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Choledochal cyst: patterns of presentation, management, and outcome-case series
e516
Electronic Poster Abstracts
studies to demonstrate that RS is useful to avoid bile duct injury.
EP03F-007 CHOLEDOCHAL CYST: PATTERNS OF PRESENTATION, MANAGEMENT, AND OUTCOME-CASE SERIES D. Anna Reddy, V. Venkatarami Reddy, G. Sivaramakrishna, C. Chandramaliteeswaran and M. Brahmeswara Rao Surgical Gastroenterology, Srivenkateswara Institute of Medical Sciences, India Introduction: Choledochal cysts, typically a problem of infancy and childhood, can present in adults. Due to their malignant potential, complete excision with biliary reconstruction is the treatment of choice. Aim: To analyze the clinical, radiological characteristics, treatment offered and post-operative complications in patients with choledochal cysts treated at our institute. Methods: All patients diagnosed with choledochal cysts from 2000 to 2015 in our institute were retrospectively assessed. Demographic data, blood investigations, radiological characteristics, surgery done and post-operative complications were recorded and analyzed. Results: A total of 38 patients were diagnosed with choledochal cyst in the study period. 71% were female. Pain abdomen was the most common presenting symptom (97%), followed by jaundice (18%). Cholangitis was seen in 21% of the patients. Bilirubin was elevated in 21%, Alkaline phosphatase was elevated in 34%. 89% had Type I choledochal cysts, 8% had type IVA cysts, one patient had type IVB cyst. Anomalous pancreatico-biliary junction was identified on pre operative imaging in 4 patients. Cyst excision with reconstruction was done in patients with type I, type IV Bcholedochal cysts. Left Hepatectomy was done in 2 patients with type IVA cysts, one patient with type IVA cyst underwent left lateral segmentectomy. Post operatively wound infection was seen in 18%, bile leak was seen in 5%. Both patients with bile leak were managed conservatively. Conclusion: In choledochal cysts, typical triad of pain abdomen, jaundice and mass is uncommon. Complete excision is the treatment of choice to avoid complications like cirrhosis, hepaticolithiasis, pancreatitis, cholangitis, and cholangiocarcinoma.
EP03F-008 ENDOSCOPIC SELF-EXPANDABLE METALLIC STENTING VERSUS SURGICAL BYPASS FOR UNRESECTABLE MALIGNANT BILIARY OBSTRUCTION K. W. Ma1, A. C. Y. Chan1, W. C. Dai2, S. Tsang2, K. S. H. Chok2, T. T. Cheung2, S. C. Chan2 and C. M. Lo2 1 University of Hong Kong, and 2University of Hong Kong, Queen Mary Hospital, Hong Kong Background: Studies comparing surgical bypass and endoscopic metallic stenting (EMS) are scarce. This study serves to share our experience in this issue.
Method: Consecutive patients receiving surgery or endoscopic metallic stent insertion for malignant biliary obstruction were recruited. Results: There were 47 and 44 patients in surgery and EMS group respectively. The median age was 68 and 70 (P = 0.13). Majority of patients in surgery group had carcinoma of pancreas, constituting 92% of the cases, while in the EMS group, it is more evenly distributed with pancreatic cancer, cholangiocarcinoma and metastatic diseases amounting to 50%, 22.7% and 18.2% respectively. The median survival after intervention was seven and five months for surgery and EMS group respectively (P = 0.268). Hospital mortality was found in three patients from both groups. There was no difference between surgery and EMS group in terms of therapeutic successful rate (95.7% vs 93.2% P = 0.67) and complication rate (17% vs 11% P = 0.55), however, the reintervention rate (14.9% vs 47.7% P = 0.001) and need of percutaneous transhepatic biliary drainage (6.4% vs 27.3% P = 0.01) were significantly higher in EMS group, and the median hospital length of stay (3 vs 13 days P < 0.001) was significantly shorter in EMS group. Conclusion: Surgical bypass is the preferred treatment for apparently fit patients as it provides more durable biliary drainage, albeit, longer is the hospital stay. EMS remains an indispensible alternative for frail patients who might not withstand a major operation and with short expected survival.
EP03F-009 IMMUNOHISTOCHEMICAL FHENOTYPE AND SURVIVAL IN TUMORS OF THE AMPULLA OF VATER J. P. L. d. S. Santos1, P. T. Vidigal2, E. Paulino2, L. D. P. Lima3, H. A. Lima4, S. D. A. Araújo2, C. J. Machado5 and V. Resende6 1 Centro de Pós-Graduação, 2Departamento de Patologia, 3 Hospital das Clínicas, 4Faculdade de Medicina, 5 Departamento de Medicina Preventiva e Social, and 6 Departamento de Cirurgia, Universidade Federal de Minas Gerais, Brazil Several histopathologic features of ampullary tumors have been shown to be correlated with prognosis. We classified the tumors in pancreatobiliary and intestinal types and evaluated their relation with staging and survival. 33 Patients with ampullary carcinomas underwent to pancreaticoduodenectomy R0 resections. Clinicopathologic features were assessed. The immunohistochemical markers were MUC1, MUC2, MUC5AC, CDX2, CK7, CK20. The data were analyzed using univariate and multivariate methods. The two step cluster method was used to determine the immunohistochemical markers that best discriminate the intestinal from pancreaticobiliary type. The age of patients was 62.5 years, and the interquartile range from 54 to 62. There were 11 (33.3%) intestinal type and 21 (66.7%) pancreaticobiliary tumors. There was an association between N1 and pancreaticobiliary classification (p = 0.032). In univariate analysis, the variables with impact on survival were N (p = 0.004), T (p = 0.022) and stage (p < 0.001). The final model showed positive nodes (N1) associated with shorter survival (HR = 9.5; p = 0.006) compared to patients with N0. Overall survival at 12, 36 and 60 months was 88.5%, 67.0%, 47.6%, respectively.
HPB 2016, 18 (S1), e385ee601
Electronic Poster Abstracts
studies to demonstrate that RS is useful to avoid bile duct injury.
EP03F-007 CHOLEDOCHAL CYST: PATTERNS OF PRESENTATION, MANAGEMENT, AND OUTCOME-CASE SERIES D. Anna Reddy, V. Venkatarami Reddy, G. Sivaramakrishna, C. Chandramaliteeswaran and M. Brahmeswara Rao Surgical Gastroenterology, Srivenkateswara Institute of Medical Sciences, India Introduction: Choledochal cysts, typically a problem of infancy and childhood, can present in adults. Due to their malignant potential, complete excision with biliary reconstruction is the treatment of choice. Aim: To analyze the clinical, radiological characteristics, treatment offered and post-operative complications in patients with choledochal cysts treated at our institute. Methods: All patients diagnosed with choledochal cysts from 2000 to 2015 in our institute were retrospectively assessed. Demographic data, blood investigations, radiological characteristics, surgery done and post-operative complications were recorded and analyzed. Results: A total of 38 patients were diagnosed with choledochal cyst in the study period. 71% were female. Pain abdomen was the most common presenting symptom (97%), followed by jaundice (18%). Cholangitis was seen in 21% of the patients. Bilirubin was elevated in 21%, Alkaline phosphatase was elevated in 34%. 89% had Type I choledochal cysts, 8% had type IVA cysts, one patient had type IVB cyst. Anomalous pancreatico-biliary junction was identified on pre operative imaging in 4 patients. Cyst excision with reconstruction was done in patients with type I, type IV Bcholedochal cysts. Left Hepatectomy was done in 2 patients with type IVA cysts, one patient with type IVA cyst underwent left lateral segmentectomy. Post operatively wound infection was seen in 18%, bile leak was seen in 5%. Both patients with bile leak were managed conservatively. Conclusion: In choledochal cysts, typical triad of pain abdomen, jaundice and mass is uncommon. Complete excision is the treatment of choice to avoid complications like cirrhosis, hepaticolithiasis, pancreatitis, cholangitis, and cholangiocarcinoma.
EP03F-008 ENDOSCOPIC SELF-EXPANDABLE METALLIC STENTING VERSUS SURGICAL BYPASS FOR UNRESECTABLE MALIGNANT BILIARY OBSTRUCTION K. W. Ma1, A. C. Y. Chan1, W. C. Dai2, S. Tsang2, K. S. H. Chok2, T. T. Cheung2, S. C. Chan2 and C. M. Lo2 1 University of Hong Kong, and 2University of Hong Kong, Queen Mary Hospital, Hong Kong Background: Studies comparing surgical bypass and endoscopic metallic stenting (EMS) are scarce. This study serves to share our experience in this issue.
Method: Consecutive patients receiving surgery or endoscopic metallic stent insertion for malignant biliary obstruction were recruited. Results: There were 47 and 44 patients in surgery and EMS group respectively. The median age was 68 and 70 (P = 0.13). Majority of patients in surgery group had carcinoma of pancreas, constituting 92% of the cases, while in the EMS group, it is more evenly distributed with pancreatic cancer, cholangiocarcinoma and metastatic diseases amounting to 50%, 22.7% and 18.2% respectively. The median survival after intervention was seven and five months for surgery and EMS group respectively (P = 0.268). Hospital mortality was found in three patients from both groups. There was no difference between surgery and EMS group in terms of therapeutic successful rate (95.7% vs 93.2% P = 0.67) and complication rate (17% vs 11% P = 0.55), however, the reintervention rate (14.9% vs 47.7% P = 0.001) and need of percutaneous transhepatic biliary drainage (6.4% vs 27.3% P = 0.01) were significantly higher in EMS group, and the median hospital length of stay (3 vs 13 days P < 0.001) was significantly shorter in EMS group. Conclusion: Surgical bypass is the preferred treatment for apparently fit patients as it provides more durable biliary drainage, albeit, longer is the hospital stay. EMS remains an indispensible alternative for frail patients who might not withstand a major operation and with short expected survival.
EP03F-009 IMMUNOHISTOCHEMICAL FHENOTYPE AND SURVIVAL IN TUMORS OF THE AMPULLA OF VATER J. P. L. d. S. Santos1, P. T. Vidigal2, E. Paulino2, L. D. P. Lima3, H. A. Lima4, S. D. A. Araújo2, C. J. Machado5 and V. Resende6 1 Centro de Pós-Graduação, 2Departamento de Patologia, 3 Hospital das Clínicas, 4Faculdade de Medicina, 5 Departamento de Medicina Preventiva e Social, and 6 Departamento de Cirurgia, Universidade Federal de Minas Gerais, Brazil Several histopathologic features of ampullary tumors have been shown to be correlated with prognosis. We classified the tumors in pancreatobiliary and intestinal types and evaluated their relation with staging and survival. 33 Patients with ampullary carcinomas underwent to pancreaticoduodenectomy R0 resections. Clinicopathologic features were assessed. The immunohistochemical markers were MUC1, MUC2, MUC5AC, CDX2, CK7, CK20. The data were analyzed using univariate and multivariate methods. The two step cluster method was used to determine the immunohistochemical markers that best discriminate the intestinal from pancreaticobiliary type. The age of patients was 62.5 years, and the interquartile range from 54 to 62. There were 11 (33.3%) intestinal type and 21 (66.7%) pancreaticobiliary tumors. There was an association between N1 and pancreaticobiliary classification (p = 0.032). In univariate analysis, the variables with impact on survival were N (p = 0.004), T (p = 0.022) and stage (p < 0.001). The final model showed positive nodes (N1) associated with shorter survival (HR = 9.5; p = 0.006) compared to patients with N0. Overall survival at 12, 36 and 60 months was 88.5%, 67.0%, 47.6%, respectively.
HPB 2016, 18 (S1), e385ee601