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Contemporary Analysis of Complications Associated with Biliary Stents During Neoadjuvant Therapy for Pancreatic Adenocarcinoma
Vol. 225, No. 4S2, October 2017
and radiation were associated with a survival benefit for GBC (chemotherapy: 14.6 months vs 11.5 months; p¼0.05, radiation: 16.8 months vs 11.3 months; p<0.001) and EHC (chemotherapy: 22.4 months vs 15.3 months; p<0.001, radiation: 23 months vs 16.7 months; p<0.001). Nodal positive disease benefited from chemotherapy for all disease sites (GBC: 23.6 months vs 16.8 months; p<0.001, IHC 23 vs 17.2 months; p¼0.004, EHC: 24.3 vs 18.2 months; p<0.001) whereas radiation was associated with a survival benefit for GBC (25 months vs 18 months; p<0.001) and EHC (24.3 months vs 20 months; p<0.001). CONCLUSIONS: Surgical margins and the presence of nodal disease are the main determinants of survival outcomes after resection of localized biliary tract cancer. Adjuvant chemotherapy and radiation should be strongly considered in node positive patients as they derive the greatest benefit. Contemporary Analysis of Complications Associated with Biliary Stents During Neoadjuvant Therapy for Pancreatic Adenocarcinoma Bradford J Kim, MD, Laura R Prakash, Nisha Narula, MD, Catherine H Davis, MD, Thomas A Aloia, MD, FACS, Jean Nicolas Vauthey, MD, Jeffrey E Lee, MD, FACS, Jason B Fleming, MD, FACS, Matthew H Katz, MD, FACS, Ching-Wei D Tzeng, MD, FACS University of Texas MD Anderson Cancer Center, Houston, TX INTRODUCTION: Concern regarding risk for pre- or post-pancreaticoduodenectomy (PD) infection in patients with biliary stents may affect willingness to administer neoadjuvant therapy (NT) to patients with resectable pancreatic head adenocarcinoma (PDAC). We sought to document the contemporary incidence of stent-related complications (SRC) during NT and analyze their impact on postoperative infection. METHODS: Consecutive patients from a single institution (2011 to 2015) with PDAC treated with biliary decompression, NT, and PD were analyzed. Clinical variables and incidence of both infectious and non-infectious SRC (“stent cholangitis” defined as requiring antibiotics with admission and/or exchange) were compared to composite postoperative infections (defined as surgical site infection [SSI], organ space infection [OSI], and/or cholangitis).
Scientific Poster Presentations: 2017 Clinical Congress
e121
intervention, there was no association with composite surgical infections. The concern for post-PD infectious sequelae from biliary stents should not preclude the consideration of neoadjuvant therapy for PDAC. Evaluation of Our Approach (Modified Blumgart Anastomosis) to Reducing the Incidence of Postoperative Pancreatic Fistula after a Pancreaticoduodenectomy in Cases with a Soft Pancreas Ken Hayashi, Shigetoshi Yamada, Hiroshi Kusanagi, MD, Nobuyasu Kano, MD, FACS Kameda Medical Center, Kamogawa, Japan INTRODUCTION: Postoperative pancreatic fistula (POPF) is the most critical complication after a pancreaticoduodenectomy (PD), especially in cases with a soft pancreas. The ideal technical pancreatic reconstruction after PD continues to be debated. The aim of the present study was to evaluate our approach (modified Blumgart anastomosis) to reducing the incidence of POPF after PD. METHODS: Between August 2011 and December 2016, 116 patients who underwent PD were enrolled. Pancreatic reconstruction was performed using the modified Kakita method between August 2011 and May 2015 (K-group: n ¼ 72) and the modified Blumgart method between June 2015 and December 2016 (B-group: n ¼ 31). We then compared the clinical data for the 2 groups retrospectively. RESULTS: The median age was 70 (26-86) years (73 men and 43 women). Seventy-seven cases had a soft pancreas, while 39 cases had a hard pancreas. The incidence of POPF (Grade B, C) as defined according to the ISGPF was 25.0% overall, 30.6% for the K-group, and 15.9% for the B-group, with no significance difference observed between the 2 groups (p ¼ 0.077). Among the cases with soft pancreas, the incidence of POPF (Grade B, C) was 33.8% overall, 45.7% in the K-group, and 19.4% in the B-group, with a significant difference observed between the 2 groups (p ¼ 0028). CONCLUSIONS: The modified Blumgart method is useful for reducing the incidence of POPF, especially in cases with a soft pancreas.
RESULTS: Among 114 patients (median duration NT: 74 days; median time from first stent to surgery: 163 days), 110 (96%) had initial endoscopic (vs percutaneous) stents. Initial stents were plastic in 80 (70%), of which 47 (41%) were exchanged to metal before NT. Fifteen (13%) patients had stent cholangitis. SRC resulted in 66 preoperative stent replacements in 32 (28%) patients. Post-PD rates of SSI, OSI, and cholangitis were 23%, 5%, and 4%, respectively [composite rate 30%]. Grade 3 complication rate was 18%. After adjusting for pre-/intraoperative variables, SRC was not associated with composite surgical infections (p¼0.576).
Exploring Epithelial-Mesenchymal Transition: Suppressive miRNAs Using Combination of Cell-Based Reporter System and miRNA Library Hidekazu Hiramoto, Tomoki Muramatsu, Daisuke Ichikawa, MD, Kousuke Tanimoto, PhD, Syuhei Komatsu, Satoru Yasukawa, Eigo Otsuji, Johji Inazawa Kyoto Prefectural University of Medicine, Kyoto, Japan; Tokyo Medical and Dental University, Tokyo, Japan
CONCLUSIONS: Although SRC occurred in almost one-third of PDAC patients stented before and during NT, with appropriate
INTRODUCTION: The epithelial-mesenchymal transition (EMT) is known to contribute to malignant phenotypes including
and radiation were associated with a survival benefit for GBC (chemotherapy: 14.6 months vs 11.5 months; p¼0.05, radiation: 16.8 months vs 11.3 months; p<0.001) and EHC (chemotherapy: 22.4 months vs 15.3 months; p<0.001, radiation: 23 months vs 16.7 months; p<0.001). Nodal positive disease benefited from chemotherapy for all disease sites (GBC: 23.6 months vs 16.8 months; p<0.001, IHC 23 vs 17.2 months; p¼0.004, EHC: 24.3 vs 18.2 months; p<0.001) whereas radiation was associated with a survival benefit for GBC (25 months vs 18 months; p<0.001) and EHC (24.3 months vs 20 months; p<0.001). CONCLUSIONS: Surgical margins and the presence of nodal disease are the main determinants of survival outcomes after resection of localized biliary tract cancer. Adjuvant chemotherapy and radiation should be strongly considered in node positive patients as they derive the greatest benefit. Contemporary Analysis of Complications Associated with Biliary Stents During Neoadjuvant Therapy for Pancreatic Adenocarcinoma Bradford J Kim, MD, Laura R Prakash, Nisha Narula, MD, Catherine H Davis, MD, Thomas A Aloia, MD, FACS, Jean Nicolas Vauthey, MD, Jeffrey E Lee, MD, FACS, Jason B Fleming, MD, FACS, Matthew H Katz, MD, FACS, Ching-Wei D Tzeng, MD, FACS University of Texas MD Anderson Cancer Center, Houston, TX INTRODUCTION: Concern regarding risk for pre- or post-pancreaticoduodenectomy (PD) infection in patients with biliary stents may affect willingness to administer neoadjuvant therapy (NT) to patients with resectable pancreatic head adenocarcinoma (PDAC). We sought to document the contemporary incidence of stent-related complications (SRC) during NT and analyze their impact on postoperative infection. METHODS: Consecutive patients from a single institution (2011 to 2015) with PDAC treated with biliary decompression, NT, and PD were analyzed. Clinical variables and incidence of both infectious and non-infectious SRC (“stent cholangitis” defined as requiring antibiotics with admission and/or exchange) were compared to composite postoperative infections (defined as surgical site infection [SSI], organ space infection [OSI], and/or cholangitis).
Scientific Poster Presentations: 2017 Clinical Congress
e121
intervention, there was no association with composite surgical infections. The concern for post-PD infectious sequelae from biliary stents should not preclude the consideration of neoadjuvant therapy for PDAC. Evaluation of Our Approach (Modified Blumgart Anastomosis) to Reducing the Incidence of Postoperative Pancreatic Fistula after a Pancreaticoduodenectomy in Cases with a Soft Pancreas Ken Hayashi, Shigetoshi Yamada, Hiroshi Kusanagi, MD, Nobuyasu Kano, MD, FACS Kameda Medical Center, Kamogawa, Japan INTRODUCTION: Postoperative pancreatic fistula (POPF) is the most critical complication after a pancreaticoduodenectomy (PD), especially in cases with a soft pancreas. The ideal technical pancreatic reconstruction after PD continues to be debated. The aim of the present study was to evaluate our approach (modified Blumgart anastomosis) to reducing the incidence of POPF after PD. METHODS: Between August 2011 and December 2016, 116 patients who underwent PD were enrolled. Pancreatic reconstruction was performed using the modified Kakita method between August 2011 and May 2015 (K-group: n ¼ 72) and the modified Blumgart method between June 2015 and December 2016 (B-group: n ¼ 31). We then compared the clinical data for the 2 groups retrospectively. RESULTS: The median age was 70 (26-86) years (73 men and 43 women). Seventy-seven cases had a soft pancreas, while 39 cases had a hard pancreas. The incidence of POPF (Grade B, C) as defined according to the ISGPF was 25.0% overall, 30.6% for the K-group, and 15.9% for the B-group, with no significance difference observed between the 2 groups (p ¼ 0.077). Among the cases with soft pancreas, the incidence of POPF (Grade B, C) was 33.8% overall, 45.7% in the K-group, and 19.4% in the B-group, with a significant difference observed between the 2 groups (p ¼ 0028). CONCLUSIONS: The modified Blumgart method is useful for reducing the incidence of POPF, especially in cases with a soft pancreas.
RESULTS: Among 114 patients (median duration NT: 74 days; median time from first stent to surgery: 163 days), 110 (96%) had initial endoscopic (vs percutaneous) stents. Initial stents were plastic in 80 (70%), of which 47 (41%) were exchanged to metal before NT. Fifteen (13%) patients had stent cholangitis. SRC resulted in 66 preoperative stent replacements in 32 (28%) patients. Post-PD rates of SSI, OSI, and cholangitis were 23%, 5%, and 4%, respectively [composite rate 30%]. Grade 3 complication rate was 18%. After adjusting for pre-/intraoperative variables, SRC was not associated with composite surgical infections (p¼0.576).
Exploring Epithelial-Mesenchymal Transition: Suppressive miRNAs Using Combination of Cell-Based Reporter System and miRNA Library Hidekazu Hiramoto, Tomoki Muramatsu, Daisuke Ichikawa, MD, Kousuke Tanimoto, PhD, Syuhei Komatsu, Satoru Yasukawa, Eigo Otsuji, Johji Inazawa Kyoto Prefectural University of Medicine, Kyoto, Japan; Tokyo Medical and Dental University, Tokyo, Japan
CONCLUSIONS: Although SRC occurred in almost one-third of PDAC patients stented before and during NT, with appropriate
INTRODUCTION: The epithelial-mesenchymal transition (EMT) is known to contribute to malignant phenotypes including