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Downstaging of liver metastases from pancreatic cancer following primary chemotherapy: A new indication for surgery?
e774
E-AHPBA: Poster Abstracts
Of 16 LW patients, 12 [75%] had cancer [92% R0 resection]. Median tumor size was 21 mm [IQR17-30], median operative time 420 min [IQR371-484] and median blood loss 450 mL [IQR250-1000]. After LW, 3 patients [19%] developed an ISGPF grade B pancreatic fistula, 4 patients [25%] a ISGPS grade B/C gastroparesis and 7 patients [44%] underwent a reintervention (radiologic/endoscopic). Median length of stay was 14 days [IQR9-17]. Conclusions: In this initial experience in a selected group of patients undergoing laparoscopic pancreatic surgery, no obvious improvement or deterioration of relevant outcomes was found. Future comparative studies will have to determine the true added value of laparoscopic pancreatic surgery.
PANCREAS CANCER 0695 DELAYED POST-PANCREATECTOMY HEMORRHAGE AFTER LEFT PANCREATECTOMY: INCIDENCE, RISK FACTORS AND UNUSUAL CLINICAL PRESENTATIONS M. C. Salandini, F. Muffatti, M. Bissolati, O. Adamenko, F. Aleotti, S. Nobile, S. Crippa, S. Partelli, M. Falconi and G. Balzano San Raffaele Scientific Institute, Italy Aims: Few data on delayed post-left pancreatectomy hemorrhage (D-PLPH) are available in the literature. Methods: The institutional prospective database was queried in order to select data on consecutive left pancreatectomies (LPs) performed between March 2006 and December 2013, focusing on patients who experienced DPLPH. Results: 373 cases were analyzed. LPs with spleen and splenic vessels preservation (SSVP) were performed in 107 (28.6%) cases and a laparoscopic approach was used in 142 (38%). Nine patients (2.4%) experienced D-PLPH, 55.5% of them after discharge. Mean time from surgery to bleeding was 26.4 days (range: 3e51). Source of bleeding was splenic artery (SA: 3 cases), gastroduodenal artery (GDA: 1 case), left-gastric artery (LGA: 1 case), common hepatic artery (CHA: 1 case), others (3 cases). A postoperative fistula was present in 8 patients (88.9%). Four cases (44.4%) had an intraluminal bleeding. In 1 case DPLPH occurred from gastric varices due to a splenic vein thrombosis, successfully endoscopically treated. In the other three cases hemorrhage was from LGA, SA and CHE, respectively. Two patients were treated with embolization and the last with an arterial stenting followed by a surgical relaparotomy. Mortality was nil. In the whole cohort multivariable analysis showed that D-PLPH was significantly associated with spleen preservation (RR 4.1, 95%CI: 1e17, p = 0.050) and postoperative fistula (RR 7.7, 95% CI: 0.95e63, p = 0.055). Conclusions: D-PLPH might occur also after several days from pancreatic resection. In case of digestive bleeding, possible extraluminal hemorrhage with fistulization throughout either gastric or duodenal wall should be considered. A risk-benefit balance of SSVP in LP should considered due to the increased risk for DPLPH.
PANCREAS CANCER 0697 DOWNSTAGING OF LIVER METASTASES FROM PANCREATIC CANCER FOLLOWING PRIMARY CHEMOTHERAPY: A NEW INDICATION FOR SURGERY? F. Muffatti1, S. Crippa1, E. Sebastiani2, A. Bittoni2, S. Zanon1, A. Lanese2, K. Andrikou2, G. Balzano1, M. Reni1, S. Cascinu2 and M. Falconi1 1 San Raffaele Scientific Institute; 2Ospedali Riuniti Ancona, Italy Aims: New chemotherapy regimens have improved survival for stage IV pancreatic ductal adenocarcinoma (PDAC) and occasionally downstaging of liver metastases can be observed. Aim of this work is to analyze the outcomes of a cohort of patients undergoing primary chemotherapy for liver metastases from PDAC and evaluate the results of surgical resection. Methods: Retrospective analysis of a cohort of patients with liver metastases from PDAC from two referral centers who underwent primary chemotherapy. Exclusion criteria: patients with extra-hepatic metastases, patients with ECOG 3, patients undergoing supportive care alone. Results: 127 patients (76 males, 51 females, median age 65 years) were identified. 62 patients (49%) had a resectable/ borderline resectable tumor at diagnosis, and 65 (51%) a locally advanced PDAC. 111 patients (87.5%) had an ECOG score of 0e1. Liver metastases were unilobar in 29% of patients. Chemotherapy regimens included gemcitabine alone (16%), GEMOX (27.5%), FOLFIRINOX (8%), PEXG/PEFG (48.5%). 56 patients (44%) had a complete (n = 9) or partial response (n = 47). Surgical resection was carried out in 11 patients (8.5%), including all with complete response. Median disease-specific survival (DSS) and progression-free survival (PFS) for the entire cohort were 11 and 7 months. Months. Independent predictors of DSS were PEXG/FOLFIRINOX (HR:0.358) and surgical resection (HR:0.139). Median DSS and PFS for 56 patients with partial/complete response were 15 and 9 months, respectively. In this sub-group median DSS (46 versus 11 months) and PFS (21 versus 8 months) were significantly longer for patients undergoing resection (P < 0.0001). Conclusions: Although complete response is a rare, partial response can be accomplished in 4 out of 10 patients with liver metastases from PDAC. In this cohort median DSS reached 11 months, mainly due to chemotherapy regimens with multiple agents. Surgical resection can be considered when complete response is achieved after primary chemotherapy and it is associated with improved survival.
PANCREAS CANCER 0706 COMPARISON OF ROBOT-ASSISTED AND LAPAROSCOPIC MINIMALLY INVASIVE APPROACHES FOR PANCREATIC NEUROENDOCRINE NEOPLASMS F. Muffatti1, O. Adamenko1, S. Partelli1, R. Cirocchi2, J. Desiderio2, S. Crippa1, A. Parisi2 and M. Falconi1 1 San Raffaele Scientific Institute; 2St Maria Hospital, Italy
HPB 2016, 18 (S2), e747ee781
E-AHPBA: Poster Abstracts
Of 16 LW patients, 12 [75%] had cancer [92% R0 resection]. Median tumor size was 21 mm [IQR17-30], median operative time 420 min [IQR371-484] and median blood loss 450 mL [IQR250-1000]. After LW, 3 patients [19%] developed an ISGPF grade B pancreatic fistula, 4 patients [25%] a ISGPS grade B/C gastroparesis and 7 patients [44%] underwent a reintervention (radiologic/endoscopic). Median length of stay was 14 days [IQR9-17]. Conclusions: In this initial experience in a selected group of patients undergoing laparoscopic pancreatic surgery, no obvious improvement or deterioration of relevant outcomes was found. Future comparative studies will have to determine the true added value of laparoscopic pancreatic surgery.
PANCREAS CANCER 0695 DELAYED POST-PANCREATECTOMY HEMORRHAGE AFTER LEFT PANCREATECTOMY: INCIDENCE, RISK FACTORS AND UNUSUAL CLINICAL PRESENTATIONS M. C. Salandini, F. Muffatti, M. Bissolati, O. Adamenko, F. Aleotti, S. Nobile, S. Crippa, S. Partelli, M. Falconi and G. Balzano San Raffaele Scientific Institute, Italy Aims: Few data on delayed post-left pancreatectomy hemorrhage (D-PLPH) are available in the literature. Methods: The institutional prospective database was queried in order to select data on consecutive left pancreatectomies (LPs) performed between March 2006 and December 2013, focusing on patients who experienced DPLPH. Results: 373 cases were analyzed. LPs with spleen and splenic vessels preservation (SSVP) were performed in 107 (28.6%) cases and a laparoscopic approach was used in 142 (38%). Nine patients (2.4%) experienced D-PLPH, 55.5% of them after discharge. Mean time from surgery to bleeding was 26.4 days (range: 3e51). Source of bleeding was splenic artery (SA: 3 cases), gastroduodenal artery (GDA: 1 case), left-gastric artery (LGA: 1 case), common hepatic artery (CHA: 1 case), others (3 cases). A postoperative fistula was present in 8 patients (88.9%). Four cases (44.4%) had an intraluminal bleeding. In 1 case DPLPH occurred from gastric varices due to a splenic vein thrombosis, successfully endoscopically treated. In the other three cases hemorrhage was from LGA, SA and CHE, respectively. Two patients were treated with embolization and the last with an arterial stenting followed by a surgical relaparotomy. Mortality was nil. In the whole cohort multivariable analysis showed that D-PLPH was significantly associated with spleen preservation (RR 4.1, 95%CI: 1e17, p = 0.050) and postoperative fistula (RR 7.7, 95% CI: 0.95e63, p = 0.055). Conclusions: D-PLPH might occur also after several days from pancreatic resection. In case of digestive bleeding, possible extraluminal hemorrhage with fistulization throughout either gastric or duodenal wall should be considered. A risk-benefit balance of SSVP in LP should considered due to the increased risk for DPLPH.
PANCREAS CANCER 0697 DOWNSTAGING OF LIVER METASTASES FROM PANCREATIC CANCER FOLLOWING PRIMARY CHEMOTHERAPY: A NEW INDICATION FOR SURGERY? F. Muffatti1, S. Crippa1, E. Sebastiani2, A. Bittoni2, S. Zanon1, A. Lanese2, K. Andrikou2, G. Balzano1, M. Reni1, S. Cascinu2 and M. Falconi1 1 San Raffaele Scientific Institute; 2Ospedali Riuniti Ancona, Italy Aims: New chemotherapy regimens have improved survival for stage IV pancreatic ductal adenocarcinoma (PDAC) and occasionally downstaging of liver metastases can be observed. Aim of this work is to analyze the outcomes of a cohort of patients undergoing primary chemotherapy for liver metastases from PDAC and evaluate the results of surgical resection. Methods: Retrospective analysis of a cohort of patients with liver metastases from PDAC from two referral centers who underwent primary chemotherapy. Exclusion criteria: patients with extra-hepatic metastases, patients with ECOG 3, patients undergoing supportive care alone. Results: 127 patients (76 males, 51 females, median age 65 years) were identified. 62 patients (49%) had a resectable/ borderline resectable tumor at diagnosis, and 65 (51%) a locally advanced PDAC. 111 patients (87.5%) had an ECOG score of 0e1. Liver metastases were unilobar in 29% of patients. Chemotherapy regimens included gemcitabine alone (16%), GEMOX (27.5%), FOLFIRINOX (8%), PEXG/PEFG (48.5%). 56 patients (44%) had a complete (n = 9) or partial response (n = 47). Surgical resection was carried out in 11 patients (8.5%), including all with complete response. Median disease-specific survival (DSS) and progression-free survival (PFS) for the entire cohort were 11 and 7 months. Months. Independent predictors of DSS were PEXG/FOLFIRINOX (HR:0.358) and surgical resection (HR:0.139). Median DSS and PFS for 56 patients with partial/complete response were 15 and 9 months, respectively. In this sub-group median DSS (46 versus 11 months) and PFS (21 versus 8 months) were significantly longer for patients undergoing resection (P < 0.0001). Conclusions: Although complete response is a rare, partial response can be accomplished in 4 out of 10 patients with liver metastases from PDAC. In this cohort median DSS reached 11 months, mainly due to chemotherapy regimens with multiple agents. Surgical resection can be considered when complete response is achieved after primary chemotherapy and it is associated with improved survival.
PANCREAS CANCER 0706 COMPARISON OF ROBOT-ASSISTED AND LAPAROSCOPIC MINIMALLY INVASIVE APPROACHES FOR PANCREATIC NEUROENDOCRINE NEOPLASMS F. Muffatti1, O. Adamenko1, S. Partelli1, R. Cirocchi2, J. Desiderio2, S. Crippa1, A. Parisi2 and M. Falconi1 1 San Raffaele Scientific Institute; 2St Maria Hospital, Italy
HPB 2016, 18 (S2), e747ee781