- Email: [email protected]
425. Treatment Outcomes of Gall Bladder Cancer, 10 Years Experience
S162
ABSTRACTS
7 Laboratory of Anatomy-Histology and Embryology, Faculty of Nursing, University of Athens, Athens, Greece
Aim: The aim of our study is the presentation of our experience at thyroidectomies and the analysis of technique with standard dissection and recognition of recurrent laryngeal nerve to prevent damage nerve. Material-Method: This is a retrospective study from 2006 to 2015. Includes the results from thyroidectomies performed by the same surgical team with the same standard method.Contains 625 patients age 19e79 years old average age 46 years. From these, 358 were women and 267 men. 432 interventions performed because of diagnosis of multinodular goiter and others 193 because of thyroid cancer. Results: All the patients were underwent to total thyroidectomy via transverse incision 2 cm above the jugular notch of sternum. In all patients was performed bilateral recognition and dissection of recurrent laryngeal nerve. We no use nervostimulator. In 10 pts (all with thyroid cancer near to the nerve) presented temporary hoarseness , and 1 patient presented permanent hoarseness postoperatively after extended lymph node dissection but it was necessary for oncologic clearance. The laryngoscopy was negative in patients with temporary hoarseness. Other complications were parodic hypocalcaemia in 76 patients and permanent hypocalcaemia in 4 patients. There was no postoperatively bleeding or reoperation or damage of esophagus. The thyroid remnant after study with gammagraphy was below 1%. Conclusions: During thyroidectomy the most common complication is the damage of recurrent laryngeal nerve. Our recommendation is that the safest method to avoid damage is the dissection and recognition of the nerve in each intervention either in case of malignancy or in case of benign lesions. Furthermore it ensures the whole excision of the gland with the least remnant with the maximum oncologic result and the minimum danger of recurrence. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.262
409. Neck lymph node dissection: Results and complications T. Piperos1, I. Flessas2, D. Balalis2, K. Theodoulou3, E. Konstantinou4, K. Birbas5, I. Tsiaoussis6 1 General Surgeon, Department of Surgery, Eugenideion Hospital, Marousi, Athens, Greece
2
General Surgeon, Laboratory of Anatomy-Histology and Embryology, Faculty of Nursing, University of Athens, Athens, Greece 3 General Surgeon, Department of Surgery, Eugenideion Hospital, University of Athens, Athens, Greece 4 Department of Anaesthesiology, Faculty of Nursing, University of Athens, Athens, Greece 5 General Surgeon, Department of Surgery, Faculty of Nursing, University of Athens, “Agioi Anargyroi” Hospital, Athens, Greece 6 General Surgeon, Laboratory of Anatomy, Medical School, University of Crete, Heraklion, Crete, Greece Aim: The aim of our study is the presentation and analysis of our experience to lymph node dissection of neck for thyroid cancer. Material-Method: The study is retrospective and includes the years from 2006e2015. During this period was addressed 63 patients with thyroid cancer, 39 women and 24 men, aged 19e71 years old, average 47 years. Preoperatively all patients had had an ultrasonographyto identify the irregular lymph nodes. Results: 18 patients were underwent to extended bilaterally neck lymph node dissection and 45 ipsilateral lymph node dissection. It was done an transverse incision above the jugular notch with extension to the sternoclavicular muscle. It was no use of nervostimulator. In 24 patients was performed central neck lymph node dissection. Intraoperatively was done recognition and carefully dissection to the recurrent laryngeal nerve in all patients and in one case was done en block excision the nerve with the tumor. In all interventions we used 1 vacuum drainage. Postoperatively 1 patient had permanent hoarseness and 18 patients had permanent hypoparathyroidism. 1 patient had lymphorroia for one month. 2 patients had recurrent of tumor 18 months postoperatively. Conclusions: The thyroid cancer is common medical condition. Because of the fact that at the thyroid cancer is common the presence of pathological lymph nodes, especially to the papillary cancer, our recommendation is a detailed ultrasonography for identification irregular neck lymph nodes. The standard therapy is the carefully lymph node neck dissection of all pathological lymph nodes with full recognition and dissection of recurrent laryngeal nerve. The maneuvers aim at maximum oncologic result with the minimum possible morbidity. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.263
Poster Session: Hepatobiliary and Pancreatic Cancer 425. Treatment Outcomes of Gall Bladder Cancer, 10 Years Experience A. Zedan SECI, Surgical Oncology, Cairo, Egypt Background: Gallbladder cancer (GBC) represents the most common and aggressive biliary tract cancer with overall 5-year survival being only 5%e10%. Survival following resection, especially in early stages, has shown some improvement due to advances in surgical treatment. Advanced stages, however, continue to have dismal outcome. Complete surgical resection offers the only chance for cure, which extended from simple cholecystectomy to major hepatectomy or enbloc resection of adjacent organs. The aim of this study was to examine the predictors of longterm survival in patients with gall bladder cancer. Methods: We retrospectively evaluated 38 patients who underwent curative (R0) resection for GBC between January 2001 and December 2010 in Surgical Oncology Department, South Egypt Cancer Institute,
Assiut University, Egypt. Surgical procedures included simple cholecystectomy (10.5%), radical cholecystectomy (75.4%), bile duct resection (33.8), and right hepatectomy (7.8%). Adjacent organ resection was performed in (23.4%), duodenal sleeve resection (10.4%), segmental colectomy (5.2%), segmental gastrectomy (2.6%), Hepatopancreaticoduodenectomy (5.3 %). Adjuvant chemotherapy was given for (68.4%) of patients and adjuvant radiotherapy for (36.8%) of patients. Median follow up period of the patients was 38 months (0.5e69 months). Results: The median disease free survival (DFS) for GBC patients was 38 months. Univariate analysis revealed that patient’s age, comorbidities, weight loss, jaundice, tumor differentiation, organ invasion, lymph node metastasis, perineural invasion, tumor stage and chemotherapy were associated with the patient’s survival. Of these, weight loss, jaundice, lymph node metastasis and tumor stage were found to influence the overall survival on the multivariate Cox Hazard Regression analysis. First year overall survival estimate was 86.84% 5.5%, 2nd year ¼ 71.05% 7.4%, Third year 60.53% 7.9% fifth year ¼ 15.79% 5.9%.
ABSTRACTS Conclusion: Curative surgical resection remains the only effective approach for treatment of GBC. This study confirms that jaundice, weight loss and aggressive tumor (advanced stage and regional lymph nodes metastasis) are predictors of poor prognosis. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.265
427. Liver adenomatosis: A precancerous entity? A. Frena1, S. Patauner1, A. Mega2 1 Central Hospital of Bolzano, Hepatobiliary Surgery, Bolzano, Italy 2 Central Hospital of Bolzano, Hepatology, Bolzano, Italy Background: Liver adenomatosis (LA) can be defined a rare entity in which numerous (>10) hepatocellular adenomas occur in patients with a normal hepatic parenchyma without history of steroid use or glycogen storage disease. Material and methods: In the last five years we followed the cases of 3 women (37, 43, and 51 yrs.) suffering from LA and treated by liver resection. In all cases an intraparenchymal hemorrhage of the greater lesion was present. According to the original Flejou’s description of the disease, all patients had only a serous increase of alkaline phosphatase and gGT. Results: Up to the present, all patients are alive without signs of recurrence of the disease. Microscopic examination of the specimens revealed that all lesions were composed of benign hepatocytes arranged in irregularly thickened cords, separed by sinusoids. The histologic findings were characteristic of liver cell adenomas; in view of the large number of lesions present (in all cases >20), the diagnosis of LA was established. Conclusions: This report confirms the existence of the unusual entity of liver adenomas. These lesions can be extremely vascular and prone to hemorrhage: this argues for removing large adenomas even in the presence of LA. The distinction between LA and well-differentiated hepatocellular carcinoma (Edmonson I) is very difficult on histology alone. A long follow-up is essential to confirm the diagnosis. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.267
428. Inframesocolic superior mesenteric artery first approach as an introductory procedure of radical antegrade modular pancreatosplenectomy for distal pancreatic cancer M. Hoshikawa, S. Aosasa, H. Abe, M. Nishikawa, T. Noro, S. Hiraki, Y. Kajiwara, T. Moriya, T. Yamasaki, E. Shinto, H. Tsujimoto, H. Ueno, T. Tanimizu, K. Hase, J. Yamamoto National Defense Medical College, Surgery, Tokorozawa, Japan Background: The superior mesenteric artery (SMA)-first approaches are operative tactics purposing for identifying resectability early during the pancreatoduodenectomy. In case of a locally advanced left-sided pancreatic cancer, the early judgment of an involvement of the SMA also determines a possibility of curative resection. During either radical antegrade modular pancreatosplenectomy (RAMPS) or classic left-toright distal pancreatectomy, dissection of the SMA is performed after transection of the pancreas or wide detachment of the distal pancreas and spleen. Herein, we describe an inframesocolic SMA-first approach as an introductory procedure when treating carcinoma of the pancreatic body and tail. Surgical techniques: The omentum and transverse colon are superiorly retracted and the small intestine is retracted to the right. The peritoneum is incised at the duodenal recess and the aorta, inferior vena cava, and left renal vein are exposed by mobilizing and rotating the fourth portion of the duodenum and the uncinated process of the pancreas. These procedures will expose the left aortic wall and left
S163 adrenal gland. The mesentery base is then incised, the ligament of Treitz is opened on the left and anterior side of the mesenteric root, and duodenojejunal flexure is pulled down. The SMA is then identified. Dissection of the SMA proceeds to the origin of the SMA. Next, the transverse colon is pulled downward, and the gastrocolic ligament is incised, opening the omental bursa. After dissecting the inferior border of the pancreas to the right, the superior mesenteric vein (SMV) is exposed and the mesocolon is opened on the left side of the SMA. The common hepatic artery and the portal vein are exposed along the superior border of the pancreas. The neck of the pancreas is tunneled and divided with a linear stapler and tilted to the left in order to facilitate lymph node dissection around the celiac axis (CA). Subsequently, the splenic vein was ligated at its origin. The anterior surface of the SMA, which is already exposed, is located and proximally dissected until reaching the SMA origin. After these procedures are completed, the RAMPS procedures are performed. Conclusion: The procedure described here was performed in seven patients in our department and all patients underwent R0 resection. This introductory procedure of inframesocolic SMA-first approach for left-sided pancreatic cancer is feasible and useful with giving solidity and safety to RAMPS. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.268
429. Prognostic factors and outcome of partial hepatectomy for huge (‡10 cm) hepatocellular carcinoma B.K. Goh, J.H. Kam, S.Y. Lee, C.Y. Chan, P. Jeyaraj, P.C. Cheow, P.K. Chow, L.L. Ooi, A.Y. Chung Singapore General Hospital, Hepatopancreatobiliary and Transplantation Surgery, Singapore, Singapore Background: This study was performed with the primary objective to determine the prognostic factors and after partial hepatectomy (PH) for huge (10 cm) HCC. Methods: Between 2000 to 2013, 920 patients underwent resection for HCC of which there were 166 patients who underwent LR for a huge primary HCC which met the study criteria. Results: One-hundred and sixty-six patients underwent LR for huge HCC. The 30-day/in-hospital postoperative mortality rate was 4.2%. The 5year overall survival (OS) and the 5-year recurrence-free survival (RFS) was 43% and 24%, respectively. Univariate analyses demonstrated that tumor size, multifocal disease, elevated AFP, microvascular invasion, R1 resection and satellite nodules were significant predictive factors of RFS. On multivariate analysis, elevated AFP, microvascular invasion and R1 resection were independent predictors of RFS. Hepatitis B positivity, tumor rupture, elevated NLR, elevated PLR, elevated AFP, multinodular, microvascular invasion, R1 resection and satellite nodules were significant prognostic factors of OS on univariate analyses. Hepatitis B positivity, tumor rupture and R1 resection were independent predictors of OS on multivariate analyses. Conclusions: Elevated AFP, microvascular invasion, R1 resection, hepatitis B positivity and tumor rupture were independent prognostic factors after PH for huge HCC. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.269
430. Predictors of successful percutaneous biliary drainage for incurable malignant biliary obstruction S. Pietruszka, R. Pach, P. Kulig, M. Sierzega, P. Kolodziejczyk, J. Kulig Jagiellonian University, Department of General- Oncological and Gastrointestinal Surgery, Krakow, Poland Background: Patients with periampullary and liver neoplasms in the course of their diseases frequently develop jaundice that cannot be relieved
ABSTRACTS
7 Laboratory of Anatomy-Histology and Embryology, Faculty of Nursing, University of Athens, Athens, Greece
Aim: The aim of our study is the presentation of our experience at thyroidectomies and the analysis of technique with standard dissection and recognition of recurrent laryngeal nerve to prevent damage nerve. Material-Method: This is a retrospective study from 2006 to 2015. Includes the results from thyroidectomies performed by the same surgical team with the same standard method.Contains 625 patients age 19e79 years old average age 46 years. From these, 358 were women and 267 men. 432 interventions performed because of diagnosis of multinodular goiter and others 193 because of thyroid cancer. Results: All the patients were underwent to total thyroidectomy via transverse incision 2 cm above the jugular notch of sternum. In all patients was performed bilateral recognition and dissection of recurrent laryngeal nerve. We no use nervostimulator. In 10 pts (all with thyroid cancer near to the nerve) presented temporary hoarseness , and 1 patient presented permanent hoarseness postoperatively after extended lymph node dissection but it was necessary for oncologic clearance. The laryngoscopy was negative in patients with temporary hoarseness. Other complications were parodic hypocalcaemia in 76 patients and permanent hypocalcaemia in 4 patients. There was no postoperatively bleeding or reoperation or damage of esophagus. The thyroid remnant after study with gammagraphy was below 1%. Conclusions: During thyroidectomy the most common complication is the damage of recurrent laryngeal nerve. Our recommendation is that the safest method to avoid damage is the dissection and recognition of the nerve in each intervention either in case of malignancy or in case of benign lesions. Furthermore it ensures the whole excision of the gland with the least remnant with the maximum oncologic result and the minimum danger of recurrence. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.262
409. Neck lymph node dissection: Results and complications T. Piperos1, I. Flessas2, D. Balalis2, K. Theodoulou3, E. Konstantinou4, K. Birbas5, I. Tsiaoussis6 1 General Surgeon, Department of Surgery, Eugenideion Hospital, Marousi, Athens, Greece
2
General Surgeon, Laboratory of Anatomy-Histology and Embryology, Faculty of Nursing, University of Athens, Athens, Greece 3 General Surgeon, Department of Surgery, Eugenideion Hospital, University of Athens, Athens, Greece 4 Department of Anaesthesiology, Faculty of Nursing, University of Athens, Athens, Greece 5 General Surgeon, Department of Surgery, Faculty of Nursing, University of Athens, “Agioi Anargyroi” Hospital, Athens, Greece 6 General Surgeon, Laboratory of Anatomy, Medical School, University of Crete, Heraklion, Crete, Greece Aim: The aim of our study is the presentation and analysis of our experience to lymph node dissection of neck for thyroid cancer. Material-Method: The study is retrospective and includes the years from 2006e2015. During this period was addressed 63 patients with thyroid cancer, 39 women and 24 men, aged 19e71 years old, average 47 years. Preoperatively all patients had had an ultrasonographyto identify the irregular lymph nodes. Results: 18 patients were underwent to extended bilaterally neck lymph node dissection and 45 ipsilateral lymph node dissection. It was done an transverse incision above the jugular notch with extension to the sternoclavicular muscle. It was no use of nervostimulator. In 24 patients was performed central neck lymph node dissection. Intraoperatively was done recognition and carefully dissection to the recurrent laryngeal nerve in all patients and in one case was done en block excision the nerve with the tumor. In all interventions we used 1 vacuum drainage. Postoperatively 1 patient had permanent hoarseness and 18 patients had permanent hypoparathyroidism. 1 patient had lymphorroia for one month. 2 patients had recurrent of tumor 18 months postoperatively. Conclusions: The thyroid cancer is common medical condition. Because of the fact that at the thyroid cancer is common the presence of pathological lymph nodes, especially to the papillary cancer, our recommendation is a detailed ultrasonography for identification irregular neck lymph nodes. The standard therapy is the carefully lymph node neck dissection of all pathological lymph nodes with full recognition and dissection of recurrent laryngeal nerve. The maneuvers aim at maximum oncologic result with the minimum possible morbidity. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.263
Poster Session: Hepatobiliary and Pancreatic Cancer 425. Treatment Outcomes of Gall Bladder Cancer, 10 Years Experience A. Zedan SECI, Surgical Oncology, Cairo, Egypt Background: Gallbladder cancer (GBC) represents the most common and aggressive biliary tract cancer with overall 5-year survival being only 5%e10%. Survival following resection, especially in early stages, has shown some improvement due to advances in surgical treatment. Advanced stages, however, continue to have dismal outcome. Complete surgical resection offers the only chance for cure, which extended from simple cholecystectomy to major hepatectomy or enbloc resection of adjacent organs. The aim of this study was to examine the predictors of longterm survival in patients with gall bladder cancer. Methods: We retrospectively evaluated 38 patients who underwent curative (R0) resection for GBC between January 2001 and December 2010 in Surgical Oncology Department, South Egypt Cancer Institute,
Assiut University, Egypt. Surgical procedures included simple cholecystectomy (10.5%), radical cholecystectomy (75.4%), bile duct resection (33.8), and right hepatectomy (7.8%). Adjacent organ resection was performed in (23.4%), duodenal sleeve resection (10.4%), segmental colectomy (5.2%), segmental gastrectomy (2.6%), Hepatopancreaticoduodenectomy (5.3 %). Adjuvant chemotherapy was given for (68.4%) of patients and adjuvant radiotherapy for (36.8%) of patients. Median follow up period of the patients was 38 months (0.5e69 months). Results: The median disease free survival (DFS) for GBC patients was 38 months. Univariate analysis revealed that patient’s age, comorbidities, weight loss, jaundice, tumor differentiation, organ invasion, lymph node metastasis, perineural invasion, tumor stage and chemotherapy were associated with the patient’s survival. Of these, weight loss, jaundice, lymph node metastasis and tumor stage were found to influence the overall survival on the multivariate Cox Hazard Regression analysis. First year overall survival estimate was 86.84% 5.5%, 2nd year ¼ 71.05% 7.4%, Third year 60.53% 7.9% fifth year ¼ 15.79% 5.9%.
ABSTRACTS Conclusion: Curative surgical resection remains the only effective approach for treatment of GBC. This study confirms that jaundice, weight loss and aggressive tumor (advanced stage and regional lymph nodes metastasis) are predictors of poor prognosis. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.265
427. Liver adenomatosis: A precancerous entity? A. Frena1, S. Patauner1, A. Mega2 1 Central Hospital of Bolzano, Hepatobiliary Surgery, Bolzano, Italy 2 Central Hospital of Bolzano, Hepatology, Bolzano, Italy Background: Liver adenomatosis (LA) can be defined a rare entity in which numerous (>10) hepatocellular adenomas occur in patients with a normal hepatic parenchyma without history of steroid use or glycogen storage disease. Material and methods: In the last five years we followed the cases of 3 women (37, 43, and 51 yrs.) suffering from LA and treated by liver resection. In all cases an intraparenchymal hemorrhage of the greater lesion was present. According to the original Flejou’s description of the disease, all patients had only a serous increase of alkaline phosphatase and gGT. Results: Up to the present, all patients are alive without signs of recurrence of the disease. Microscopic examination of the specimens revealed that all lesions were composed of benign hepatocytes arranged in irregularly thickened cords, separed by sinusoids. The histologic findings were characteristic of liver cell adenomas; in view of the large number of lesions present (in all cases >20), the diagnosis of LA was established. Conclusions: This report confirms the existence of the unusual entity of liver adenomas. These lesions can be extremely vascular and prone to hemorrhage: this argues for removing large adenomas even in the presence of LA. The distinction between LA and well-differentiated hepatocellular carcinoma (Edmonson I) is very difficult on histology alone. A long follow-up is essential to confirm the diagnosis. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.267
428. Inframesocolic superior mesenteric artery first approach as an introductory procedure of radical antegrade modular pancreatosplenectomy for distal pancreatic cancer M. Hoshikawa, S. Aosasa, H. Abe, M. Nishikawa, T. Noro, S. Hiraki, Y. Kajiwara, T. Moriya, T. Yamasaki, E. Shinto, H. Tsujimoto, H. Ueno, T. Tanimizu, K. Hase, J. Yamamoto National Defense Medical College, Surgery, Tokorozawa, Japan Background: The superior mesenteric artery (SMA)-first approaches are operative tactics purposing for identifying resectability early during the pancreatoduodenectomy. In case of a locally advanced left-sided pancreatic cancer, the early judgment of an involvement of the SMA also determines a possibility of curative resection. During either radical antegrade modular pancreatosplenectomy (RAMPS) or classic left-toright distal pancreatectomy, dissection of the SMA is performed after transection of the pancreas or wide detachment of the distal pancreas and spleen. Herein, we describe an inframesocolic SMA-first approach as an introductory procedure when treating carcinoma of the pancreatic body and tail. Surgical techniques: The omentum and transverse colon are superiorly retracted and the small intestine is retracted to the right. The peritoneum is incised at the duodenal recess and the aorta, inferior vena cava, and left renal vein are exposed by mobilizing and rotating the fourth portion of the duodenum and the uncinated process of the pancreas. These procedures will expose the left aortic wall and left
S163 adrenal gland. The mesentery base is then incised, the ligament of Treitz is opened on the left and anterior side of the mesenteric root, and duodenojejunal flexure is pulled down. The SMA is then identified. Dissection of the SMA proceeds to the origin of the SMA. Next, the transverse colon is pulled downward, and the gastrocolic ligament is incised, opening the omental bursa. After dissecting the inferior border of the pancreas to the right, the superior mesenteric vein (SMV) is exposed and the mesocolon is opened on the left side of the SMA. The common hepatic artery and the portal vein are exposed along the superior border of the pancreas. The neck of the pancreas is tunneled and divided with a linear stapler and tilted to the left in order to facilitate lymph node dissection around the celiac axis (CA). Subsequently, the splenic vein was ligated at its origin. The anterior surface of the SMA, which is already exposed, is located and proximally dissected until reaching the SMA origin. After these procedures are completed, the RAMPS procedures are performed. Conclusion: The procedure described here was performed in seven patients in our department and all patients underwent R0 resection. This introductory procedure of inframesocolic SMA-first approach for left-sided pancreatic cancer is feasible and useful with giving solidity and safety to RAMPS. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.268
429. Prognostic factors and outcome of partial hepatectomy for huge (‡10 cm) hepatocellular carcinoma B.K. Goh, J.H. Kam, S.Y. Lee, C.Y. Chan, P. Jeyaraj, P.C. Cheow, P.K. Chow, L.L. Ooi, A.Y. Chung Singapore General Hospital, Hepatopancreatobiliary and Transplantation Surgery, Singapore, Singapore Background: This study was performed with the primary objective to determine the prognostic factors and after partial hepatectomy (PH) for huge (10 cm) HCC. Methods: Between 2000 to 2013, 920 patients underwent resection for HCC of which there were 166 patients who underwent LR for a huge primary HCC which met the study criteria. Results: One-hundred and sixty-six patients underwent LR for huge HCC. The 30-day/in-hospital postoperative mortality rate was 4.2%. The 5year overall survival (OS) and the 5-year recurrence-free survival (RFS) was 43% and 24%, respectively. Univariate analyses demonstrated that tumor size, multifocal disease, elevated AFP, microvascular invasion, R1 resection and satellite nodules were significant predictive factors of RFS. On multivariate analysis, elevated AFP, microvascular invasion and R1 resection were independent predictors of RFS. Hepatitis B positivity, tumor rupture, elevated NLR, elevated PLR, elevated AFP, multinodular, microvascular invasion, R1 resection and satellite nodules were significant prognostic factors of OS on univariate analyses. Hepatitis B positivity, tumor rupture and R1 resection were independent predictors of OS on multivariate analyses. Conclusions: Elevated AFP, microvascular invasion, R1 resection, hepatitis B positivity and tumor rupture were independent prognostic factors after PH for huge HCC. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.269
430. Predictors of successful percutaneous biliary drainage for incurable malignant biliary obstruction S. Pietruszka, R. Pach, P. Kulig, M. Sierzega, P. Kolodziejczyk, J. Kulig Jagiellonian University, Department of General- Oncological and Gastrointestinal Surgery, Krakow, Poland Background: Patients with periampullary and liver neoplasms in the course of their diseases frequently develop jaundice that cannot be relieved