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Mental disorder is an important risk factor for adverse events after pancreatectomy
Abstracts / Pancreatology 13 (2013) S1–S80
S73
[P-168].
[P-170].
Microcystic serous cystadenoma mimicking pancreatic malignancy
Minimally Invasive ramps in well-selected left-sided pancreatic cancer with Yonsei criteria: Long-term (>median 3 years) oncologic outcome
Hee Joon Kim, Choong Young Kim, Jung Chul Kim, Hyun Jong Kim, Young Hoe Hur, Yang Seok Koh, Chol Kyoon Cho Department of Surgery, Chonnam National University Medical School, Gwangju, South Korea Background: Typically, serous cystadenomas of pancreas are frequently microcystic or oligocystic. On CT scan, serous cystadenoma generally are surrounded by a fibrous capsule and contain numerous tiny cysts, which are sometimes so small that the cystic nature is difficult to appreciate, because it is below the limits of CT resolution. Herein, we present a case of serous cystadenoma mimicking pancreatic adenocarcinoma on imaging study. Patient: A 74-year-old woman was referred to our institution for evaluation of incidentally found pancreatic body and tail mass on CT scan. Physical examination and laboratory data including tumor markers were within the normal range. The patient had not experienced a recent weight loss of abdominal pain. Abdominal CT revealed a about 76cm sized heterogeneously enhancing mass in pancreatic tail. And, in pancreatic body, a about 53cm sized heterogeneously enhancing mass was found. Result: A preoperative diagnosis of pancreatic adenocarcinoma of body and tail was made, a anterior radical antegrade modular pancreatosplenectomy was performed. Macroscopically, there were a 66cm sized well marginated multicystic mass in body, and a 1210cm well capsulated multicystic mass in tail. Microscopic findings revealed microcystic serous cystadenoma. Conclusion: Microcystic serous cystadenomas are sometimes difficult to differentiate from soild tumor. Herein, we present a case of microcystic serous cystadenoma mimicking pancreatic malignancy. Keywords: Serous cystic neoplasm, Cystic tumor
[P-169]. Mental disorder is an important risk factor for adverse events after pancreatectomy Chien-Chang Liao, Ta-Liang Chen Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan Background/aim: Patients with mental disorder were known to have a higher risk of complications during hospitalization. Quality of care has become the key factor in reducing their potential mortality afterwards. Our aim is to validate the features of adverse outcomes after pancreatectomy for surgical patients with mental disorder. Methods: We present a population-based study of patients with mental disorder receiving pancreatectomy from the Taiwan National Health Insurance Research Database within the years 2004 and 2008 compared with surgical patients without mental disorders. Eight major postoperative complications and mortality after complications were evaluated among patients with mental disorder. Results: Patients with mental disorder had significantly higher risk for postoperative complications, including acute renal failure, pneumonia, bleeding, septicemia, stroke, and 30-day postoperative mortality (adjusted OR ¼ 2.01; 95% CI: 1.87–2.49), than surgical patients without mental disorders. Preoperative related outpatient visits for mental disorders was associated with postoperative mortality. When compared with surgical patients without mental disorders, people had preoperative visits of emergency care or hospitalization for mental disorders had increased mortality after pancreatectomy. Conclusions: In patients receiving pancreatectomy, people with mental disorders showed significantly higher 30-day postoperative complications and mortality when compared with people without mental disorders. Our findings suggest the urgency revising the protocol of postoperative care for this specific population. Keywords: Pancreatectomy, Mental disorder, Adverse events
Sung Hwan Lee, Ho Kyoung Hwang, Sung Hoon Choi, Woo Jung Lee, Chang Moo Kang Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea Background/aim: Though minimally invasive techniques for distal pancreatectomy with or without splenectomy have been regarded as a feasible and safe treatment for benign and borderline malignant lesions of pancreas, it is still debatable in management of left-sided pancreatic cancer in terms of feasibility and oncologic safety. Methods: From June 2007 to November 2010, 12 patients underwent laparoscopic or robotic radical antegrade modular pancreatosplenectomy (RAMPS) for well-selected left-side pancreatic cancer. Yonsei criteria for selecting patients included following tumor condition; pancreas-confined tumor, intact fascia layer between the distal pancreas and left adrenal gland and kidney, tumor apart more than 1 or 2cm from celiac axis. We compared the clinicopathologic factors and oncologic outcomes of minimally invasive surgery (MIS) group and open group for treating left-sided pancreatic cancer. Results: In MIS group, the mean of tumor size was 2.75 1.32 cm and retrieved lymph nodes were 10.5 7.14. The resection margins were confirmed to negative for malignancy in all patients. In comparison with open group (n¼24), there were statistically significant factors in terms of tumor size (2.75 1.32 vs. 3.93 1.50 cm, P¼0.028), hospital stay (12.25 6.79 vs. 21.83 13.76 days, P¼0.008). In survival analysis, the MIS group had better overall survival periods than the open group (60.0 vs. 30.7 months, P¼0.046). In order to overcome the heterogeneity of subject between the MIS and open group, we divided the open group into two groups depending on Yonsei criteria. There were no significant difference of median overall survival periods between the MIS group and the open group within Yonsei Criteria (60.00 vs. 60.72 months, P¼0.495). Conclusions: Minimally invasive RAMPS is not only technically feasible but also oncologically safe in well selected left-sided pancreatic cancer. Yonsei Criteria for selecting minimally approach need to be validated based on large volume experiences. Keywords: Pancreatic cancer, Minimally invasive surgery, RAMPS, Oncologic outcome
[P-171]. 3D models of arteries constructed using MD-CT images pancreatoduodenectomy safely following dissection of the inferior pancreaticoduodenal artery Akihiko Horiguchi, Shin Ishihara, Masahiro Ito, Yukio Asano General, Pancreatic Surgery, Fujita-health University, Toyoake, Japan
S73
[P-168].
[P-170].
Microcystic serous cystadenoma mimicking pancreatic malignancy
Minimally Invasive ramps in well-selected left-sided pancreatic cancer with Yonsei criteria: Long-term (>median 3 years) oncologic outcome
Hee Joon Kim, Choong Young Kim, Jung Chul Kim, Hyun Jong Kim, Young Hoe Hur, Yang Seok Koh, Chol Kyoon Cho Department of Surgery, Chonnam National University Medical School, Gwangju, South Korea Background: Typically, serous cystadenomas of pancreas are frequently microcystic or oligocystic. On CT scan, serous cystadenoma generally are surrounded by a fibrous capsule and contain numerous tiny cysts, which are sometimes so small that the cystic nature is difficult to appreciate, because it is below the limits of CT resolution. Herein, we present a case of serous cystadenoma mimicking pancreatic adenocarcinoma on imaging study. Patient: A 74-year-old woman was referred to our institution for evaluation of incidentally found pancreatic body and tail mass on CT scan. Physical examination and laboratory data including tumor markers were within the normal range. The patient had not experienced a recent weight loss of abdominal pain. Abdominal CT revealed a about 76cm sized heterogeneously enhancing mass in pancreatic tail. And, in pancreatic body, a about 53cm sized heterogeneously enhancing mass was found. Result: A preoperative diagnosis of pancreatic adenocarcinoma of body and tail was made, a anterior radical antegrade modular pancreatosplenectomy was performed. Macroscopically, there were a 66cm sized well marginated multicystic mass in body, and a 1210cm well capsulated multicystic mass in tail. Microscopic findings revealed microcystic serous cystadenoma. Conclusion: Microcystic serous cystadenomas are sometimes difficult to differentiate from soild tumor. Herein, we present a case of microcystic serous cystadenoma mimicking pancreatic malignancy. Keywords: Serous cystic neoplasm, Cystic tumor
[P-169]. Mental disorder is an important risk factor for adverse events after pancreatectomy Chien-Chang Liao, Ta-Liang Chen Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan Background/aim: Patients with mental disorder were known to have a higher risk of complications during hospitalization. Quality of care has become the key factor in reducing their potential mortality afterwards. Our aim is to validate the features of adverse outcomes after pancreatectomy for surgical patients with mental disorder. Methods: We present a population-based study of patients with mental disorder receiving pancreatectomy from the Taiwan National Health Insurance Research Database within the years 2004 and 2008 compared with surgical patients without mental disorders. Eight major postoperative complications and mortality after complications were evaluated among patients with mental disorder. Results: Patients with mental disorder had significantly higher risk for postoperative complications, including acute renal failure, pneumonia, bleeding, septicemia, stroke, and 30-day postoperative mortality (adjusted OR ¼ 2.01; 95% CI: 1.87–2.49), than surgical patients without mental disorders. Preoperative related outpatient visits for mental disorders was associated with postoperative mortality. When compared with surgical patients without mental disorders, people had preoperative visits of emergency care or hospitalization for mental disorders had increased mortality after pancreatectomy. Conclusions: In patients receiving pancreatectomy, people with mental disorders showed significantly higher 30-day postoperative complications and mortality when compared with people without mental disorders. Our findings suggest the urgency revising the protocol of postoperative care for this specific population. Keywords: Pancreatectomy, Mental disorder, Adverse events
Sung Hwan Lee, Ho Kyoung Hwang, Sung Hoon Choi, Woo Jung Lee, Chang Moo Kang Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea Background/aim: Though minimally invasive techniques for distal pancreatectomy with or without splenectomy have been regarded as a feasible and safe treatment for benign and borderline malignant lesions of pancreas, it is still debatable in management of left-sided pancreatic cancer in terms of feasibility and oncologic safety. Methods: From June 2007 to November 2010, 12 patients underwent laparoscopic or robotic radical antegrade modular pancreatosplenectomy (RAMPS) for well-selected left-side pancreatic cancer. Yonsei criteria for selecting patients included following tumor condition; pancreas-confined tumor, intact fascia layer between the distal pancreas and left adrenal gland and kidney, tumor apart more than 1 or 2cm from celiac axis. We compared the clinicopathologic factors and oncologic outcomes of minimally invasive surgery (MIS) group and open group for treating left-sided pancreatic cancer. Results: In MIS group, the mean of tumor size was 2.75 1.32 cm and retrieved lymph nodes were 10.5 7.14. The resection margins were confirmed to negative for malignancy in all patients. In comparison with open group (n¼24), there were statistically significant factors in terms of tumor size (2.75 1.32 vs. 3.93 1.50 cm, P¼0.028), hospital stay (12.25 6.79 vs. 21.83 13.76 days, P¼0.008). In survival analysis, the MIS group had better overall survival periods than the open group (60.0 vs. 30.7 months, P¼0.046). In order to overcome the heterogeneity of subject between the MIS and open group, we divided the open group into two groups depending on Yonsei criteria. There were no significant difference of median overall survival periods between the MIS group and the open group within Yonsei Criteria (60.00 vs. 60.72 months, P¼0.495). Conclusions: Minimally invasive RAMPS is not only technically feasible but also oncologically safe in well selected left-sided pancreatic cancer. Yonsei Criteria for selecting minimally approach need to be validated based on large volume experiences. Keywords: Pancreatic cancer, Minimally invasive surgery, RAMPS, Oncologic outcome
[P-171]. 3D models of arteries constructed using MD-CT images pancreatoduodenectomy safely following dissection of the inferior pancreaticoduodenal artery Akihiko Horiguchi, Shin Ishihara, Masahiro Ito, Yukio Asano General, Pancreatic Surgery, Fujita-health University, Toyoake, Japan