- Email: [email protected]
Audit of emergency presentation of pancreatic cancer
e780
E-AHPBA: Poster Abstracts
pancreatic neoplasm. The purpose of this study was to analyze a single-institution experience for surgically treated PNET. Methods: Patients who were surgically treated for PNET at the Center of General Surgery and Liver Transplantation between January 2000 and December 2014 were retrospectivelly reviewed. Patients were classified based on revised WHO and ENET- (European Neuroendocrine Tumor Society) TNM. Pancreaticoduodedenctomy, central pancreatetomy, distal pancretectomy, enucleation were peformed for the primary tumor resection. After gaining a considerable experience in robotic surgery we start to perform robotic pancreatic resections. Results: From 2000 to 2014, 115 patients underwent surgery for PNETs in our center. The median age at the surgery was 54 years (range, 14e81). Surgery with curative intent of the primary tumor was performed in 106 patients; OF 115 patients, 25 (21,73%) presented with synchronous liver metastases; they underwent liver directed therapy: resection (5), transarterial chemoembolization (1), radiofrequency ablation (1). The median survival after curative resection of the primary tumor was 43.5 months (range, 1e 241 months). The 1-, 3- and 5-year overall survival rates were 94.2 %, 87.4 %, 85.4 % and 81.5% after 10 years. Statistically significant prognostics factors were : tumor size >2 cm (P = 0.002), lymphovascular invasion (P = 0.017) of synchronous liver metastases (P 0.001),ENET stage (P 0.001), tumor WHO grade (P 0.001). Conclusions: In our study, the 5-year survival rate was 85.4 % and 10-year survival rate is 81.5%, which is within the range of that reported by most large series. The present study confirm that the ENET classification (Staging and grading) can be used to predict long term survival in patients with PNETs. Patients with locally advanced diseases and metastatic PNETS benefit from radical resection of the primary tumor; resection of the primary tumor was associated with an improved survival.
PANCREAS CANCER 0829 TIME TRENDS OF LYMPHNODE RETRIEVAL FOR PANCREATIC ADENOCARCINOMA IN A HIGH VOLUME CENTER INCREASED LYMPH NODE YIELD IS NOT NECESSARILY ASSOCIATED WITH A GREATER NUMBER OF LYMPH NODE POSITIVE CANCERS L. Maggino, G. Malleo, F. Gulino, G. Butturini, R. Salvia and C. Bassi University of Verona, Italy Aims: Lymph node (LN) involvement is a major prognostic factor in pancreatic adenocarcinoma (PDAC). The total number of examined LN (exLN) is an important parameter in assessing the quality of surgery and histopathological analysis; still its impact on accurate staging is poorly understood.
Our aim was to assess the trends in LN harvesting over time in a Western high volume center, and its relationship with the identification of LN positive (N+) tumors. Methods: Surgical and pathological data of 811 patients who underwent resection for PDAC between 1999 and 2013 were retrospectively reviewed. Patients were divided in three groups according to the year of surgery (group 1: 1999e2005; group 2: 2006e2009; group 3: 2010e2013). We compared the mean exLN number and the proportion of N1 patients among the groups. When detailed pathological data on the specific site of LN retrieval were available (582 patients) each LN station was analyzed separately. Results: The mean number of exLN was 30.05 (SD 14,74; range 3e104). Comparison between the three groups showed a significant increase (ANOVA test: p < 0.001) in LN yield both for pancreaticoduodenectomies (mean exLN: 24.911.6 vs 25.210.2 vs 37.214.4) and distal pancreatectomies (21.911.5 vs 26.211.7 vs 34.912.0). This trend affected most of the LN stations without a clear topographic predominance. Conversely no corresponding significant trend in the proportion of N+ cases (81.3% vs 80.9% vs 83.5%; Chi square test: p = 0,691) was found. Conclusions: We show a generalized increase in LN harvesting in a Western high volume center over time. However, this is not necessarily associated with an increased number of N+ cancers.
PANCREAS CANCER 0840 AUDIT OF EMERGENCY PRESENTATION OF PANCREATIC CANCER D. Ojo, A. R. Dennison and G. Garcea University Hospitals of Leicester NHS Trust, UK Aims: There are political and clinical imperatives driving the need for the earlier diagnosis of malignancy and improved outcomes. According to the National Cancer Intelligence Network (NCIN), pancreatic cancer has the 3rd highest emergency presentation of all cancers in the UK (a 2010 study including 47% of all pancreatic cancers diagnosed that year). This audit evaluated any presentations to primary care in patients admitted with an emergency diagnosis of pancreatic cancer, to determine if earlier diagnosis was feasible Methods: We traced back through patients’ journeys with a diagnosis of pancreatic cancer made on an emergency admission. 51 newly diagnosed pancreatic cancers patients presented as an emergency in 2013 with adequate data records. Patient notes were then evaluated to determine if any patients had consulted their GP within 6 months of presentation with symptoms which could have been an early warning of pancreatic cancer. The definition of emergency presentation was any attendance to hospital via an emergency GP referral, emergency department or referral from outpatient clinic. Results: 51% of patients had presented to their GP within 6 months prior to diagnosis with symptoms (not including referral preceding their emergency admission). 20 of the 51 patients had previously undergone procedures to investigate upper abdominal pain performed within 6 months of
HPB 2016, 18 (S2), e747ee781
E-HPBA: Poster Abstracts presentation; 11 patients undergoing ultrasound scans and 7 oesophagogastroduodenoscopy. The rate of resectable disease in patients presenting as an emergency was predictably poor comprising only 5 out of 51. 49% of patients at their emergency presentation were found to have metastases and 29% found to have locally advanced disease
HPB 2016, 18 (S2), e747ee781
e781
Conclusions: The high prevalence of investigations for upper abdominal pain in this cohort would suggest that symptoms worthy of GP consultation often precede the emergency presentation of pancreas cancer. Expansion on this data collection is urgently needed both to increase GP awareness and hopefully improve early detection.
E-AHPBA: Poster Abstracts
pancreatic neoplasm. The purpose of this study was to analyze a single-institution experience for surgically treated PNET. Methods: Patients who were surgically treated for PNET at the Center of General Surgery and Liver Transplantation between January 2000 and December 2014 were retrospectivelly reviewed. Patients were classified based on revised WHO and ENET- (European Neuroendocrine Tumor Society) TNM. Pancreaticoduodedenctomy, central pancreatetomy, distal pancretectomy, enucleation were peformed for the primary tumor resection. After gaining a considerable experience in robotic surgery we start to perform robotic pancreatic resections. Results: From 2000 to 2014, 115 patients underwent surgery for PNETs in our center. The median age at the surgery was 54 years (range, 14e81). Surgery with curative intent of the primary tumor was performed in 106 patients; OF 115 patients, 25 (21,73%) presented with synchronous liver metastases; they underwent liver directed therapy: resection (5), transarterial chemoembolization (1), radiofrequency ablation (1). The median survival after curative resection of the primary tumor was 43.5 months (range, 1e 241 months). The 1-, 3- and 5-year overall survival rates were 94.2 %, 87.4 %, 85.4 % and 81.5% after 10 years. Statistically significant prognostics factors were : tumor size >2 cm (P = 0.002), lymphovascular invasion (P = 0.017) of synchronous liver metastases (P 0.001),ENET stage (P 0.001), tumor WHO grade (P 0.001). Conclusions: In our study, the 5-year survival rate was 85.4 % and 10-year survival rate is 81.5%, which is within the range of that reported by most large series. The present study confirm that the ENET classification (Staging and grading) can be used to predict long term survival in patients with PNETs. Patients with locally advanced diseases and metastatic PNETS benefit from radical resection of the primary tumor; resection of the primary tumor was associated with an improved survival.
PANCREAS CANCER 0829 TIME TRENDS OF LYMPHNODE RETRIEVAL FOR PANCREATIC ADENOCARCINOMA IN A HIGH VOLUME CENTER INCREASED LYMPH NODE YIELD IS NOT NECESSARILY ASSOCIATED WITH A GREATER NUMBER OF LYMPH NODE POSITIVE CANCERS L. Maggino, G. Malleo, F. Gulino, G. Butturini, R. Salvia and C. Bassi University of Verona, Italy Aims: Lymph node (LN) involvement is a major prognostic factor in pancreatic adenocarcinoma (PDAC). The total number of examined LN (exLN) is an important parameter in assessing the quality of surgery and histopathological analysis; still its impact on accurate staging is poorly understood.
Our aim was to assess the trends in LN harvesting over time in a Western high volume center, and its relationship with the identification of LN positive (N+) tumors. Methods: Surgical and pathological data of 811 patients who underwent resection for PDAC between 1999 and 2013 were retrospectively reviewed. Patients were divided in three groups according to the year of surgery (group 1: 1999e2005; group 2: 2006e2009; group 3: 2010e2013). We compared the mean exLN number and the proportion of N1 patients among the groups. When detailed pathological data on the specific site of LN retrieval were available (582 patients) each LN station was analyzed separately. Results: The mean number of exLN was 30.05 (SD 14,74; range 3e104). Comparison between the three groups showed a significant increase (ANOVA test: p < 0.001) in LN yield both for pancreaticoduodenectomies (mean exLN: 24.911.6 vs 25.210.2 vs 37.214.4) and distal pancreatectomies (21.911.5 vs 26.211.7 vs 34.912.0). This trend affected most of the LN stations without a clear topographic predominance. Conversely no corresponding significant trend in the proportion of N+ cases (81.3% vs 80.9% vs 83.5%; Chi square test: p = 0,691) was found. Conclusions: We show a generalized increase in LN harvesting in a Western high volume center over time. However, this is not necessarily associated with an increased number of N+ cancers.
PANCREAS CANCER 0840 AUDIT OF EMERGENCY PRESENTATION OF PANCREATIC CANCER D. Ojo, A. R. Dennison and G. Garcea University Hospitals of Leicester NHS Trust, UK Aims: There are political and clinical imperatives driving the need for the earlier diagnosis of malignancy and improved outcomes. According to the National Cancer Intelligence Network (NCIN), pancreatic cancer has the 3rd highest emergency presentation of all cancers in the UK (a 2010 study including 47% of all pancreatic cancers diagnosed that year). This audit evaluated any presentations to primary care in patients admitted with an emergency diagnosis of pancreatic cancer, to determine if earlier diagnosis was feasible Methods: We traced back through patients’ journeys with a diagnosis of pancreatic cancer made on an emergency admission. 51 newly diagnosed pancreatic cancers patients presented as an emergency in 2013 with adequate data records. Patient notes were then evaluated to determine if any patients had consulted their GP within 6 months of presentation with symptoms which could have been an early warning of pancreatic cancer. The definition of emergency presentation was any attendance to hospital via an emergency GP referral, emergency department or referral from outpatient clinic. Results: 51% of patients had presented to their GP within 6 months prior to diagnosis with symptoms (not including referral preceding their emergency admission). 20 of the 51 patients had previously undergone procedures to investigate upper abdominal pain performed within 6 months of
HPB 2016, 18 (S2), e747ee781
E-HPBA: Poster Abstracts presentation; 11 patients undergoing ultrasound scans and 7 oesophagogastroduodenoscopy. The rate of resectable disease in patients presenting as an emergency was predictably poor comprising only 5 out of 51. 49% of patients at their emergency presentation were found to have metastases and 29% found to have locally advanced disease
HPB 2016, 18 (S2), e747ee781
e781
Conclusions: The high prevalence of investigations for upper abdominal pain in this cohort would suggest that symptoms worthy of GP consultation often precede the emergency presentation of pancreas cancer. Expansion on this data collection is urgently needed both to increase GP awareness and hopefully improve early detection.