Tu1623 Impact of Pancreatic Fistula on Recurrence and Long-Term Prognosis of Periampullary Adenocarcinomas After Pancreaticoduodenectomy

resection of PDAC. This observation suggests that therapies targeting ZEB1 and its downstream pathways could hit both cancer cells and supporting CAF.

impaired pancreatic exocrine function following PPPD compared to the younger patients, and that cumulative 7-hour 13CO2 exhalation of 13C-mixed triglyceride breath test is an important predictive marker of exocrine pancreatic insufficiency, even in a subclinical condition. These findings may have potential implications for the selection of therapeutic strategies in the clinical setting.

Tu1622 Portal Venous Resection in Cancer of the Pancreatic Head: What Are the Relevant Predictors of Survival? Hryhoriy Lapshyn, Ulrich F. Wellner, Birte Kulemann, Jens Hoeppner, Peter Bronsert, Dirk Bausch, Ulrich T. Hopt, Frank Makowiec, Tobias Keck, Uwe A. Wittel

Tu1625 Increased Bacterial Translocation in Aging Animals Is Not Related to Decreased Intestinal Antimicrobial Peptide Expression in Acute Pancreatitis Debora G. Cunha, Fabiano Pinheiro da Silva, Denise F. Barbeiro, Marcia K. Koike, Marcel C Machado, Irineu T. Velasco

Introduction: When tumors are found to be adherent to the superior mesenteric or portal vein during pancreatoduodenectomy, en bloc portal venous resection (PVR) is an option to achieve complete tumor resection. It has also been reported that PVR without confirmed histopathologic portal venous infiltration (PVI) is associated with significantly better survival. The aim of this study was to evaluate oncologic outcome and prognostic factors in patients receiving PVR for pancreatic cancer. Methods: A unicenter retrospective study was performed on the basis of a prospectively maintained database. IBM SPSS Version 21 was used for all calculations with the significance level set to p=0.05. Results: From 2001 to 2013, 103 patients received pancreatoduodenectomy with PVR for pancreatic head cancer. Median survival in patients with PVR without PVI was 25 months, whereas confirmed PVI was associated with poor median survival of 14 months (p<0.05). In patients with PVR, only PVI and lymph node ratio, but not margin status, T or N stage, grading, lymphatic, microvessel or perineural infiltration, age or gender were independent prognostic factors in a multivariate Cox proportional hazards model. Conclusion: Portal venous resection for tumor adherence in pancreatic cancer is associated with equal median survival as in patients without PVR when there is no histopathologic infiltation of the large veins. Additional prognostic information is only provided by lymph node ratio, whereas margin status and other standard histopathologic parameters have no additional predictive value in this situation.

Introduction/background:Acute pancreatitis (AP) in elderly patients in spite of similar occurrence of local complications is followed by a substantial increase in organ failure and mortality rates. We have recently demonstrated that aging is related to increased bacterial translocation and distant organ damage in acute pancreatitis. Enteric antimicrobial peptides are key effectors of innate immunity and therefore could have reduced expression in aging animals with acute pancreatitis. The aim of the present study was to evaluate the effect of aging on intestinal expression of antimicrobial peptides in acute pancreatitis Methods :AP was induced in male Wistar rats by an intraductal 2.5% taurocholate injection and divided in 2 experimental groups(20 rats each group) G-1 young 3 month old rats and older (18 month old rats). Twelve hours after AP fragments of distal ileum were collected for evaluation of the gene expression of alfa defensins 5 and 7 ,Cramp, IL-1 beta , IL-10 and TNF -alpha. Results : A significant increase in the intestinal expression of alpha defensins 5 and 7 was observed in older group compared to the young animals with AP (p< 0.05).Cramp gene expression was similar in both groups .Also a significant increase in intestinal TNF-alpha expression was observed in older group compared to young rats (P<0.05). The expression of IL-1 beta was similar in both groups of animals. Intestinal IL-10 gene expression was increased in young animals compared to the older group Conclusions The increased bacterial translocation in aging animals is not related to a decreased production of antimicrobial peptides but could be related to imbalance between intestinal pro- inflammatory and anti -inflammatory cytokine production

Tu1623 Impact of Pancreatic Fistula on Recurrence and Long-Term Prognosis of Periampullary Adenocarcinomas After Pancreaticoduodenectomy Dowan Kim, Pablo E. Serrano, Peter T. Kim, Paul D. Greig, Carol-Anne Moulton, Steven Gallinger, Alice C. Wei, Sean Cleary

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Background: The impact of pancreatic fistulas (PF) on cancer-specific survival and recurrence patterns is not well understood. The objective of this study was to evaluate the impact of PF on disease-free-survival (DFS) and overall-survival (OS) after pancreaticoduodenectomy in patients with periampullary adenocarcinomas, including pancreatic, distal bile duct, duodenal and ampullary adenocarcinoma, Methods: This is a retrospective cohort study of patients undergoing pancreaticoduodenectomy for periampullary adenocarcinomas from 2000-2012. Univariate and multivariate survival analyses were performed to determine the impact of PF on DFS and OS, while controlling for pathologic and clinical factors. Results: There were 634 PD (pancreas: 347 - other periampullary: 287); median age: 65 (range: 2484) years; 424/634, 68% had node positive disease; 61/634, 10% had positive margins and 98/634, 16% were poorly differentiated. There were 81/634, 13% patients with PF. Perioperative mortality rate was 1.7% (11/634), higher in patients with PF (10 vs. 0.5%, P < 0.001). In the multivariate analysis, PF significantly reduced DFS [Hazard ratio (HR): 1.6, 95% confidence-interval (CI): 1.1-2.6] in pancreatic but not in other periampullary cancer patients. Other factors associated with decreased DFS and OS were: node, margin-positive, and higher-grade cancers. Adjuvant therapy was associated with improved OS in pancreatic cancer patients (HR: 0.7, 95% CI=0.5-0.9, P=0.02). PF was not associated with decreased OS in pancreatic or other periampullary cancer patients. Conclusion: PF increase the risk of pancreas cancer recurrence after pancreaticoduodenectomy. Low tumor grade, negative lymph nodes, and negative resection margin are associated with improved DFS and OS.

Introduction: Walled off pancreatic necrosis (WOPN) is a potentially lethal complication of acute necrotic pancreatitis occurring in 5-10% of patients. We hypothesized that minimally invasive surgical cystgastrostomy and necrosectomy is a safe and feasible approach with comparable results to endoscopic management. Method: A retrospective review of a prospectively maintained data base of patients who underwent minimally invasive surgical (laparoscopic and robotic) cystgastrostomy and necrosectomy for WOPN was compared to a retrospective cohort of patients who underwent endoscopic cystgastrostomy and necrosectomy. Periprocedural outcomes were analyzed. Failure for the surgical group was defined as the need for any reintervention due to persistence of WOPN, whereas it was defined as the need for surgery in the endoscopic group. Results: Between 2008 and 2013, 15 patients underwent minimally invasive necrosectomy (robotic =10, laparoscopic=5) and 22 patients underwent endoscopic cystgastrosotomy and necrosectomy. The surgical cohort had a larger median cyst size compared to the endoscopic group (16 cm vs 12 cm P=0.03). There were no differences in age, sex, race, BMI, Charlson Comorbidity Index (CCI), etiology of pancreatitis, and location of WOPN between both groups (all P=NS). For the surgical cohort, average OR time was 195 min, average EBL was 67 cc and 60% underwent concomitant cholecystectomy for biliary etiology. There was no mortality in either group and no statistical difference in the frequency of post procedural complications; surgical group (pulmonary embolus(1);splenic artery pseudoaneurysm (1), infected collection (2)) and endotherapy group (perforation (1), bleeding (1),infected collection (2)). Failure of WOPN to resolve occurred in 3 patients (20%) in the surgical group compared to 3 patients (13.6%) in the endoscopic group (P=0.66). Reintervention was less common in the surgical group versus the endotherapy (20% versus 59%, P= 0.041) with a median re-intervention rate of 0 (range 0-2) for the surgical group versus 1(range 0-10) for the endoscopic group (p=0.02).Mean total length of stay-inclusive of readmissions and reinterventions- was similar between both groups (Surgical group= 9 days, Endoscopy =18.1 days, P=0.087) Conclusion. Minimally invasive cystgastrostomy and necrosectomy is safe and feasible for the management of WOPN with similar success and complication rates compared to the endoscopic approach. It may be considered as the intervention of choice when combined with cholecystectomy for biliary etiology.

Tu1624 Postoperative Fat Absorptive Function and Glucose Metabolism: Does Age Affect Outcomes Following Pancreatoduodenectomy? Masahiko Morifuji, Yasushi Hashimoto, Naoya Nakagawa, Kenichiro Uemura, Yoshiaki Murakami Background: Postoperative exocrine pancreatic insufficiency and resultant maldigestion is multifactorial in nature, mainly influenced by patient-specific features of the pancreas; however, the impact of advancing age is less well understood. The aim was to evaluate the effect of aging on postoperative digestive and fat absorptive disturbances following pyloruspreserving pancreatoduodenectomy (PPPD). Methods: A prospectively collected, IRB approved database at a single institution was reviewed. Patients with an aged greater than or equal to 75 (elderly group) were compared to those with an aged less than 75 prior to surgery (control group). An optimized 13C-mixed triglyceride breath test [13C-MTG-T] using a labeled long-chain triglyceride mixture was performed to assess postoperative fat absorptive function after PPPD. Pancreatic exocrine insufficiency was defined as cumulative 7-hour 13CO2 exhalation [% dose 13C cum 7h] < 5%. Pre and postoperative HbA1c levels were measured in blood samples to assess glucose metabolism function. Diabetic patients were identified as those treated with insulin, oral hypoglycemic medications, or having an HbA1c level ≥ 6.9% (NGSP). Data pertaining [13C-MTG-T], HbA1c levels, oral pancreatic enzyme requirements, and body mass index (BMI) were measured at 1 year following surgery. Post-operative fat absorptive function was compared with pre- and post-operative patient's characteristics and glucose metabolism. Results: Consecutive 51 patients were identified from April 2005 to 2009. The elderly group ( ≥75 years) included 18 patients, while the remaining 33 patients were assigned as the control group (<75 years). The % dose 13C cum 7h was significantly higher in the elderly group (6.5 ± 5.1%) compared to the control group (3.3 ± 2.4%; P<0.05). The number of patients requiring oral pancreatic enzyme was significantly higher in the elderly group (12 of 18; 83%) comparing to the control group (11 of 33; 33%; P<0.05). The difference in either HbA1c or body mass index (BMI) between the two groups is not statistically significant. Conclusion: Aging is not associated with

Tu1627 Maturation of Robot-Assisted Pancreaticoduodenectomy Program Within an Established Pancreatic Surgery Unit Noaman Ali, Mihir M. Shah, Kevin M. El-Hayek, Jane Wey, Sricharan Chalikonda, Matthew Walsh Background: There are potential advantages to the application of minimally invasive techniques to pancreaticoduodenectomy (PD). Technical feasibility and patient selection are important factors that will impact outcomes. We present a single center experience focusing on trends in patient selection and outcomes of robot-assisted pancreaticoduodenectomy (RAPD) Methods: Retrospective review of a prospectively maintained database of all open and robotic pancreaticoduodenectomy from March 2009 to July 2013. Results: 65 patients underwent attempted RAPD at a single institution during the study period. Concurrently,

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SSAT Abstracts

SSAT Abstracts

Minimally Invasive Surgical Cystgastrostomy and Necrosectomy for the Management of Walled Off Pancreatic Necrosis; Comparison With Endoscopic Approach At a High Volume Pancreatic Center Mohammad Khreiss, Georgios Papachristou, Mustapha Daouadi, Mazen Zenati, Kenneth Lee, Melissa E. Hogg, Adam Slivka, Jennifer Chennat, Andres Gelrud, Herbert Zeh, Amer H. Zureikat