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Pancreatic incidentalomas implicate a potentially curable disease with favorable outcome and should therefore always be carefully evaluated
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Abstracts / Pancreatology 12 (2012) 502–597
Material and methods: From 2000 through 2010, 21 patients with fulminant acute pancreatitis were managed surgically. All patients had severe clinical deterioration during initial period of treatment. 15 patients underwent early (during first 2 weeks) open drainage with delayed necrosectomy – group 1, others were operated on 3d or 4th week of the disease (debridement with open packing or closed lavage) - group 2. Results: Median (IQR) admission APACHE II score didn't differ between groups amounting 23,5 (18-26) and 20 (18-27) for gr. 1, 2 respectively. There were no any significant differences in local complications severity: gr. 1 Balthazar CT index – 7 (6-10) vs gr. 2 CT index – 7,5 (6-8). All 6 patients of delayed surgery group had infected necrosis at the time of operation. It was significantly more often then in gr. 1 – 26,7% (4/15), p<0,05. Among 15 patients managed with early drainage 7 died (46,7%). Mortality rate in gr. 2 reached 83,3% (5/6). Deaths in all patients were caused by sepsis-induced organ failure. Mortality rate differences between groups didn't reach statistical significance. Conclusion: Widely accepted strategy: to delay surgery waiting for pancreatic necrosis demarcation seems to be not as beneficial in fulminant pancreatitis as in case of severe acute pancreatitis.
Methods: Primary pancreatic resections (indication chronic pancreatitis (CP) excluded) from 2004-09 were collected from our prospective registry. Histology, demographics, morbidity, mortality and survival analysis was done. Results: In all 360 cases were identified (PI ¼ 35, 9.7 %). Compared to SPL, overweight was more prevalent in PI (63 vs. 36 %; p<0.01), but demographics, morbidity, mortality were not different. Cystic lesions were observed in 66 (18 %) and compared to SPL, cysts were more prevalent in PI (51 vs. 14 %; p<0.001) with a trend towards non-mucinous cysts (56 vs. 31 %; p¼0.09). The diagnoses differed between PI and SPL: malignant 26 vs. 66 %; pre-malignant 29 vs. 13 %, pNET 17 vs. 8 %; benign 28 vs. 6 %, and CP 0 vs. 7 % (P<0,001). In malignant lesions there were no difference in N-stage (PI 57 vs. SPL 76%; p¼0.4). Overall survival rate was better for PI compared to SPL (2 years 77 vs. 63 %, 5 years 74 vs. 46 %; p¼0.02) but there were no differences in diagnosis related survival. Conclusion: Almost half of PIs are either pre-malignant or of nonexocrine origin. Incidental pancreatic lesions found “en passant” should therefore be carefully evaluated as they implicate a potentially curable disease.
P-203B. P-203. Early drainage versus delayed debridement for fulminant necrotizing pancreatitis M. Rubtsov, S. Galeev, Y. Abdullaev, A. Kostigyn. Clinical Hospital of Saint-Luke, Saint-Petersburg, Russia
Background and design of multicenter randomized study: Pancreaticojejunostomy versus pancreaticogastrostomy in patients with soft residual pancreas and small diameter of pancreatic duct D. Radenkovic 1, D. Bajec 1, P. Gregoric 2, N. Ivancevic 2, B. Karadzic 2, V. Jeremic 2, A. Antic 1, I. Pejovic 1, S. Kmezic 1. 1
Introduction: Controversy still exists in surgical management of fulminant acute pancreatitis. Material and methods: From 2000 through 2010, 21 patients with fulminant acute pancreatitis were managed surgically. All patients had severe clinical deterioration during initial period of treatment. 15 patients underwent early (during first 2 weeks) open drainage with delayed necrosectomy – group 1, others were operated on 3d or 4th week of the disease (debridement with open packing or closed lavage) - group 2. Results: Median (IQR) admission APACHE II score didn't differ between groups amounting 23,5 (18-26) and 20 (18-27) for gr. 1, 2 respectively. There were no any significant differences in local complications severity: gr. 1 Balthazar CT index – 7 (6-10) vs gr. 2 CT index – 7,5 (6-8). All 6 patients of delayed surgery group had infected necrosis at the time of operation. It was significantly more often then in gr. 1 – 26,7% (4/15), p<0,05. Among 15 patients managed with early drainage 7 died (46,7%). Mortality rate in gr. 2 reached 83,3% (5/6). Deaths in all patients were caused by sepsis-induced organ failure. Mortality rate differences between groups didn't reach statistical significance. Conclusion: Widely accepted strategy: to delay surgery waiting for pancreatic necrosis demarcation seems to be not as beneficial in fulminant pancreatitis as in case of severe acute pancreatitis.
P-203A. Pancreatic incidentalomas implicate a potentially curable disease with favorable outcome and should therefore always be carefully evaluated
Clinic for Digestive Surgery, Clinical Center of Serbia and School of Medicine, University of Belgrade, Belgrade, Serbia 2 Clinic for Emergency Surgery, Clinical Center of Serbia and School of Medicine, University of Belgrade, Belgrade, Serbia Introduction: Pancreaticoduodenectomy is the standards procedure for various disease of the pancreas and periampullariy region. Pancreaticojejunal (PJ) anastomosis is the most often used method of reconstruction after pancreaticoduodenectomy. Pancreatic fistula (PF) remains a common complication and the main cause of other morbidities and mortality. Several technique modifications such as placement of the stents, reinforcement of anasomosis with fibrin glue, pancreatic duct occlusion and pancreaticogastrostomy (PG) type of anastomosis was used in order to decrease PF rate. It was shown that the higher risk of PF was noticed in patients with soft residual pancreas and small diameter of pancreatic duct. Randomized multicenter controlled study (PanAm) was conducted to compare differences in morbidity between PG and PJ in these patients. Patients and methods: Ninety-four patients with soft pancreas and small pancreatic duct will be randomly allocated to two groups: I) reconstruction of digestive tract using PJ anastomosis or II) reconstruction of digestive tract using PGJ anastomosis. Patients will be recruited from 5 hospitals during two years period. The primary endpoint is the total morbidity rate within hospitalization. Secondary endpoints are pancreatic fistula rate, mortality and duration of hospital and ICU stay. A total sample size of 94 patients was calculated to demonstrate that PG type of anastomosis can reduce total morbidity rate from 40% to 20% with 80% power at 5% alpha. Conclusion: PanAm study is designed to reveal a reduction in morbidity by using PG anastomosis in comparison with PJ anastomosis in patients with soft pancreas and small pancreatic duct.
A. Skarin, G. Sandblom, Å. Andrén-Sandberg, C. Ansorge, U. Arnelo, R. Segersvärd. Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden Background: Asymptomatic “en passent” found pancreatic incidentalomas (PI) are increasingly being detected. They are usually treated according to guidelines for symptomatic pancreatic lesions (SPL) even though evidence is scarce. Aim: To compare diagnoses, N-stage and outcome after resection of PI and SPL respectively.
P-204. CECT detection of acute postnecrotic collections D. Khokha 1, A. Litvin 2, V. Khokha 3. 1
State Medical University, Gomel, City Hospital, Mozyr, Belarus Regional Clinical Hospital, State Medical University, Gomel, Belarus 3 City Hospital, Mozyr, Belarus 2
Introduction: The distinction between the different types of peripancreatic collections facilitates the choice of the treatment.
Abstracts / Pancreatology 12 (2012) 502–597
Material and methods: From 2000 through 2010, 21 patients with fulminant acute pancreatitis were managed surgically. All patients had severe clinical deterioration during initial period of treatment. 15 patients underwent early (during first 2 weeks) open drainage with delayed necrosectomy – group 1, others were operated on 3d or 4th week of the disease (debridement with open packing or closed lavage) - group 2. Results: Median (IQR) admission APACHE II score didn't differ between groups amounting 23,5 (18-26) and 20 (18-27) for gr. 1, 2 respectively. There were no any significant differences in local complications severity: gr. 1 Balthazar CT index – 7 (6-10) vs gr. 2 CT index – 7,5 (6-8). All 6 patients of delayed surgery group had infected necrosis at the time of operation. It was significantly more often then in gr. 1 – 26,7% (4/15), p<0,05. Among 15 patients managed with early drainage 7 died (46,7%). Mortality rate in gr. 2 reached 83,3% (5/6). Deaths in all patients were caused by sepsis-induced organ failure. Mortality rate differences between groups didn't reach statistical significance. Conclusion: Widely accepted strategy: to delay surgery waiting for pancreatic necrosis demarcation seems to be not as beneficial in fulminant pancreatitis as in case of severe acute pancreatitis.
Methods: Primary pancreatic resections (indication chronic pancreatitis (CP) excluded) from 2004-09 were collected from our prospective registry. Histology, demographics, morbidity, mortality and survival analysis was done. Results: In all 360 cases were identified (PI ¼ 35, 9.7 %). Compared to SPL, overweight was more prevalent in PI (63 vs. 36 %; p<0.01), but demographics, morbidity, mortality were not different. Cystic lesions were observed in 66 (18 %) and compared to SPL, cysts were more prevalent in PI (51 vs. 14 %; p<0.001) with a trend towards non-mucinous cysts (56 vs. 31 %; p¼0.09). The diagnoses differed between PI and SPL: malignant 26 vs. 66 %; pre-malignant 29 vs. 13 %, pNET 17 vs. 8 %; benign 28 vs. 6 %, and CP 0 vs. 7 % (P<0,001). In malignant lesions there were no difference in N-stage (PI 57 vs. SPL 76%; p¼0.4). Overall survival rate was better for PI compared to SPL (2 years 77 vs. 63 %, 5 years 74 vs. 46 %; p¼0.02) but there were no differences in diagnosis related survival. Conclusion: Almost half of PIs are either pre-malignant or of nonexocrine origin. Incidental pancreatic lesions found “en passant” should therefore be carefully evaluated as they implicate a potentially curable disease.
P-203B. P-203. Early drainage versus delayed debridement for fulminant necrotizing pancreatitis M. Rubtsov, S. Galeev, Y. Abdullaev, A. Kostigyn. Clinical Hospital of Saint-Luke, Saint-Petersburg, Russia
Background and design of multicenter randomized study: Pancreaticojejunostomy versus pancreaticogastrostomy in patients with soft residual pancreas and small diameter of pancreatic duct D. Radenkovic 1, D. Bajec 1, P. Gregoric 2, N. Ivancevic 2, B. Karadzic 2, V. Jeremic 2, A. Antic 1, I. Pejovic 1, S. Kmezic 1. 1
Introduction: Controversy still exists in surgical management of fulminant acute pancreatitis. Material and methods: From 2000 through 2010, 21 patients with fulminant acute pancreatitis were managed surgically. All patients had severe clinical deterioration during initial period of treatment. 15 patients underwent early (during first 2 weeks) open drainage with delayed necrosectomy – group 1, others were operated on 3d or 4th week of the disease (debridement with open packing or closed lavage) - group 2. Results: Median (IQR) admission APACHE II score didn't differ between groups amounting 23,5 (18-26) and 20 (18-27) for gr. 1, 2 respectively. There were no any significant differences in local complications severity: gr. 1 Balthazar CT index – 7 (6-10) vs gr. 2 CT index – 7,5 (6-8). All 6 patients of delayed surgery group had infected necrosis at the time of operation. It was significantly more often then in gr. 1 – 26,7% (4/15), p<0,05. Among 15 patients managed with early drainage 7 died (46,7%). Mortality rate in gr. 2 reached 83,3% (5/6). Deaths in all patients were caused by sepsis-induced organ failure. Mortality rate differences between groups didn't reach statistical significance. Conclusion: Widely accepted strategy: to delay surgery waiting for pancreatic necrosis demarcation seems to be not as beneficial in fulminant pancreatitis as in case of severe acute pancreatitis.
P-203A. Pancreatic incidentalomas implicate a potentially curable disease with favorable outcome and should therefore always be carefully evaluated
Clinic for Digestive Surgery, Clinical Center of Serbia and School of Medicine, University of Belgrade, Belgrade, Serbia 2 Clinic for Emergency Surgery, Clinical Center of Serbia and School of Medicine, University of Belgrade, Belgrade, Serbia Introduction: Pancreaticoduodenectomy is the standards procedure for various disease of the pancreas and periampullariy region. Pancreaticojejunal (PJ) anastomosis is the most often used method of reconstruction after pancreaticoduodenectomy. Pancreatic fistula (PF) remains a common complication and the main cause of other morbidities and mortality. Several technique modifications such as placement of the stents, reinforcement of anasomosis with fibrin glue, pancreatic duct occlusion and pancreaticogastrostomy (PG) type of anastomosis was used in order to decrease PF rate. It was shown that the higher risk of PF was noticed in patients with soft residual pancreas and small diameter of pancreatic duct. Randomized multicenter controlled study (PanAm) was conducted to compare differences in morbidity between PG and PJ in these patients. Patients and methods: Ninety-four patients with soft pancreas and small pancreatic duct will be randomly allocated to two groups: I) reconstruction of digestive tract using PJ anastomosis or II) reconstruction of digestive tract using PGJ anastomosis. Patients will be recruited from 5 hospitals during two years period. The primary endpoint is the total morbidity rate within hospitalization. Secondary endpoints are pancreatic fistula rate, mortality and duration of hospital and ICU stay. A total sample size of 94 patients was calculated to demonstrate that PG type of anastomosis can reduce total morbidity rate from 40% to 20% with 80% power at 5% alpha. Conclusion: PanAm study is designed to reveal a reduction in morbidity by using PG anastomosis in comparison with PJ anastomosis in patients with soft pancreas and small pancreatic duct.
A. Skarin, G. Sandblom, Å. Andrén-Sandberg, C. Ansorge, U. Arnelo, R. Segersvärd. Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden Background: Asymptomatic “en passent” found pancreatic incidentalomas (PI) are increasingly being detected. They are usually treated according to guidelines for symptomatic pancreatic lesions (SPL) even though evidence is scarce. Aim: To compare diagnoses, N-stage and outcome after resection of PI and SPL respectively.
P-204. CECT detection of acute postnecrotic collections D. Khokha 1, A. Litvin 2, V. Khokha 3. 1
State Medical University, Gomel, City Hospital, Mozyr, Belarus Regional Clinical Hospital, State Medical University, Gomel, Belarus 3 City Hospital, Mozyr, Belarus 2
Introduction: The distinction between the different types of peripancreatic collections facilitates the choice of the treatment.