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Quality of life after pancreatic surgery good enough to justify palliative resections?
Electronic Poster Abstracts University Hospital, Karolinska Institutet, Sweden, 2 General Surgery, Hepatobiliary Unit, Department of General Surgery, Catholic University of Rome, A. Gemelli Hospital, and 3Department of Emergency Surgery, Faculty of Medicine and Psychology ‘Sapienza’, St. Andrea Hospital, Italy Postoperative complications (PC) are reported and discussed in almost all surgical scientific papers. The most common classification for PC is the ClavieneDindo classification (CDc). To be able to compare scientific data it is demanded to have a common classification. Often CDc is used in scientific papers with the arbitrary decision to divide the PC in minor and major complications with different cut off inside grade 3. From 2009 to 2013 we collected a total of 1212 patients that had undergone pancreatic and liver surgery. We analyzed all the PC and divided them using the CDc. In particular we looked at the differences between the CDc 3a and 3b using the length of stay (LoS) as an indirect parameter of severity. A total of 280 patients (23%) were classified as CDc grade 3, 184 (15.1%) CDc 3a and 96 (7.9%) CDc 3b. The mean LoS was 19.6 vs 19.1 days comparing CDc 3a and CDc 3b, without statistically significant differences. This study suggests the need to characterize severe complications by using CD 3a and more in order to allow homogeneity when comparing complication rates between different studies. Using 3b grade and more as cutoff for severe complications lead to underestimation of severe complications.
EP02D-029 IMPLEMENTATION OF ENHANCED RECOVERY PROGRAMME AFTER PANCREATODUODENECTOMY: A LARGE SINGLE-CENTRE OBSERVATIONAL STUDY B. Jaber, A. Shamali, M. Rawashdeh, E. Barnett, A. Takhar, T. Armstrong and M. Abu Hilal Southampton University Hospital Foundation Trust, United Kingdom Introduction: The terms ‘enhanced recovery programme’ (ERP) and ‘fast track surgery’ refer to multimodal strategies aiming to streamline peri-operative care pathways, to maximise effectiveness and minimise costs. Data on enhanced recovery programmes after pancreatoduodenectomy (ERP-PD) is limited. Our aim is to evaluate the feasibility, safety and clinical outcomes of ERP-PD when implemented at a high-volume UK university referral centre. Methods: A total of 103 consecutive patients were prospectively enrolled for the ERP-PD and compared with 137 consecutive patients previously treated during an equal time frame. Results: Patients in the ERP-PD group had a significant shorter time to remove naso-gastric tube (median of 3 vs. 9 days, p = 0.0001), shorter time until unlimited oral intake (median of 5 vs. 12 days, p < 0.0001), and had shorter length of stay (median of 8 days vs. 13 days, p = 0.002) compared to the pre-pathway group.
HPB 2016, 18 (S1), e385ee601
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Postoperative complications were less frequent in the ERP-PD group (p = 0.014). Major pancreatic leak (grade B and C), lymphatic leak, readmission rate and chest infection were found to be less in the ERP-PD group, (p = 0.048, 0.007, 0.005 and 0.00001 respectively). No difference in peri-operative mortality rates was found. Conclusion: Our findings support the feasibility and safety of ERP-PD. Improved patients’ outcomes in terms of less post-operative complications and significantly shorter length of hospital stay.
EP02D-030 QUALITY OF LIFE AFTER PANCREATIC SURGERY GOOD ENOUGH TO JUSTIFY PALLIATIVE RESECTIONS? B. M. Zonderhuis1, T. N. Hendriks2, T. Y. S. Le Large2, L. Meijer2, F. Daams2 and G. Kazemier2 1 Surgery, and 2VU University Medical Center, Netherlands Introduction: Postoperative morbidity and mortality after pancreatic surgery have decreased to 1e4% in high-volume centers. The vast majority of patients however develop recurrent disease early after surgery and those resections should be considered palliative. It is often argued that removing the pancreatic tumor results in improved Quality of Life (QoL) even in palliative setting. To investigate whether palliative resections for pancreatic adenocarcinoma are justified a baseline of QoL following pancreatic surgery was performed. Method: Two hundred consecutive patients from our database who underwent pancreatic resection were considered to participate. All eligible patients were asked to complete the EORTC QLQ-C30 and PAN26 questionnaires. Results: Seventy-seven patients (46 pancreaticoduodenectomy (PD), 16 distal pancreatectomy (DP)) were alive and eligible to participate in this study. Response rate was 80.5%. QoL at a median of 18 months after surgery did not differ significantly from the general population (score: 74.7 20.9 vs. 71.2 22.4). However, 25% of patients reported severe gastrointestinal problems (bloating, flatulence, frequent defecation, sudden urge to defecation, uncomfortable feeling in the abdomen, and dietary constrains). Of those, 70% improved with more aggressive pancreatic enzyme suppletion. Risk factors for worse QoL were PD (p = 0.05), chemotherapy (p = 0.03) or recent surgery (p = 0.02). Conclusion: Patients who underwent pancreatic surgery have a good QoL, comparable to the healthy population. These results justify a study on the value of pancreatic surgery in palliative setting.
EP02D-031 AGGRESSIVE SURGICAL RESECTION FOR PANCREATIC NEUROENDOCRINE TUMORS S. Zaheer, J. Datta, C. Vollmer, M. Lee, J. Drebin, D. Fraker and R. Roses Department of Surgery, Hospital of the University of Pennsylvania, United States
EP02D-029 IMPLEMENTATION OF ENHANCED RECOVERY PROGRAMME AFTER PANCREATODUODENECTOMY: A LARGE SINGLE-CENTRE OBSERVATIONAL STUDY B. Jaber, A. Shamali, M. Rawashdeh, E. Barnett, A. Takhar, T. Armstrong and M. Abu Hilal Southampton University Hospital Foundation Trust, United Kingdom Introduction: The terms ‘enhanced recovery programme’ (ERP) and ‘fast track surgery’ refer to multimodal strategies aiming to streamline peri-operative care pathways, to maximise effectiveness and minimise costs. Data on enhanced recovery programmes after pancreatoduodenectomy (ERP-PD) is limited. Our aim is to evaluate the feasibility, safety and clinical outcomes of ERP-PD when implemented at a high-volume UK university referral centre. Methods: A total of 103 consecutive patients were prospectively enrolled for the ERP-PD and compared with 137 consecutive patients previously treated during an equal time frame. Results: Patients in the ERP-PD group had a significant shorter time to remove naso-gastric tube (median of 3 vs. 9 days, p = 0.0001), shorter time until unlimited oral intake (median of 5 vs. 12 days, p < 0.0001), and had shorter length of stay (median of 8 days vs. 13 days, p = 0.002) compared to the pre-pathway group.
HPB 2016, 18 (S1), e385ee601
e395
Postoperative complications were less frequent in the ERP-PD group (p = 0.014). Major pancreatic leak (grade B and C), lymphatic leak, readmission rate and chest infection were found to be less in the ERP-PD group, (p = 0.048, 0.007, 0.005 and 0.00001 respectively). No difference in peri-operative mortality rates was found. Conclusion: Our findings support the feasibility and safety of ERP-PD. Improved patients’ outcomes in terms of less post-operative complications and significantly shorter length of hospital stay.
EP02D-030 QUALITY OF LIFE AFTER PANCREATIC SURGERY GOOD ENOUGH TO JUSTIFY PALLIATIVE RESECTIONS? B. M. Zonderhuis1, T. N. Hendriks2, T. Y. S. Le Large2, L. Meijer2, F. Daams2 and G. Kazemier2 1 Surgery, and 2VU University Medical Center, Netherlands Introduction: Postoperative morbidity and mortality after pancreatic surgery have decreased to 1e4% in high-volume centers. The vast majority of patients however develop recurrent disease early after surgery and those resections should be considered palliative. It is often argued that removing the pancreatic tumor results in improved Quality of Life (QoL) even in palliative setting. To investigate whether palliative resections for pancreatic adenocarcinoma are justified a baseline of QoL following pancreatic surgery was performed. Method: Two hundred consecutive patients from our database who underwent pancreatic resection were considered to participate. All eligible patients were asked to complete the EORTC QLQ-C30 and PAN26 questionnaires. Results: Seventy-seven patients (46 pancreaticoduodenectomy (PD), 16 distal pancreatectomy (DP)) were alive and eligible to participate in this study. Response rate was 80.5%. QoL at a median of 18 months after surgery did not differ significantly from the general population (score: 74.7 20.9 vs. 71.2 22.4). However, 25% of patients reported severe gastrointestinal problems (bloating, flatulence, frequent defecation, sudden urge to defecation, uncomfortable feeling in the abdomen, and dietary constrains). Of those, 70% improved with more aggressive pancreatic enzyme suppletion. Risk factors for worse QoL were PD (p = 0.05), chemotherapy (p = 0.03) or recent surgery (p = 0.02). Conclusion: Patients who underwent pancreatic surgery have a good QoL, comparable to the healthy population. These results justify a study on the value of pancreatic surgery in palliative setting.
EP02D-031 AGGRESSIVE SURGICAL RESECTION FOR PANCREATIC NEUROENDOCRINE TUMORS S. Zaheer, J. Datta, C. Vollmer, M. Lee, J. Drebin, D. Fraker and R. Roses Department of Surgery, Hospital of the University of Pennsylvania, United States