with metastatic disease and failure in the endoscopic/percutaneous treatment (necessary palliation). Elective palliation consisted of Roux-en-Y hepaticojejunostomy and gastrojejunostomy and necessary palliation consisted of laparoscopic hepaticojejunostomy alone. Results: A total of 63 patients received laparoscopic surgical palliation. 49 received laparoscopic double derivation and 14 hepaticojejunostomy alone. Morbidity rate was 26.8% and mortality was 1.58%. There was no need for late surgeries in any of the patients. Conclusion: Laparoscopic double derivation (hepaticojejunostomy and gastrojejunostomy) is a good option for palliation in locally advanced pancreatic cancer. Even when percutaneous or endoscopic palliation fails, the laparoscopic palliation is a feasible option for patients with systemic disease.
EP02C-077 PROGNOSIS FACTORS IN RESECTED IPMN. EXPERIENCE OF 10 YEARS IN HOSPITAL CLINIC BARCELONA J. Ferrer1, R. García Perez1, M. Alkorta2, J. Bombi3, M. A. López-Boado4, S. Sanchez4, R. Ayuso4, A. Gines5, J. Fuster4, L. Fernández-Cruz4 and J. C. García-Valdecasas4 1 HPB and Transplant Surgery, Hospital Clinic, 2Hospital Donosti, 3Histopathology, 4Hospital Clinic, and 5Digestive Medicine, Spain Introduction: Knowledge about the IPMN (Intraductal papillary mucinous neoplasia), has increased notably in recent years. However, there is still controversy regarding which tumors should be resected or not. We present our series of IPMN and management at the Hospital Clinic. Methods: We discuss the current evaluation of IPMN, along with diagnosis, treatment and prognostic in last 10 years who underwent resection surgery in Hospital Clinic, Barcelona. Results: The preoperative diagnostic evaluation of IPMN is often problematic, with special enphasis in differenteiation of main-duct disease from branch-duct disease (MD-IPMN vs. BD-IPMN). In our serie, IPMN can develop into invasive pancreatic cancer. Large IPMN and IPMN associated with degeneration signs are more likely to relapse. Regarding the treatment, partial pancreatectomy with clean margins is the treatment of choice. Conclusion: Early detenction of IPMN and surgical treatment can lead to cure. As IPMN seems to be a slowgrowing precursor of pancreatic cáncer, a better understanding of the biology and growth of pancreatic cancer is needed to enable further improvements in diagnosis and treatment.
EP02C-075 OUTCOMES OF PATIENTS WITH PANCREATIC CARCINOMA RESECTED IN A SINGLE BRAZILIAN CENTER M. C. Marques, H. S. C. Ribeiro, W. L. Costa Jr., A. L. Diniz, A. L. Godoy, I. C. Farias, A. M. Cury Filho and F. J. F. Coimbra Department of Abdominal Surgery, A.C. Camargo Cancer Center, Brazil Introduction: Pancreatic adenocarcinoma is an aggressive disease with a high rate of relapse following curative resection. In this study, we analyzed early and long term outcomes of patients with resected pancreatic carcinoma. Methods: A retrospective analyzes in the medical charts of patients who underwent pancreatic resection for pancreatic adenocarcinoma from 1998 to 2014 was performed. Results: Eighty-five patients underwent pancreatic resection for pancreatic carcinoma in the study period, 40 a pylorus-preserving duodenopancreatectomy, 27 a gastroduodenopancreatectomy, 1 a total pancreatectomy and 17 distal pancreatectomy. Median age was 62 years old (40e87). Gender distribution was similar and most patients were ASA I (58.8%) and III (27.1%). Median operative time was 540 minutes (180e1080). Blood transfusion was necessary in 33 patients. Postoperative morbidity was frequent (98.8%) most of then minor complications (64.7%). Mortality rate was 8.2%. Median diameter of the tumor was 3.3 cm (0e9), extrapancreatic extension was frequent (68.2%) and 41.2% of the patients had node positive disease. Complete resections (R0) corresponded to 81.2%. Neo-adjuvant treatment was administered in 15 patients. Median estimated overall survival (OS) and disease free survival (DFS) were respectively 39 and 21 months. Five year OS was 34.4% and DFS 22.6%. No variable was predictor of OS in this cohort. The only independent predictor of DFS was node positive disease (HR = 2.1, p = 0.012, 95% CI 1.1e4.0). Conclusion: Long-term outcomes for patients with resected pancreatic carcinoma are poor and node positive disease was a predictor of survival this cohort.
EP02C-076 LAPAROSCOPIC DOUBLE DERIVATION FOR PALLIATION OF ADVANCED PANCREATIC CANCER G. Kohan, N. Sanchez, R. Klappenbach, O. Ditulio and A. Faerberg Surgery, University of Buenos Aires, Argentina Introduction: Over 75% of patients with pancreatic cancer have unresectable disease at the time of diagnosis. So palliation of symptoms is an important aspect that the pancreatic surgeon must resolve. The objective of this study is to show that although endoscopic treatment is the standard palliation, surgical laparoscopic treatment is both feasible and effective for these patients. Materials and methods: All patients were studied with dynamic contrast-enhanced computed tomography scans for preoperative evaluation. Endoscopic or percutaneous HPB 2016, 18 (S1), e1ee384
e367
palliation was the first choice for patients with metastatic disease and for patients with locally advanced pancreatic cancer with bad performance status. Laparoscopic palliation was indicated for patients with jaundice and locally advanced pancreatic cancer (elective palliation) and for patients with jaundice with metastatic disease and failure in the endoscopic/percutaneous treatment (necessary palliation). Elective palliation consisted of Roux-en-Y hepaticojejunostomy and gastrojejunostomy and necessary palliation consisted of laparoscopic hepaticojejunostomy alone. Results: A total of 63 patients received laparoscopic surgical palliation. 49 received laparoscopic double derivation and 14 hepaticojejunostomy alone. Morbidity rate was 26.8% and mortality was 1.58%. There was no need for late surgeries in any of the patients. Conclusion: Laparoscopic double derivation (hepaticojejunostomy and gastrojejunostomy) is a good option for palliation in locally advanced pancreatic cancer. Even when percutaneous or endoscopic palliation fails, the laparoscopic palliation is a feasible option for patients with systemic disease.
EP02C-077 PROGNOSIS FACTORS IN RESECTED IPMN. EXPERIENCE OF 10 YEARS IN HOSPITAL CLINIC BARCELONA J. Ferrer1, R. García Perez1, M. Alkorta2, J. Bombi3, M. A. López-Boado4, S. Sanchez4, R. Ayuso4, A. Gines5, J. Fuster4, L. Fernández-Cruz4 and J. C. García-Valdecasas4 1 HPB and Transplant Surgery, Hospital Clinic, 2Hospital Donosti, 3Histopathology, 4Hospital Clinic, and 5Digestive Medicine, Spain Introduction: Knowledge about the IPMN (Intraductal papillary mucinous neoplasia), has increased notably in recent years. However, there is still controversy regarding which tumors should be resected or not. We present our series of IPMN and management at the Hospital Clinic. Methods: We discuss the current evaluation of IPMN, along with diagnosis, treatment and prognostic in last 10 years who underwent resection surgery in Hospital Clinic, Barcelona. Results: The preoperative diagnostic evaluation of IPMN is often problematic, with special enphasis in differenteiation of main-duct disease from branch-duct disease (MD-IPMN vs. BD-IPMN). In our serie, IPMN can develop into invasive pancreatic cancer. Large IPMN and IPMN associated with degeneration signs are more likely to relapse. Regarding the treatment, partial pancreatectomy with clean margins is the treatment of choice. Conclusion: Early detenction of IPMN and surgical treatment can lead to cure. As IPMN seems to be a slowgrowing precursor of pancreatic cáncer, a better understanding of the biology and growth of pancreatic cancer is needed to enable further improvements in diagnosis and treatment.