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Left-sided portal hypertension after pancreaticoduodenectomy with resection of superior mesenteric-portal vein confluence: Efficacy of concomitant splenic artery resection
Abstracts / Pancreatology 16 (2016) S1eS192
Backgound: This study compared postoperative complications of a newly developed method of inserting end-to-side pancreaticojejunostomy, without stitches on the pancreatic cut end or pancreatic duct, with conventional pancreaticojejunostomy after pancreaticoduodenectomy. Methods: From 2012 to 2015, 108 consecutive patients underwent pancreaticoduodenectomy. A modified child's reconstruction was performed with inserting or conventional pancreaticojejunostomy. Clinical course and postoperative complications were retrospectively evaluated. Results: Five patients were excluded, four who underwent hepatopancreatoduodenectomy and one who did not require pancreaticojejunostomy because of an atrophic pancreatic remnant. Of the 103 patients analyzed, 41 and 62 underwent surgery with the inserting and conventional methods, respectively. The incidence of postoperative Clavien-Dindo ＞II complications (36.6% [15/41] vs 27.4% [17/62]) was similar in the two groups. However, the rates of grade C postoperative pancreatic fistulas (7.3% [3/41] vs 0% [0/62], P¼0.030) and re-operation for postoperative complications (14.6% [6/41] vs 3.2% [2/62], P¼0.034) were significantly higher in the inserting than in the conventional group. There were no in-hospital deaths in both groups. Conclusions: Conventional pancreaticojejunostomy is safer than the end-to-side inserting method, as the latter has a risk of severe complications. Improvements in pancreatico-digestive anastomosis techniques are required.
S61
Objective: The aim of this study was to evaluate the influence of postoperative short-term outcomes on long-term survival in pancreatic adenocarcinoma. Patients and methods: A total of 293 patients undergoing surgical resection (PD in 231 and DP in 62) for pancreatic adenocarcinoma were enrolled. Multivariate analyses were performed to identify prognostic factors and evaluate the impact of postoperative short-term outcomes on long-term survival. Results: Postoperative complications were occurred as follows; Clavien-Dindo grade I in 13 patients, grade II in 50, grade IIIa in 86, and grade IIIb/IV in 14. One hundred thirty patients did not develop postoperative complication. Median postoperative hospital stay was 20 days (7-189 days). Median survival was 24 months in grade 0, 24 months in grade I, 26 months in grade II, 26 months in grade IIIa, and 28 months in grade IIIb/IV. There were no significant differences between each group. As for the postoperative hospital stay, median survival time were 26 months in patients with hospital stay <6 weeks and 14 months in patients with hospital stay ＞6 weeks (p¼0.008). Multivariate analysis revealed lymph node metastases, absence of adjuvant chemotherapy, CA19-9 ＞300 U/ml, and postoperative hospital stay ＞6 weeks as significant prognostic factors. Conclusion: Clavien-Dindo grading did not influence the postoperative survival in pancreatic adenocarcinoma. However, longer postoperative hospital stay adversely affected the patients' survival.
F-054. Effect of postoperative complications after pancreatectomy for pancreatic cancer on patients' prognosis: A retrospective clinical review 1
2
1
1
Yusuke Watanabe , Yusuke Niina , Yusuke Mizuuchi , Yuji Abe , Kazuyoshi Nishihara 1
F-056. Left-sided portal hypertension after pancreaticoduodenectomy with resection of superior mesenteric-portal vein confluence: Efficacy of concomitant splenic artery resection
1
Kitakyushu Municipal Medical Center, Department of Surgery, Japan Kitakyushu Municipal Medical Center, Department of Gastroenterology, Japan 2
Purpose: The relationship between postoperative complications after pancreatectomy for pancreatic cancer and prognosis remains unclear. The aim of this study was to determine the influence of postoperative complications on survival of patients who underwent pancreatic cancer resection. Methods: The medical records of 122 patients who underwent pancreatic cancer resection were retrospectively reviewed. Results: Postoperative complications occurred in 38 (31%) patients. Univariate analysis showed that symptoms, CA19-9 level, portal vein resection, transfusion, tumor size, G-status, T-status, N-status, postoperative complications, and adjuvant chemotherapy were significant prognostic factors for both recurrence-free survival (RFS) and overall survival (OS). Multivariate analysis showed that portal vein resection, tumor size, G-status, and postoperative complications were significant independent factors for RFS and that age, portal vein resection, tumor size, G-status, N-status, postoperative complications, and adjuvant chemotherapy were significant independent factors for OS. Although almost all factors related to biological features or tumor progression were predominant independent factors for survival, postoperative complications were the independent factors associated with survival. Conclusions: Postoperative complications after pancreatic cancer resection affect prognosis. Decreasing these complications might improve the prognosis of patients with pancreas cancer.
F-055. Impact of postoperative short-term outcomes on the survival of patients with pancreatic adenocarcinoma Teiichi Sugiura, Yukiyasu Okamura, Takaaki Ito, Yusuke Yamamoto, Ryo Ashida, Katsuhiko Uesaka Division of Hepato-Billiary-Pancreatic Surgery, Shizuoka Cancer Center
Kazuyuki Gyoten, Shugo Mizuno, Yusuke Iizawa, Akihiro Tanemura, Hiroyuki Kato, Yasuhiro Murata, Naohisa Kuriyama, Yoshinori Azumi, Masashi Kishiwada, Masanobu Usui, Hiroyuki Sakurai, Shuji Isaji Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University School of Medicine, Japan Background: We developed pancreaticoduodenectomy (PD) with splenic artery (SA) resection for pancreatic ductal adenocarcinoma (PDAC) invading SA (PD-SAR:Biomed Res Int 2014), in which the portalsuperior mesenteric vein (PV/SMV) confluence, the splenic vein (SV) and SA were resected followed by reconstruction of PV/SMV without reconstruction of SV and SA. The aim of this study is to evaluate the influence of division of SV as well as SA on left-sided portal hypertension (LPH) after PD. Patients and methods: Between 2005 and 2015, the 89 PDAC patients were classified into the three groups:Group A (n¼18): SV and SA were preserved, Group B (n¼58): SA was preserved and SV was resected, and Group C (n¼13): SA and SV were resected (PD-SAR). LPH was evaluated by analyzing the frequency of developed varices and variceal bleeding, and postoperative platelet counts ratio and spleen volume ratio compared to preoperative data at 1, 3, 6, 12 and 24 months (M) after PD. Results: The backgrounds among three groups did not significantly differed except for the rates of locally advanced PDAC defined as unresectable according to NCCN guidelines (5.5%, 21 and 53 in Groups A, B and C:p<0.05) and R0 resection (94%, 91 and 60 in Groups A, B and C:p<0.01). In Group C, there were no complications related to SA resection. The incidence of postoperative varices was evaluated by CT scan in Groups A, B and C was 16.6%, 60.3 and 38.5, respectively (p<0.001). Variceal bleeding occurred only in Group B (6.6%). Platelet counts and spleen volume ratio of Group B was lowest in every points. Conclusion: PD with resection of PV/SMV confluence without reconstruction of SV caused LPH, which increases the risk of variceal bleeding and hypersplenism. The concomitant division of SA can attenuate LPH.
Backgound: This study compared postoperative complications of a newly developed method of inserting end-to-side pancreaticojejunostomy, without stitches on the pancreatic cut end or pancreatic duct, with conventional pancreaticojejunostomy after pancreaticoduodenectomy. Methods: From 2012 to 2015, 108 consecutive patients underwent pancreaticoduodenectomy. A modified child's reconstruction was performed with inserting or conventional pancreaticojejunostomy. Clinical course and postoperative complications were retrospectively evaluated. Results: Five patients were excluded, four who underwent hepatopancreatoduodenectomy and one who did not require pancreaticojejunostomy because of an atrophic pancreatic remnant. Of the 103 patients analyzed, 41 and 62 underwent surgery with the inserting and conventional methods, respectively. The incidence of postoperative Clavien-Dindo ＞II complications (36.6% [15/41] vs 27.4% [17/62]) was similar in the two groups. However, the rates of grade C postoperative pancreatic fistulas (7.3% [3/41] vs 0% [0/62], P¼0.030) and re-operation for postoperative complications (14.6% [6/41] vs 3.2% [2/62], P¼0.034) were significantly higher in the inserting than in the conventional group. There were no in-hospital deaths in both groups. Conclusions: Conventional pancreaticojejunostomy is safer than the end-to-side inserting method, as the latter has a risk of severe complications. Improvements in pancreatico-digestive anastomosis techniques are required.
S61
Objective: The aim of this study was to evaluate the influence of postoperative short-term outcomes on long-term survival in pancreatic adenocarcinoma. Patients and methods: A total of 293 patients undergoing surgical resection (PD in 231 and DP in 62) for pancreatic adenocarcinoma were enrolled. Multivariate analyses were performed to identify prognostic factors and evaluate the impact of postoperative short-term outcomes on long-term survival. Results: Postoperative complications were occurred as follows; Clavien-Dindo grade I in 13 patients, grade II in 50, grade IIIa in 86, and grade IIIb/IV in 14. One hundred thirty patients did not develop postoperative complication. Median postoperative hospital stay was 20 days (7-189 days). Median survival was 24 months in grade 0, 24 months in grade I, 26 months in grade II, 26 months in grade IIIa, and 28 months in grade IIIb/IV. There were no significant differences between each group. As for the postoperative hospital stay, median survival time were 26 months in patients with hospital stay <6 weeks and 14 months in patients with hospital stay ＞6 weeks (p¼0.008). Multivariate analysis revealed lymph node metastases, absence of adjuvant chemotherapy, CA19-9 ＞300 U/ml, and postoperative hospital stay ＞6 weeks as significant prognostic factors. Conclusion: Clavien-Dindo grading did not influence the postoperative survival in pancreatic adenocarcinoma. However, longer postoperative hospital stay adversely affected the patients' survival.
F-054. Effect of postoperative complications after pancreatectomy for pancreatic cancer on patients' prognosis: A retrospective clinical review 1
2
1
1
Yusuke Watanabe , Yusuke Niina , Yusuke Mizuuchi , Yuji Abe , Kazuyoshi Nishihara 1
F-056. Left-sided portal hypertension after pancreaticoduodenectomy with resection of superior mesenteric-portal vein confluence: Efficacy of concomitant splenic artery resection
1
Kitakyushu Municipal Medical Center, Department of Surgery, Japan Kitakyushu Municipal Medical Center, Department of Gastroenterology, Japan 2
Purpose: The relationship between postoperative complications after pancreatectomy for pancreatic cancer and prognosis remains unclear. The aim of this study was to determine the influence of postoperative complications on survival of patients who underwent pancreatic cancer resection. Methods: The medical records of 122 patients who underwent pancreatic cancer resection were retrospectively reviewed. Results: Postoperative complications occurred in 38 (31%) patients. Univariate analysis showed that symptoms, CA19-9 level, portal vein resection, transfusion, tumor size, G-status, T-status, N-status, postoperative complications, and adjuvant chemotherapy were significant prognostic factors for both recurrence-free survival (RFS) and overall survival (OS). Multivariate analysis showed that portal vein resection, tumor size, G-status, and postoperative complications were significant independent factors for RFS and that age, portal vein resection, tumor size, G-status, N-status, postoperative complications, and adjuvant chemotherapy were significant independent factors for OS. Although almost all factors related to biological features or tumor progression were predominant independent factors for survival, postoperative complications were the independent factors associated with survival. Conclusions: Postoperative complications after pancreatic cancer resection affect prognosis. Decreasing these complications might improve the prognosis of patients with pancreas cancer.
F-055. Impact of postoperative short-term outcomes on the survival of patients with pancreatic adenocarcinoma Teiichi Sugiura, Yukiyasu Okamura, Takaaki Ito, Yusuke Yamamoto, Ryo Ashida, Katsuhiko Uesaka Division of Hepato-Billiary-Pancreatic Surgery, Shizuoka Cancer Center
Kazuyuki Gyoten, Shugo Mizuno, Yusuke Iizawa, Akihiro Tanemura, Hiroyuki Kato, Yasuhiro Murata, Naohisa Kuriyama, Yoshinori Azumi, Masashi Kishiwada, Masanobu Usui, Hiroyuki Sakurai, Shuji Isaji Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University School of Medicine, Japan Background: We developed pancreaticoduodenectomy (PD) with splenic artery (SA) resection for pancreatic ductal adenocarcinoma (PDAC) invading SA (PD-SAR:Biomed Res Int 2014), in which the portalsuperior mesenteric vein (PV/SMV) confluence, the splenic vein (SV) and SA were resected followed by reconstruction of PV/SMV without reconstruction of SV and SA. The aim of this study is to evaluate the influence of division of SV as well as SA on left-sided portal hypertension (LPH) after PD. Patients and methods: Between 2005 and 2015, the 89 PDAC patients were classified into the three groups:Group A (n¼18): SV and SA were preserved, Group B (n¼58): SA was preserved and SV was resected, and Group C (n¼13): SA and SV were resected (PD-SAR). LPH was evaluated by analyzing the frequency of developed varices and variceal bleeding, and postoperative platelet counts ratio and spleen volume ratio compared to preoperative data at 1, 3, 6, 12 and 24 months (M) after PD. Results: The backgrounds among three groups did not significantly differed except for the rates of locally advanced PDAC defined as unresectable according to NCCN guidelines (5.5%, 21 and 53 in Groups A, B and C:p<0.05) and R0 resection (94%, 91 and 60 in Groups A, B and C:p<0.01). In Group C, there were no complications related to SA resection. The incidence of postoperative varices was evaluated by CT scan in Groups A, B and C was 16.6%, 60.3 and 38.5, respectively (p<0.001). Variceal bleeding occurred only in Group B (6.6%). Platelet counts and spleen volume ratio of Group B was lowest in every points. Conclusion: PD with resection of PV/SMV confluence without reconstruction of SV caused LPH, which increases the risk of variceal bleeding and hypersplenism. The concomitant division of SA can attenuate LPH.