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Effects of volumetric fat parameters on severity of acute pancreatitis
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Abstracts / Pancreatology 12 (2012) e1–e8
Oral Presentation
1.1.
Conclusions: Total pancreatectomy is effective in reducing pain and improving quality of life in patients with chronic pancreatitis. The addition of autologous islet cell transplantation may result in insulin independence and reduces insulin requirements in those who are not. Take-home message: Impact of Total Pancreatectomy on quality of life in patients with chronic pancreatitis.
Comparative effects of caffeine metabolites on ca2+ signalling, cellular necrosis and acute pancreatitis M.C. Cane 1, W. Huang 1, 2, A.V. Tepikin 1, R. Sutton 2, D.N. Criddle 1
1.3.
1
Prevention of post-ercp acute pancreatitis: Complete systematic review
Department of Cellular and Molecular Physiology, Institute of Translational Medicine, University of Liverpool, UK, 2 Liverpool NIHR Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, UK
K. Altaf 1, M.A Javed 1, F. Wright 2, R. Sutton 1 1
Category: Malignant Abstract: Sustained elevations of cytosolic Ca2+ induce pancreatic acinar cell (PAC) death. Caffeine inhibits Ca2+ elevations and necrosis in vitro, and ameliorates AP in vivo, potentially via inhibition of the inositol 1,4,5 -trisphosphate receptor (IP3R). We aimed to compare inhibition of IP3R-mediated Ca2+ signals by methylxanthines (caffeine, theophylline and paraxanthine) distinct from effects on IP3 production using caged IP3 (ciIP3-PM). Additionally, the relative amelioration of PAC necrosis in vitro and AP in vivo was determined. Ca2+ elevations (Fluo-4) and bile acid (500mM TLC-S) -induced necrosis (propidium iodide) were assessed using confocal microscopy of murine PACs. AP was induced by seven hourly injections (i.p.) of caerulein and the effect of xanthine treatment on standard parameters was assessed at 24 hours. All three xanthines inhibited IP3-mediated signals by >72.1%4.6 at 5mM and inhibited necrosis by almost half at 10mM. Caffeine ameliorated pancreatitis in a dose-dependent manner; serum amylase was reduced from 46.34.7 U/L to 30.94.4 and 26.23.1 U/L at 10 and 25 mg kg-1 respectively (p<0.05). Conversely, neither paraxanthine nor theophylline significantly ameliorated AP. Take-home message: Xanthines markedly inhibited IP3R-mediated Ca2+ release and necrosis, whereas neither theophylline nor paraxanthine significantly ameliorated AP in vivo, indicating a possible alternative mechanism by which caffeine ameliorates caerulein-induced AP.
1.2. Patient satisfaction following total pancreatectomy (with or without islet cell transplantation) for chronic pancreatitis G. Garcea, C.P. Pollard, A.R. Dennison
Liverpool NIHR Pancreas Biomedical Research Unit, Royal Liverpool and Broadgreen University Hospitals, NHS Trust, UK, 2 CRUK Cancer Research Centre, University of Liverpool, UK
Category: Malignant Background: Post-ERCP acute pancreatitis (post-ERCP-AP) occurs in w5% of patients undergoing ERCP, severe in w1%. Despite multiple trials, optimal prophylaxis remains undetermined. We sought to clarify the effectiveness of prophylactic interventions for post-ERCP AP through multiple meta-analyses of randomised clinical trials (RCTs). Methods: MEDLINE, EMBASE and the Cochrane Library were searched by two independent reviewers to identify all RCTs that tested treatments to reduce post-ERCP AP. Data were extracted to permit Jadad scoring, grouping of RCTs by therapeutic mechanism and separate meta-analysis of each group. The main outcome measure was post-ERCP AP; defined as amylase elevated to >3x upper limit of normal with >24 h abdominal pain. Results: 49 high quality RCTs (Jadad 3) were identified. Pancreatic stents (trials (T)– 3;patients(P)–294;RR-0.21;95%CI0.09-0.50) were most effective; significant reductions in post-ERCP AP resulted from nonsteroidal anti-inflammatory drugs (NSAIDs;T–8;P–1901;RR-0.59;CI-0.380.92), secretion inhibitors (T–12;P–4178;RR-0.61;CI-0.43-0.88), protease inhibitors (T–6; P–3296;RR-0.59;CI-0.38-0.93) and smooth muscle relaxants (T–6;P–1903;RR-0.68;CI-0.48-0.97). Anti-oxidants (T–5;P–2100;RR0.90;CI-0.54-1.50), anti-coagulants (T–2;P–553;RR-0.94;CI-0.54-1.65), non-ionic (vs ionic) contrast agents (T–3;P–2155;RR-1.12;CI-0.86-1.46) and steroids (T–4;P–2039;RR-1.18;CI-0.93-1.50) did not reduce post-ERCP AP. Conclusion: Pancreatic stents, NSAIDs, protease and secretion inhibitors and smooth muscle relaxants reduce the risk of post-ERCP AP. Large well-designed RCTs of combination versus single agent prophylaxis are required. Take-home message: Post-ERCP AP can be prevented by using pharmacological agents and interventional techniques. Large RCTs are required to ascertain the results.
Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester, UK Category: Malignant Introduction: Total pancreatectomy (TP) is the last resort in pain control for chronic pancreatitis. Patients who had undergone a previous total pancreatectomy (+/- autologous islet cell transplantation) were polled to evaluate their outcome. Methods: Questionnaires were mailed to all patients alive following TP. Reponses were collated. Questions asked related to patients' pain scores pre and post surgery; insulin requirements and quality of life. Results: 77 patients were polled (60 “islets” & 17 “non-islets”), return rates were 45% for islet and 35.3% respectively. 97% reported that they were pleased with their operation with over 90% reporting that their pancreas pain had gone completely. Median visual analogue scores for pain (VAS) were 10 pre-operatively and 2 post-operatively. 25.9% of islet patients were insulin independent and those requiring insulin had lower daily requirements than non-islet patients (39 versus 60 units). The majority of patients reported that the surgery had improved their quality of life and they would recommend it to others (97.0% and 100%).
1.4. Effects of volumetric fat parameters on severity of acute pancreatitis D.P. O'Leary, D. O'Neill, S. O'Neill, E. Myers, M.M. Maher, H.P. Redmond Cork University Hospital, Ireland Category: Malignant Abstract: Obesity is a well-established risk factor for acute pancreatitis. Increased visceral fat adiposity has been shown to exacerbate the proinflammatory milieu experienced by patients. This study aimed to investigate the relationship between severity of acute pancreatitis and individual fat volumes measured on Computed Tomography (CT) scan. Methods: Consecutive patients admitted to Cork University Hospital with acute pancreatitis between 2005 and 2010 were evaluated. Webbased image analysis software, Osirix v3.9, was used to calculate individual fat volume parameters by segmentation of abdominal tissues.
Abstracts / Pancreatology 12 (2012) e1–e8
Results: A total of 214 patients were identified. 62 patients underwent a CT scan and were thus eligible for inclusion. Visceral fat volume was the volumetric fat parameter with the most significant association with severe acute pancreatitis (p¼0.003). There was a significant association between visceral fat volume and subsequent development of systemic complications of severe acute pancreatitis (p¼0.003). There was a strong association between mortality and visceral fat volume (p¼0.019). Conclusion: Overall, CT volumetry indicates a strong association between visceral fat, severe acute pancreatitis and the subsequent development of systemic complications. This data suggests that visceral fat volume analysis should be incorporated into future predictive scoring systems. Take-home message: Visceral fat volume significantly contributes to the pro-inflammatory milieu experienced by patients with acute pancreatitis.
1.5. Utility of eus-fna for identifying (pre-)malignant pancreatic cysts Hannah R. Dadds 1, Geraldine Keane 2, Matthew T. Huggett 1, 2, Stephen P. Pereira 1, 2 1
UCL Institute of Hepatology, UCLH, UK 2 Department of Gastroenterology, UCLH, UK
Category: Benign & Inflammatory Introduction: EUS-FNA has been increasingly utilised to differentiate (pre-)malignant pancreatic cysts from benign disease. We reviewed the management of patients with cystic lesions of the pancreas at a single centre. Methods: From Jan 2004 - Dec 2010, all HPB multidisciplinary meeting records at UCLH were reviewed for the diagnosis of a pancreatic cystic lesion. All patients with a cystic lesion on initial imaging were included in the study. Results: Of 224 patients identified with pancreatic cystic lesions, 46 (21%) had surgical resection of their cysts and 170 (70%) were treated conservatively; 8 (4%) patients were lost to follow-up. Of the 178/224 with confirmed diagnosis of the pancreatic cyst subtype, 90 (51%) had benign cysts (mostly pseudocysts) while 88 (48%) had cystic lesions showing (pre-)malignant disease (37 intraductal papillary mucinous neoplasms (IPMN)), 7 mucinous adenomas and 44 carcinoma (CA)). To date, no CA have been detected in the surveillance group 170/224. 126 (56%) patients underwent EUS-FNA, 26 (21%) of these patients had preoperative EUS-FNA followed by surgical resection of their cystic lesions - 6 IPMN & 10 CA were diagnosed. In this group, operative histology showed EUS-FNA to have a sensitivity, specificity, PPV & NPV for identifying mucinous from nonmucinous cysts of 100%, 88%, 83% and 100%, respectively. Conclusion: EUS-FNA is an accurate and reliable diagnostic tool for the identification of (pre-)malignant mucinous pancreatic cysts. Take-home message: EUS-FNA has been increasingly utilised to differentiate (pre-)malignant pancreatic cysts from benign disease. We reviewed the management of patients with cystic lesions of the pancreas at a single centre. We concluded that EUS-FNA is an accurate and reliable diagnostic tool for the identification of (pre-)malignant mucinous pancreatic cysts.
1.6. N-3 fatty acids in the aetiology of pancreatic cancer. Data from a uk prospective cohort study using 7-day food diaries P.J.R. Banim 1, R. Luben 2, A. McTaggart 2, K.-T. Khaw 2, N. Wareham 3, A.R. Hart 1 1
Norwich Medical School, University of East Anglia, Norwich, UK Institute of Public Health, University of Cambridge, UK, 3 MRC Epidemiology, University of Cambridge, Cambridge, UK
2
e3
Category: Malignant Introduction: N-3 fatty acids exert biological effects on oncogenes, apoptosis and inflammatory processes which could prevent pancreatic cancer. This prospective cohort study investigated the risk of developing pancreatic cancer according to dietary n-3 fatty acid intake, estimated from seven-day food diaries (7-DFDs). Methods: 23,658 participants were recruited into the European Prospective Investigation into Cancer-Norfolk, completing 7-DFDs at enrolment and monitored for 10 years to identify participants who developed pancreatic cancer. A case-cohort analysis was performed using 3,970 control participants, estimating hazard ratios (HRs) for developing pancreatic cancer for total n-3's, eicosapentenoic acid (EPA) and docosapentenoic acid (DHA) intake, adjusted for age, gender, energy intake, smoking, body mass index and diabetes. Results: 51 participants developed pancreatic cancer with the highest quintile of total n-3 intake vs. the lowest HR¼0.30 (95%CI¼0.071.21,p¼0.092) with a trend across quintiles of HR¼0.84 (95%CI¼0.671.07,p¼0.16). The highest quintile of DHA intake was associated with a 60% protective effect (HR¼0.40,95%CI¼0.15-1.08,p¼0.070) with a trend HR¼0.80 (95%CI¼0.65-0.98,p¼0.031). EPA intake was associated with a non-significant decreased risk (trend HR¼0.85,95%CI¼0.70-1.05,p¼0.13). Conclusion: Increased dietary n-3 fatty acid intake, and in particular DHA, was associated with a decreased risk of developing pancreatic cancer, suggesting they should be measured in future work and may prevent disease. Take-home message: Dietary n-3 fatty acid intake, and in particular docosahexenoic acid, was associated with a decreased risk of developing pancreatic cancer for which there are plausible biological mechanisms.
2.1. Clinopathologic factors influencing syrvival of patients with distal bile duct adenocarcinoma Dr. D.A. Anthoney 1, Dr. K. Kamposioras 1, Dr. A. Cairns 2, Mr. A.M. Smith 3, Mr. K. Menon 3, Dr. G. Ferentinos 4, Dr. C.S. Verbeke 2 1 Department of Oncology, The Leeds Teaching Hospitals NHS Trust, Leeds, UK, 2 Department of Histopathology, The Leeds Teaching Hospitals NHS Trust, Leeds, UK, 3 Department of Surgery, The Leeds Teaching Hospitals NHS Trust, Leeds, UK, 4 Hellenic Centre for Disease Control and Prevention, Greece
Category: Malignant Background: Distal bile duct adenocarcinoma (DBDA) is a rare malignancy and the prognostic factors that influence survival following curative resection remain unknown. Aims of this study were to retrospectively analyse clinicopathological features of a series of resected DBDA and their influence on survival. Materials and Methods: Patients undergoing curative pancreatoduodenectomy for DBDA between January 2001 and April 2009 were identified from our pathology database. Histopathological, demographics, and survival data were analysed. Results: 66 patients were identified (median age: 64 years). 97% of cases were stage pT3, 76% showed nodal metastasis and 76% vascular invasion. Margin involvement was found in 71%. Overall median survival was 23.3 months (range 1–121 months);. In univariate analysis younger age (<65), tumor site (distal DBDA), size (<2cm), resection margins (R0), absence of vascular and perineural invasion, absence of LN involvement and LN ratio (<0.15) were predictors of survival. Multivariate analysis revealed that favourable factors for survival included up to 2 positive nodes (HR¼3.6), well differentiated tumors (HR¼2.4) and age younger than 65 years (HR¼1.96). Conclusion: Younger patients with well differentiated DBDA and 2 or less involved LNs have longer survival port radical resection. Confirmation of these findings in larger series is recommended.
Abstracts / Pancreatology 12 (2012) e1–e8
Oral Presentation
1.1.
Conclusions: Total pancreatectomy is effective in reducing pain and improving quality of life in patients with chronic pancreatitis. The addition of autologous islet cell transplantation may result in insulin independence and reduces insulin requirements in those who are not. Take-home message: Impact of Total Pancreatectomy on quality of life in patients with chronic pancreatitis.
Comparative effects of caffeine metabolites on ca2+ signalling, cellular necrosis and acute pancreatitis M.C. Cane 1, W. Huang 1, 2, A.V. Tepikin 1, R. Sutton 2, D.N. Criddle 1
1.3.
1
Prevention of post-ercp acute pancreatitis: Complete systematic review
Department of Cellular and Molecular Physiology, Institute of Translational Medicine, University of Liverpool, UK, 2 Liverpool NIHR Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, UK
K. Altaf 1, M.A Javed 1, F. Wright 2, R. Sutton 1 1
Category: Malignant Abstract: Sustained elevations of cytosolic Ca2+ induce pancreatic acinar cell (PAC) death. Caffeine inhibits Ca2+ elevations and necrosis in vitro, and ameliorates AP in vivo, potentially via inhibition of the inositol 1,4,5 -trisphosphate receptor (IP3R). We aimed to compare inhibition of IP3R-mediated Ca2+ signals by methylxanthines (caffeine, theophylline and paraxanthine) distinct from effects on IP3 production using caged IP3 (ciIP3-PM). Additionally, the relative amelioration of PAC necrosis in vitro and AP in vivo was determined. Ca2+ elevations (Fluo-4) and bile acid (500mM TLC-S) -induced necrosis (propidium iodide) were assessed using confocal microscopy of murine PACs. AP was induced by seven hourly injections (i.p.) of caerulein and the effect of xanthine treatment on standard parameters was assessed at 24 hours. All three xanthines inhibited IP3-mediated signals by >72.1%4.6 at 5mM and inhibited necrosis by almost half at 10mM. Caffeine ameliorated pancreatitis in a dose-dependent manner; serum amylase was reduced from 46.34.7 U/L to 30.94.4 and 26.23.1 U/L at 10 and 25 mg kg-1 respectively (p<0.05). Conversely, neither paraxanthine nor theophylline significantly ameliorated AP. Take-home message: Xanthines markedly inhibited IP3R-mediated Ca2+ release and necrosis, whereas neither theophylline nor paraxanthine significantly ameliorated AP in vivo, indicating a possible alternative mechanism by which caffeine ameliorates caerulein-induced AP.
1.2. Patient satisfaction following total pancreatectomy (with or without islet cell transplantation) for chronic pancreatitis G. Garcea, C.P. Pollard, A.R. Dennison
Liverpool NIHR Pancreas Biomedical Research Unit, Royal Liverpool and Broadgreen University Hospitals, NHS Trust, UK, 2 CRUK Cancer Research Centre, University of Liverpool, UK
Category: Malignant Background: Post-ERCP acute pancreatitis (post-ERCP-AP) occurs in w5% of patients undergoing ERCP, severe in w1%. Despite multiple trials, optimal prophylaxis remains undetermined. We sought to clarify the effectiveness of prophylactic interventions for post-ERCP AP through multiple meta-analyses of randomised clinical trials (RCTs). Methods: MEDLINE, EMBASE and the Cochrane Library were searched by two independent reviewers to identify all RCTs that tested treatments to reduce post-ERCP AP. Data were extracted to permit Jadad scoring, grouping of RCTs by therapeutic mechanism and separate meta-analysis of each group. The main outcome measure was post-ERCP AP; defined as amylase elevated to >3x upper limit of normal with >24 h abdominal pain. Results: 49 high quality RCTs (Jadad 3) were identified. Pancreatic stents (trials (T)– 3;patients(P)–294;RR-0.21;95%CI0.09-0.50) were most effective; significant reductions in post-ERCP AP resulted from nonsteroidal anti-inflammatory drugs (NSAIDs;T–8;P–1901;RR-0.59;CI-0.380.92), secretion inhibitors (T–12;P–4178;RR-0.61;CI-0.43-0.88), protease inhibitors (T–6; P–3296;RR-0.59;CI-0.38-0.93) and smooth muscle relaxants (T–6;P–1903;RR-0.68;CI-0.48-0.97). Anti-oxidants (T–5;P–2100;RR0.90;CI-0.54-1.50), anti-coagulants (T–2;P–553;RR-0.94;CI-0.54-1.65), non-ionic (vs ionic) contrast agents (T–3;P–2155;RR-1.12;CI-0.86-1.46) and steroids (T–4;P–2039;RR-1.18;CI-0.93-1.50) did not reduce post-ERCP AP. Conclusion: Pancreatic stents, NSAIDs, protease and secretion inhibitors and smooth muscle relaxants reduce the risk of post-ERCP AP. Large well-designed RCTs of combination versus single agent prophylaxis are required. Take-home message: Post-ERCP AP can be prevented by using pharmacological agents and interventional techniques. Large RCTs are required to ascertain the results.
Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester, UK Category: Malignant Introduction: Total pancreatectomy (TP) is the last resort in pain control for chronic pancreatitis. Patients who had undergone a previous total pancreatectomy (+/- autologous islet cell transplantation) were polled to evaluate their outcome. Methods: Questionnaires were mailed to all patients alive following TP. Reponses were collated. Questions asked related to patients' pain scores pre and post surgery; insulin requirements and quality of life. Results: 77 patients were polled (60 “islets” & 17 “non-islets”), return rates were 45% for islet and 35.3% respectively. 97% reported that they were pleased with their operation with over 90% reporting that their pancreas pain had gone completely. Median visual analogue scores for pain (VAS) were 10 pre-operatively and 2 post-operatively. 25.9% of islet patients were insulin independent and those requiring insulin had lower daily requirements than non-islet patients (39 versus 60 units). The majority of patients reported that the surgery had improved their quality of life and they would recommend it to others (97.0% and 100%).
1.4. Effects of volumetric fat parameters on severity of acute pancreatitis D.P. O'Leary, D. O'Neill, S. O'Neill, E. Myers, M.M. Maher, H.P. Redmond Cork University Hospital, Ireland Category: Malignant Abstract: Obesity is a well-established risk factor for acute pancreatitis. Increased visceral fat adiposity has been shown to exacerbate the proinflammatory milieu experienced by patients. This study aimed to investigate the relationship between severity of acute pancreatitis and individual fat volumes measured on Computed Tomography (CT) scan. Methods: Consecutive patients admitted to Cork University Hospital with acute pancreatitis between 2005 and 2010 were evaluated. Webbased image analysis software, Osirix v3.9, was used to calculate individual fat volume parameters by segmentation of abdominal tissues.
Abstracts / Pancreatology 12 (2012) e1–e8
Results: A total of 214 patients were identified. 62 patients underwent a CT scan and were thus eligible for inclusion. Visceral fat volume was the volumetric fat parameter with the most significant association with severe acute pancreatitis (p¼0.003). There was a significant association between visceral fat volume and subsequent development of systemic complications of severe acute pancreatitis (p¼0.003). There was a strong association between mortality and visceral fat volume (p¼0.019). Conclusion: Overall, CT volumetry indicates a strong association between visceral fat, severe acute pancreatitis and the subsequent development of systemic complications. This data suggests that visceral fat volume analysis should be incorporated into future predictive scoring systems. Take-home message: Visceral fat volume significantly contributes to the pro-inflammatory milieu experienced by patients with acute pancreatitis.
1.5. Utility of eus-fna for identifying (pre-)malignant pancreatic cysts Hannah R. Dadds 1, Geraldine Keane 2, Matthew T. Huggett 1, 2, Stephen P. Pereira 1, 2 1
UCL Institute of Hepatology, UCLH, UK 2 Department of Gastroenterology, UCLH, UK
Category: Benign & Inflammatory Introduction: EUS-FNA has been increasingly utilised to differentiate (pre-)malignant pancreatic cysts from benign disease. We reviewed the management of patients with cystic lesions of the pancreas at a single centre. Methods: From Jan 2004 - Dec 2010, all HPB multidisciplinary meeting records at UCLH were reviewed for the diagnosis of a pancreatic cystic lesion. All patients with a cystic lesion on initial imaging were included in the study. Results: Of 224 patients identified with pancreatic cystic lesions, 46 (21%) had surgical resection of their cysts and 170 (70%) were treated conservatively; 8 (4%) patients were lost to follow-up. Of the 178/224 with confirmed diagnosis of the pancreatic cyst subtype, 90 (51%) had benign cysts (mostly pseudocysts) while 88 (48%) had cystic lesions showing (pre-)malignant disease (37 intraductal papillary mucinous neoplasms (IPMN)), 7 mucinous adenomas and 44 carcinoma (CA)). To date, no CA have been detected in the surveillance group 170/224. 126 (56%) patients underwent EUS-FNA, 26 (21%) of these patients had preoperative EUS-FNA followed by surgical resection of their cystic lesions - 6 IPMN & 10 CA were diagnosed. In this group, operative histology showed EUS-FNA to have a sensitivity, specificity, PPV & NPV for identifying mucinous from nonmucinous cysts of 100%, 88%, 83% and 100%, respectively. Conclusion: EUS-FNA is an accurate and reliable diagnostic tool for the identification of (pre-)malignant mucinous pancreatic cysts. Take-home message: EUS-FNA has been increasingly utilised to differentiate (pre-)malignant pancreatic cysts from benign disease. We reviewed the management of patients with cystic lesions of the pancreas at a single centre. We concluded that EUS-FNA is an accurate and reliable diagnostic tool for the identification of (pre-)malignant mucinous pancreatic cysts.
1.6. N-3 fatty acids in the aetiology of pancreatic cancer. Data from a uk prospective cohort study using 7-day food diaries P.J.R. Banim 1, R. Luben 2, A. McTaggart 2, K.-T. Khaw 2, N. Wareham 3, A.R. Hart 1 1
Norwich Medical School, University of East Anglia, Norwich, UK Institute of Public Health, University of Cambridge, UK, 3 MRC Epidemiology, University of Cambridge, Cambridge, UK
2
e3
Category: Malignant Introduction: N-3 fatty acids exert biological effects on oncogenes, apoptosis and inflammatory processes which could prevent pancreatic cancer. This prospective cohort study investigated the risk of developing pancreatic cancer according to dietary n-3 fatty acid intake, estimated from seven-day food diaries (7-DFDs). Methods: 23,658 participants were recruited into the European Prospective Investigation into Cancer-Norfolk, completing 7-DFDs at enrolment and monitored for 10 years to identify participants who developed pancreatic cancer. A case-cohort analysis was performed using 3,970 control participants, estimating hazard ratios (HRs) for developing pancreatic cancer for total n-3's, eicosapentenoic acid (EPA) and docosapentenoic acid (DHA) intake, adjusted for age, gender, energy intake, smoking, body mass index and diabetes. Results: 51 participants developed pancreatic cancer with the highest quintile of total n-3 intake vs. the lowest HR¼0.30 (95%CI¼0.071.21,p¼0.092) with a trend across quintiles of HR¼0.84 (95%CI¼0.671.07,p¼0.16). The highest quintile of DHA intake was associated with a 60% protective effect (HR¼0.40,95%CI¼0.15-1.08,p¼0.070) with a trend HR¼0.80 (95%CI¼0.65-0.98,p¼0.031). EPA intake was associated with a non-significant decreased risk (trend HR¼0.85,95%CI¼0.70-1.05,p¼0.13). Conclusion: Increased dietary n-3 fatty acid intake, and in particular DHA, was associated with a decreased risk of developing pancreatic cancer, suggesting they should be measured in future work and may prevent disease. Take-home message: Dietary n-3 fatty acid intake, and in particular docosahexenoic acid, was associated with a decreased risk of developing pancreatic cancer for which there are plausible biological mechanisms.
2.1. Clinopathologic factors influencing syrvival of patients with distal bile duct adenocarcinoma Dr. D.A. Anthoney 1, Dr. K. Kamposioras 1, Dr. A. Cairns 2, Mr. A.M. Smith 3, Mr. K. Menon 3, Dr. G. Ferentinos 4, Dr. C.S. Verbeke 2 1 Department of Oncology, The Leeds Teaching Hospitals NHS Trust, Leeds, UK, 2 Department of Histopathology, The Leeds Teaching Hospitals NHS Trust, Leeds, UK, 3 Department of Surgery, The Leeds Teaching Hospitals NHS Trust, Leeds, UK, 4 Hellenic Centre for Disease Control and Prevention, Greece
Category: Malignant Background: Distal bile duct adenocarcinoma (DBDA) is a rare malignancy and the prognostic factors that influence survival following curative resection remain unknown. Aims of this study were to retrospectively analyse clinicopathological features of a series of resected DBDA and their influence on survival. Materials and Methods: Patients undergoing curative pancreatoduodenectomy for DBDA between January 2001 and April 2009 were identified from our pathology database. Histopathological, demographics, and survival data were analysed. Results: 66 patients were identified (median age: 64 years). 97% of cases were stage pT3, 76% showed nodal metastasis and 76% vascular invasion. Margin involvement was found in 71%. Overall median survival was 23.3 months (range 1–121 months);. In univariate analysis younger age (<65), tumor site (distal DBDA), size (<2cm), resection margins (R0), absence of vascular and perineural invasion, absence of LN involvement and LN ratio (<0.15) were predictors of survival. Multivariate analysis revealed that favourable factors for survival included up to 2 positive nodes (HR¼3.6), well differentiated tumors (HR¼2.4) and age younger than 65 years (HR¼1.96). Conclusion: Younger patients with well differentiated DBDA and 2 or less involved LNs have longer survival port radical resection. Confirmation of these findings in larger series is recommended.