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35. Pancreaticoduodenectomy with partial resection of pancreatic body and tail for a multifocal neuroendocrine tumor
ABSTRACTS done with CT of the chest, which showed lesion in the transition from the mid-distal esophagus in contact with 35% of the circumference of the aorta, the abdominal CT showed no alteration. The patient presented a “performance status 1”, and had a significant weight loss, dysphagia went to solid and pasty in 15 days. The patient underwent nutritional assessment and nasoenteric tube was indicated, however the patient refused it and jejunostomy was used. The multimodal treatment plan includes neoadjuvant chemoradiation with the CROSS trial scheme, which is the protocol adopted in our service (Weekly paclitaxel plus carboplatin plus concurrent RT 41.4 Gy over 5 weeks), followed by surgery 4 weeks after radiotherapy. Before surgery a new CT was performed to re-stage the cancer, and it showed a decrease in the esophageal injury and the cleavage plane with the aorta. The patient tolerated all the proposed treatment. The surgery began from the chest with left lateral decubitus (LLD). LLD was opted due to the size of the lesion and the possibility for a switch to open surgery. After dissection of the esophagus and the mediastinal lymph nodes the patient adopted the supine position with the legs opened to the abdominal time, with dissection of the stomach and preparation of the gastric tube. Anastomosis was cervical on two levels with separate stitches. Results: Total surgery time was of 240 min, estimated blood loss was of 300 ml, the patient began her diet by jejunostomy on the first day, on the fifth day a test with blue dye was performed and an orally diet with clear liquids was started. The patient was discharged on the eighth day with full liquid diet. The diet progressed on an outpatient basis, on the tenth day soft and liquid diet, on the fifteenth day soft diet and on the forty-fifth day it evolved to free diet with the removal of the jejunostomy. The anatomical pathology had a complete pathologic response (pCR) having all the 25 lymph nodes identified as cancer-free. Conclusions: The laparoscopic esophagectomy is a safe surgery and as it is minimally invasive, it allows us to have an early hospital discharge, even in larger lesions. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.040
35. Pancreaticoduodenectomy with partial resection of pancreatic body and tail for a multifocal neuroendocrine tumor A. Lukashenko, O. Kolesnik, V. Zvirich National Cancer Institute, Abdominal Oncology, Kiev, Ukraine Background: Pancreatic neuroendocrine tumours are considered a relatively unusual oncologic entity. Due to its relative good prognosis, surgery remains the goal standard therapy not only in localized disease but also in the setting of locally or metastatic disease. Material and methods: The following article demonstrates the technical aspects of pancreaticoduodenectomy with resection of pancreatic body and tail for a multifocal neuroendocrine tumor. The indication for intervention in the underlying case was a patient diagnosed with a multifocal neuroendocrine tumor infiltrating caput, body and tail of the pancreas. Results: The resection was carried out in open way, and the reconstruction, which included «duct-to-mucosa» pancreaticojejunostomy a biliodigestive anastomosis and a gastroenterostomy, was carried. The total operative time was 245 min. The blood loss accounted for 200 ml. The postoperative course was uneventful, and the patient was discharged on the eighth postoperative day. Conclusions: Pancreaticoduodenectomy with resection of pancreatic body and tail is a treatment option in carefully selected indications. The
S79 complexity of the operation demands a high level of expertise in the surgical team. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.041 36. Transanal total mesorectal excision (TaTME) for rectal cancer M.C. Arroyave Isaza, J.T. Marta, J.S. Tre´panier, M. Fernandez-Hevia, B. De Lacy, A. Otero, A.M. Lacy Hospital Clinic, Gastrointestinal Surgery, Barcelona, Spain Background: The transanal total mesorectal excision (TaTME) is now available to the surgical community in order to solve several issues with previous surgical approaches. It can be performed by a single surgical team or through combined and simultaneous dissection by two surgical teams (the Cecil Approach). Materials and methods: We present a video of a Low Anterior Resection with TME transanally and transabdominally (Cecil approach). 83 year-old woman with high blood pressure, dyslipidemia and Barrett’s esophagus. Due to rectal bleeding, the patient was diagnosed with rectal cancer 7 cm from the anal verge. Baseline staging revealed a mriT3N1 lesion plus resectable lung metastases by CT-Scan. Patient received chemoradiotherapy with moderate response to a mriT2N0. Results: The patient was placed in a lithotomy position. Four trocars were used transabdominally, a 12 mm trocar was placed umbilically for the camera, and three 5 mm trocars were also placed, two in the right iliac fossa and one in the left hemiabdomen. A gel cap platform was used for the transanal approach. The mesosigmoid peritoneum is incised to define the correct posterior plane. The inferior mesenteric artery is individualized and proximally ligated. Simultaneously the transanal approach is performed. After visualizing the rectal tumor, a purse string suture is made to close the rectal lumen. The down to up dissection is begun in a circumferential manner. We usually begin on the anterior side, where you can see some fibrosis secondary to the preoperative treatment. We continue on the posterior side dissecting the mesorectum and on the lateral side connecting the anterior and posterior planes following the “holly plane”. At the same time, the abdominal dissection is continued into the pelvic space to perform a total mesorectal excision. The left lateral side is also incised taking care not to damage the vessel and nerves. The rendez-vous between both teams is achieved, thanks to the combined work. Once the correct plane is achieved, we can continue the abdominal dissection applying the right traction. A prolene purse string on the distal rectum is made to perform the mechanical anastomosis. The correct proximal colon position is checked. The colorrectal anastomosis is checked for leakage or bleeding. Diverting ileostomy was performed. Patient was discharged on the fifth postoperative day with no complications. The ileostomy was reverted after one month. Pathology results: Moderately differentiated adenocarcinoma with fibrosis. Proximal and distal margins tumor-free. No lymph node metastases. Complete mesorectum. pT2N0. Conclusions: TaTME is a feasible and safe technique that brings several advantages in rectal cancer surgery. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.042
35. Pancreaticoduodenectomy with partial resection of pancreatic body and tail for a multifocal neuroendocrine tumor A. Lukashenko, O. Kolesnik, V. Zvirich National Cancer Institute, Abdominal Oncology, Kiev, Ukraine Background: Pancreatic neuroendocrine tumours are considered a relatively unusual oncologic entity. Due to its relative good prognosis, surgery remains the goal standard therapy not only in localized disease but also in the setting of locally or metastatic disease. Material and methods: The following article demonstrates the technical aspects of pancreaticoduodenectomy with resection of pancreatic body and tail for a multifocal neuroendocrine tumor. The indication for intervention in the underlying case was a patient diagnosed with a multifocal neuroendocrine tumor infiltrating caput, body and tail of the pancreas. Results: The resection was carried out in open way, and the reconstruction, which included «duct-to-mucosa» pancreaticojejunostomy a biliodigestive anastomosis and a gastroenterostomy, was carried. The total operative time was 245 min. The blood loss accounted for 200 ml. The postoperative course was uneventful, and the patient was discharged on the eighth postoperative day. Conclusions: Pancreaticoduodenectomy with resection of pancreatic body and tail is a treatment option in carefully selected indications. The
S79 complexity of the operation demands a high level of expertise in the surgical team. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.041 36. Transanal total mesorectal excision (TaTME) for rectal cancer M.C. Arroyave Isaza, J.T. Marta, J.S. Tre´panier, M. Fernandez-Hevia, B. De Lacy, A. Otero, A.M. Lacy Hospital Clinic, Gastrointestinal Surgery, Barcelona, Spain Background: The transanal total mesorectal excision (TaTME) is now available to the surgical community in order to solve several issues with previous surgical approaches. It can be performed by a single surgical team or through combined and simultaneous dissection by two surgical teams (the Cecil Approach). Materials and methods: We present a video of a Low Anterior Resection with TME transanally and transabdominally (Cecil approach). 83 year-old woman with high blood pressure, dyslipidemia and Barrett’s esophagus. Due to rectal bleeding, the patient was diagnosed with rectal cancer 7 cm from the anal verge. Baseline staging revealed a mriT3N1 lesion plus resectable lung metastases by CT-Scan. Patient received chemoradiotherapy with moderate response to a mriT2N0. Results: The patient was placed in a lithotomy position. Four trocars were used transabdominally, a 12 mm trocar was placed umbilically for the camera, and three 5 mm trocars were also placed, two in the right iliac fossa and one in the left hemiabdomen. A gel cap platform was used for the transanal approach. The mesosigmoid peritoneum is incised to define the correct posterior plane. The inferior mesenteric artery is individualized and proximally ligated. Simultaneously the transanal approach is performed. After visualizing the rectal tumor, a purse string suture is made to close the rectal lumen. The down to up dissection is begun in a circumferential manner. We usually begin on the anterior side, where you can see some fibrosis secondary to the preoperative treatment. We continue on the posterior side dissecting the mesorectum and on the lateral side connecting the anterior and posterior planes following the “holly plane”. At the same time, the abdominal dissection is continued into the pelvic space to perform a total mesorectal excision. The left lateral side is also incised taking care not to damage the vessel and nerves. The rendez-vous between both teams is achieved, thanks to the combined work. Once the correct plane is achieved, we can continue the abdominal dissection applying the right traction. A prolene purse string on the distal rectum is made to perform the mechanical anastomosis. The correct proximal colon position is checked. The colorrectal anastomosis is checked for leakage or bleeding. Diverting ileostomy was performed. Patient was discharged on the fifth postoperative day with no complications. The ileostomy was reverted after one month. Pathology results: Moderately differentiated adenocarcinoma with fibrosis. Proximal and distal margins tumor-free. No lymph node metastases. Complete mesorectum. pT2N0. Conclusions: TaTME is a feasible and safe technique that brings several advantages in rectal cancer surgery. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.042