- Email: [email protected]
Surgical treatment for walled-off necrosis in acute necrotizing pancreatitis
Abstracts / Pancreatology 16 (2016) S1eS130
Results: Of 301 patients, 43 patients were excluded (15 had less than 1 year of follow-up, 4 underwent surgery for malignancy at initial diagnosis and 24 had a presumptive diagnosis of serous cystadenoma). Data from 258 patients were analyzed (mean age: 59.1 years, median follow-up: 28.5 months); 97 patients had risk factors such as a cyst >3 cm or the presence of a mural nodule. Total 179 patients were managed with clinical surveillance. During surveillance, 39 patients (22%) showed changes in size or characteristics. Cyst-related malignancy occurred in 5 patients (2.8%), all of whom had risk factors and whose cysts showed changes. Conclusion: Although the risk of malignant transformation was higher in patients with PCNs than the general population, the detection of malignancy or disease-specific mortality during surveillance was low, even in the high-risk group. Continued surveillance is important regardless of whether there are significant changes.
S49
retrospectively reviewed. Depending on the site of WON, approach to the necrotic tissue differs. WON in the pancreatic head can usually be approached via gastrocolic ligament by open necrosectomy. In case of WON in the pancreatic body and tail, infracolic approach is better. Recently, videoscopic assisted retroperitoneal approach (VSARA) is favorable for WON in pancreatic body and tail. In any approach, closed lavage after necrosectomy is necessary. Results: Eight patients (6 male and 2 female, average age: 54.4) were enrolled. Six of them had infected WON, and underwent necrosectomy. Mean interval time to the operation from the onset of ANP was 2.5 months. Trans-gastrocolic ligament approach was chosen for 3 patients, and infracolic approach for one, whereas two patient underwent VSARA. Although one patient died of MOF, the others discharged hospital in good status, though more than 3 month after necrosectomy. Conclusion: When WON is formed and infected, necrosectomy with closed lavage should be required to overcome ANP. VSARA is excellent and should be one of the candidates of treatment for WON of pancreatic body and tail.
Abstract ID: 1333. Relation of obesity and fever in acute pancreatitis Jae Seon Kim, Hyo Jung Kim, Moon Kyung Joo, Jong-Jae Park, Young-Tae Bak Internal Medicine, Korea University Guro Hospital, South Korea
Abstract ID: 1335. Checkpoints in treatment of intraductal papillary mucinous neoplasms of the pancreas Kosuke Sato, Hiromune Shimamura, Kazunori Takeda
Introduction: In acute pancreatitis (AP), fever is observed frequently and related to the inflammatory process. It is suggested that obese patients express a more intense inflammatory response. Antibiotics are frequently initiated in AP without proven infection. Aims: We studied the relation obesity and characteristics of AP including fever. Patients & methods: Data from 305 patients diagnosed to AP were collected and 145 patients were excluded due to the past history of pancreatitis or pancreatic disease, malignancy, immunodeficiency. Body mass index (BMI) was classified into three groups, normal (BMI1), overweight (BMI2, 23e24.9) and obese (BMI3). Results: Of the enrolled 160 patients (male 117, mean age 55.04 years), 36.9% (59/160) were BMI1, 38.1% (61/160) BMI2 and 25% (40/160) BMI3. The mean BMI according to cause of AP was 24.4 in alcoholic (40), 24.8 in idiopathic (19), 31.4 in hyper-TG (4), 23.4 in gallstone (60) and 23.1 in recurrent alcoholic (37). Fever was observed frequently in gallstone pancreatitis (55%, 33/60) but more common in alcoholic, idiopathic and hyper-TG pancreatitis (64%, 40/63). In analysis of 63 patients excluded gallstone cause, fever incidence was higher in patients with higher BMI; 53% (10/19) in BMI1, 63% (12/19) in BMI2 and 72% (18/25) in BMI3. Also fever duration was longer in higher BMI 1.94, 2.25 and 4.88 days respectively (p<0.05). Total hospital stay and serum CRP were higher in patients with higher BMI but did not show significant difference. Infectious cause was not proved in all febrile patients. Conclusion: Obesity is related with fever in AP and antibiotics would be used for inappropriate indications.
Sendai Medical Center, Department of Surgery, Japan Introduction: Recent advances in diagnostic imaging have brought physicians more chances to find Intraductal Papillary Mucinous Neoplasms of the pancreas (IPMN). But, treatment policy of this disease still needs discussion. Aims: Here we review our IPMN cases, and discuss on checkpoints in treatment of IPMN. Patients & methods: Between January 1999 and December 2014, patients diagnosed as IPMN and underwent pancreatectomy in our hospital were enrolled. Operative records and long term outcomes were retrospectively reviewed. Cases histologically diagnosed as IPMN-derived invasive carcinoma were excluded. Results: Forty-three patients (33 males and 10 females) were entered into this study. Morphologically, 27 of them were classified into the branch duct (BD) type, whereas the number classified into the main duct (MD) type and mixed type were both 8. Nineteen cases (44.2%) coincided with malignancy in organs other than pancreas. Three patients with MD-IPMN encountered recurrence of IPMN in the remnant pancreas. All of them underwent re-resection and are still alive. On the other hand, 3 patients with BD-IPMN encountered appearance of pancreatic invasive ductal adenocarcinoma (PDAC) in remnant pancreas, and died of PDAC. Twenty-four cases did not coincide with PDAC nor malignancy in other organs. But, follow up period of these patients was significantly shorter than that of cases concomitant with recurrent diseases. Conclusion: Since MD-IPMN has potential of recurrence in the remnant pancreas, postoperative status of the remnant pancreas should strictly be followed up. In addition, malignancy in other organs is fso requently found in IPMN that follow up with systemic examination should be mandatory.
Abstract ID: 1334. Surgical treatment for walled-off necrosis in acute necrotizing pancreatitis
Abstract ID: 1339.
Hiromune Shimamura, Kazunori Takeda
Sarcopenic obesity as an independent determinant of major complications after pancreatoduodenectomy for cancer
Sendai Medical Center, Department of Surgery, Japan Introduction: Acute necrotizing pancreatitis (ANP) is still life-threatening disease. When infection of walled-off necrosis (WON) occurred, extirpation of necrotic tissues (necrosectomy) is required as well as drainage of liquid component. Aims: We focus here on surgical treatment for WON in ANP by reviewing our clinical experience. Patients & methods: Between Jan 2009 and December 2014, patients with WON-forming ANP who underwent operation in our hospital were
Marta Sandini 1, Davide Bernasconi 2, Davide Fior 3, Matilde Molinelli 4, Davide Ippolito 5, Luca Nespoli 1, Riccardo Caccialanza 6, Luca Gianotti 1 1
Milano Bicocca University, School of Medicine and Surgery, Italy Milano Bicocca University, School of Medicine and Surgery, Center of Biostatistics for Clinical Epidemiology, Italy 3 Milano Bicocca University, Department of Radiology, Italy 4 San Gerardo Hospital, School of Medicine and Surgery, Italy 5 San Gerardo Hospital, Department of Radiology, Italy 6 IRCCS Policlinico San Matteo, Nutrition and Dietetics Service, Italy 2
Results: Of 301 patients, 43 patients were excluded (15 had less than 1 year of follow-up, 4 underwent surgery for malignancy at initial diagnosis and 24 had a presumptive diagnosis of serous cystadenoma). Data from 258 patients were analyzed (mean age: 59.1 years, median follow-up: 28.5 months); 97 patients had risk factors such as a cyst >3 cm or the presence of a mural nodule. Total 179 patients were managed with clinical surveillance. During surveillance, 39 patients (22%) showed changes in size or characteristics. Cyst-related malignancy occurred in 5 patients (2.8%), all of whom had risk factors and whose cysts showed changes. Conclusion: Although the risk of malignant transformation was higher in patients with PCNs than the general population, the detection of malignancy or disease-specific mortality during surveillance was low, even in the high-risk group. Continued surveillance is important regardless of whether there are significant changes.
S49
retrospectively reviewed. Depending on the site of WON, approach to the necrotic tissue differs. WON in the pancreatic head can usually be approached via gastrocolic ligament by open necrosectomy. In case of WON in the pancreatic body and tail, infracolic approach is better. Recently, videoscopic assisted retroperitoneal approach (VSARA) is favorable for WON in pancreatic body and tail. In any approach, closed lavage after necrosectomy is necessary. Results: Eight patients (6 male and 2 female, average age: 54.4) were enrolled. Six of them had infected WON, and underwent necrosectomy. Mean interval time to the operation from the onset of ANP was 2.5 months. Trans-gastrocolic ligament approach was chosen for 3 patients, and infracolic approach for one, whereas two patient underwent VSARA. Although one patient died of MOF, the others discharged hospital in good status, though more than 3 month after necrosectomy. Conclusion: When WON is formed and infected, necrosectomy with closed lavage should be required to overcome ANP. VSARA is excellent and should be one of the candidates of treatment for WON of pancreatic body and tail.
Abstract ID: 1333. Relation of obesity and fever in acute pancreatitis Jae Seon Kim, Hyo Jung Kim, Moon Kyung Joo, Jong-Jae Park, Young-Tae Bak Internal Medicine, Korea University Guro Hospital, South Korea
Abstract ID: 1335. Checkpoints in treatment of intraductal papillary mucinous neoplasms of the pancreas Kosuke Sato, Hiromune Shimamura, Kazunori Takeda
Introduction: In acute pancreatitis (AP), fever is observed frequently and related to the inflammatory process. It is suggested that obese patients express a more intense inflammatory response. Antibiotics are frequently initiated in AP without proven infection. Aims: We studied the relation obesity and characteristics of AP including fever. Patients & methods: Data from 305 patients diagnosed to AP were collected and 145 patients were excluded due to the past history of pancreatitis or pancreatic disease, malignancy, immunodeficiency. Body mass index (BMI) was classified into three groups, normal (BMI1), overweight (BMI2, 23e24.9) and obese (BMI3). Results: Of the enrolled 160 patients (male 117, mean age 55.04 years), 36.9% (59/160) were BMI1, 38.1% (61/160) BMI2 and 25% (40/160) BMI3. The mean BMI according to cause of AP was 24.4 in alcoholic (40), 24.8 in idiopathic (19), 31.4 in hyper-TG (4), 23.4 in gallstone (60) and 23.1 in recurrent alcoholic (37). Fever was observed frequently in gallstone pancreatitis (55%, 33/60) but more common in alcoholic, idiopathic and hyper-TG pancreatitis (64%, 40/63). In analysis of 63 patients excluded gallstone cause, fever incidence was higher in patients with higher BMI; 53% (10/19) in BMI1, 63% (12/19) in BMI2 and 72% (18/25) in BMI3. Also fever duration was longer in higher BMI 1.94, 2.25 and 4.88 days respectively (p<0.05). Total hospital stay and serum CRP were higher in patients with higher BMI but did not show significant difference. Infectious cause was not proved in all febrile patients. Conclusion: Obesity is related with fever in AP and antibiotics would be used for inappropriate indications.
Sendai Medical Center, Department of Surgery, Japan Introduction: Recent advances in diagnostic imaging have brought physicians more chances to find Intraductal Papillary Mucinous Neoplasms of the pancreas (IPMN). But, treatment policy of this disease still needs discussion. Aims: Here we review our IPMN cases, and discuss on checkpoints in treatment of IPMN. Patients & methods: Between January 1999 and December 2014, patients diagnosed as IPMN and underwent pancreatectomy in our hospital were enrolled. Operative records and long term outcomes were retrospectively reviewed. Cases histologically diagnosed as IPMN-derived invasive carcinoma were excluded. Results: Forty-three patients (33 males and 10 females) were entered into this study. Morphologically, 27 of them were classified into the branch duct (BD) type, whereas the number classified into the main duct (MD) type and mixed type were both 8. Nineteen cases (44.2%) coincided with malignancy in organs other than pancreas. Three patients with MD-IPMN encountered recurrence of IPMN in the remnant pancreas. All of them underwent re-resection and are still alive. On the other hand, 3 patients with BD-IPMN encountered appearance of pancreatic invasive ductal adenocarcinoma (PDAC) in remnant pancreas, and died of PDAC. Twenty-four cases did not coincide with PDAC nor malignancy in other organs. But, follow up period of these patients was significantly shorter than that of cases concomitant with recurrent diseases. Conclusion: Since MD-IPMN has potential of recurrence in the remnant pancreas, postoperative status of the remnant pancreas should strictly be followed up. In addition, malignancy in other organs is fso requently found in IPMN that follow up with systemic examination should be mandatory.
Abstract ID: 1334. Surgical treatment for walled-off necrosis in acute necrotizing pancreatitis
Abstract ID: 1339.
Hiromune Shimamura, Kazunori Takeda
Sarcopenic obesity as an independent determinant of major complications after pancreatoduodenectomy for cancer
Sendai Medical Center, Department of Surgery, Japan Introduction: Acute necrotizing pancreatitis (ANP) is still life-threatening disease. When infection of walled-off necrosis (WON) occurred, extirpation of necrotic tissues (necrosectomy) is required as well as drainage of liquid component. Aims: We focus here on surgical treatment for WON in ANP by reviewing our clinical experience. Patients & methods: Between Jan 2009 and December 2014, patients with WON-forming ANP who underwent operation in our hospital were
Marta Sandini 1, Davide Bernasconi 2, Davide Fior 3, Matilde Molinelli 4, Davide Ippolito 5, Luca Nespoli 1, Riccardo Caccialanza 6, Luca Gianotti 1 1
Milano Bicocca University, School of Medicine and Surgery, Italy Milano Bicocca University, School of Medicine and Surgery, Center of Biostatistics for Clinical Epidemiology, Italy 3 Milano Bicocca University, Department of Radiology, Italy 4 San Gerardo Hospital, School of Medicine and Surgery, Italy 5 San Gerardo Hospital, Department of Radiology, Italy 6 IRCCS Policlinico San Matteo, Nutrition and Dietetics Service, Italy 2