Assessment of para-aortic lymph node metastasis during pancreatoduodenectomy: a personal experience of clinical implementation

Electronic Poster Abstracts (41.7%), eighteen partial colectomy (30%) and nine transverse colectomy (15%). A splenectomy was also performed in two patients and a nephrectomy in one (6.67% and 3.33% respectively). A 1:2 propensity case matching was performed to a group of PD patients with similar demographic and preoperative clinical data. Median operative time for the MPD group was 460 minutes and for the PD group 396 minutes (p < 0.001). 30-day morbidity in the MPD and PD group was 67.3% and 44.5% respectively (p < 0.05). Statistically significant differences in estimated blood loss, tumor stage, resection margin status, postoperative length of stay and 30-day mortality were not identified. Conclusion: Multivisceral resection pancreatoduodenectomy is a rare surgical occasion associated with increased operative time and higher postoperative morbidity but satisfactory surgical outcomes when performed in an experienced clinical setting.

EP02D-059 FEASIBILITY OF CLINICAL PATHWAY FOR PANCREATICODUODENECTOMY; SINGLE INSTITUTION J. Y. Park, D. W. Choi, S. H. Choi, J. S. Heo, W. Kwon, J. Bu and S. Jung Samsung Medical Center, Republic of Korea Introduction: Clinical pathways are reported to reduce the length of hospital stay and morbidity in Pancreticoduodenectomy (PD) The aim of this study was to evaluate the efficacy of implementing a clinical pathway for patients undergoing PD in single center. Methods: The patients (N = 212) who received conventional management from July 2012 to Aug 2013 were included as the conventional pathway group and the patients (N = 258) who received management of clinical pathway from Sep 2013 to Oct 2014 included as the clinical pathway group. Results: Patients in clinical pathway group were able to tolerate liquid (p < 0.001) and gruel diet (p < 0.001) earlier and remove intra-abdominal drainage (p < 0.001) earlier. The pancreatic fistula grade B rate was higher incidence than conventional pathway group (2.8% vs 10.1%; p = 0.002) There was not difference in the rates of delayed gastric emptying (DGE), post pancreatectomy hemorrhage (PPH) and mortality between the two groups. Length of stay was not difference between two groups (median 10 days vs 10 days, p = 0.861). Conclusions: The clinical pathway for PD is safe and feasible. Therefore the clinical pathway should be implemented in patients undergoing PD.

EP02D-060 ASSESSMENT OF PARA-AORTIC LYMPH NODE METASTASIS DURING PANCREATODUODENECTOMY: A PERSONAL EXPERIENCE OF CLINICAL IMPLEMENTATION B. K. Pranger1, D. S. J. Tseng2, K. P. de Jong1, I. Q. Molenaar2 and J. I. Erdmann1 1 University Medical Center Groningen, and 2University Medical Center Utrecht, Netherlands HPB 2016, 18 (S1), e385ee601

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Introduction: The value of routine intraoperative para-aortic lymph node sampling during surgical exploration in patients with suspected pancreatic ductal adenocarcinoma (PDAC) or non-pancreatic periampullary cancers (NPPC) remains unclear. The aim of this study was to assess the value and interpretation of routine para-aortic lymph node sampling. Methods: We included patients who underwent surgical exploration for PDAC or NPPC in two university centers. Routine para-aortic node sampling was performed intraoperatively in all patients. Clinicopathological and survival data were compared between patients with and without para-aortic node metastasis. Results: A total of 169 patients were evaluated. Paraaortic lymph node metastases were found in 18.3% of patients. In 45 patients no resection was performed because of para-aortic node involvement, vascular involvement or other distant metastasis. In only 4 patients para-aortic node involvement was the sole argument against resection. Overall survival for NPPC surpassed PDAC, mean survival of 26 vs 17 months (p = 0.002). There was no significant difference in survival between resected patients with and without positive para-aortic nodes, both for PDAC (p = 0.651) and NPPC (p = 0.362). Median survival in patients with para-aortic lymph node metastases who underwent pancreatoduodenectomy was 14 months versus 7 months in patients without resection (p = 0.022). After multivariate analysis, para-aortic node involvement was not significantly associated with survival (p = 0.362) in contrast to tumor origin (PDAC vs. NPPC1 (p = 0.003)). Conclusion: Routine sampling yields a significant number of positive nodes and may have prognostic value. However, as it is seldom the only argument not to resect, pragmatic use is advised.

EP02D-061 SURGICAL MANAGEMENT OF LOCALLY ADVANCED PANCREAS CANCER: THE MCGILL EXPERIENCE A. Kamath1, N. Kopek1, J. Asselah1, N. Bouganin1, D. Lamoussenery1, P. Metrakos1,2 and G. Zogopoulos1,2,3 1 Hepato-Pancreato-Biliary and Transplant Surgery, McGill University Health Center, 2The Goodman Cancer Research Centre, and 3Program in Cancer Genetics, Department of Oncology and Human Genetics, McGill University, Canada Aim: Introduction of FOLFIRINIX in treatment for pancreas cancer has shown better response. In locally advanced pancreas cancer (LAPC), better response translates to higher resectability rates. We present our experience in the management of patients with LAPC. Methods: Between September 2011 and December 2014, we identified 26 patients who were diagnosed with LAPC on staging imaging studies through a prospectively maintained institutional pancreas cancer registry. Results: Out of 26 patients, 8 were found to have only mesenteric venous involvement and underwent surgery upfront. Out of 18 patients who were enrolled in the “Pancreatectomy with En-Block Major Arterial Resection & Reconstruction (PEAR)” protocol, 12 underwent en block resection and reconstruction after 8 cycles of FOLFIRINOX, negative staging laparoscopy and 25G