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Efficacy and safety of postoperative anticoagulation therapy with enoxaparin in patients undergoing pancreatic surgery: a prospective clinical trial
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Abstracts / Pancreatology 17 (2017) S1eS142
Conclusion: Long-term nonoperative management is safe for BD-IPMN without WF and HRS. Discontinuation of surveillance cannot be recommended since one out of six patients developed WF/HRS far beyond 5 years of surveillance and without previous relevant modifications. An intensification of follow-up should be considered after 5 years.
Abstract ID: 1784. Meta-analysis on Recurrence After Curative Surgery of Pancreatic Neuroendocrine Tumors Cansu Genc 1, Tara Mackay 1, Susan van Dieren 2, Casper van Eijck 3, Els Nieveen van Dijkum 1 1 Academic Medical Center Amsterdan, Department of Surgery, Netherlands 2 Academic Medical Center Amsterdan, Department of Methodology and Statistic CRU, Netherlands 3 Erasmus Medical Center Rotterdam, Department of Surgery, Netherlands
Introduction: Follow-up after curative surgery for pancreatic neuroendocrine tumors (pNET) is designed to detect recurrence, however reliable recurrence rates are difficult to deduct from literature. Aims: This meta-analysis provides insight into the prognosis of patients after curative resection of non-metastasized grade 1 or 2 pNET through investigation of recurrence rates, time to recurrence, predictors for recurrence and survival after recurrence. Patients & methods: Literature search was performed on studies reporting recurrence after complete resection of grade 1 or 2 pNET without distant metastases or hereditary syndromes. Excluded were studies with less than 20 patients, R2 resection, high grade neuroendocrine carcinoma or (neo) adjuvant therapy. Results: Eight studies were included. Between 1982 and 2013, curative resection was performed in 734 patients, 100 had a recurrence. Mean weighted follow-up was 46.1 months. Pooled recurrence rate was 13% (95% CI 9-18%). Sub-analyses showed a pooled recurrence rate of 11% for nonfunctional tumors (p¼0.297), 8% for grade 1 tumors (p¼0.0027) and 10% for R0-resections (p¼0.0030). Weighted time to recurrence was 39.4 months. Locoregional recurrence was seen in 6%, distant metastases in 9% (p¼0.0109). Factors associated with recurrence were: tumor size, tumor grade, lymph node metastases, perineural invasion and R1 resection. Mean weighted survival after recurrence was 39.4 months. Conclusion: The presented results show that recurrence after curative surgery for pNET is not rare. Based on these results, reliable and evidence based follow-up regimen for the early detection of recurrence after curative surgery can be developed.
Abstract ID: 1787. Double balloon enteroscopy in the diagnosis and treatment of chronic pancreatitis surgery complications Aliaksandr Varabei, Anatoli Shuleika, Yury Arlouski, Egi Vizhinis Belarusian Medical Academy of Postgraduate Education, Surgery Dept, Belarus Introduction: esectiTo assess double balloon enteroscopy for diagnostics and treatment of pancreatojejunostomy complications after pancreatic resection. Aims: To assess double balloon enteroscopy for diagnostics and treatment of pancreatojejunostomy complications after pancreatic resection.
Materials & methods: During 2010 till 2017 of 26 patients with suspected of pancreatojejunostomy complications was held transoral (antegrade) double balloon enteroscopy (Fujinon, Japan) inspection. Results: Pancreatojejunostomy inspection was performed in 19 cases (73%). We didn’t have complications after this procedure. In the 12 cases was identified postoperative pancreatojejunostomy complications (stricture and failure of pancreatojejunostomy, anastomotic stricture of intrapancreatic bilioenteric anastomosis, residual stone in pancreatic duct). It was performed 12 double balloon enteroscopy minimally invasive operations of pancreatojejunostomy using a surgical laser. In 4 cases double balloon enteroscopy examinations revealed indications for open surgery. Conclusion: Double balloon enteroscopy has allowed to diagnosis specific complications of pancreatojejunostomy after resection-drainage pancreatic operations. It is a useful tool in the survey of pancreatojejunostomy when we have pain recurrence.
Abstract ID: 1788. Efficacy and safety of postoperative anticoagulation therapy with enoxaparin in patients undergoing pancreatic surgery: a prospective clinical trial Daisuke Hashimoto, Shigeki Nakagawa, Naoki Umezaki, Takanobu Yamao, Yuki Kitano, Kensuke Yamamura, Kota Arima, Takayoshi Kaida, Katsunori Imai, Yo-ichi Yamashita, Akira Chikamoto, Takatoshi Ishiko, Hideo Baba Department of Gastroenterological Surgery, Kumamoto University, Japan Introduction: Enoxaparin is low-molecular-weight heparin that is used for postoperative thromboprophylaxis. Aims: The purpose of this study was to evaluate the efficacy and safety of enoxaparin after pancreatic resection. We additionally carried out a literature review regarding venous thromboembolism (VTE) and postoperative bleeding mainly after hepatobiliary-pancreatic surgery. Patients & methods: This was a prospective, single-arm study. Patients aged 20 to 79 years who planned to undergo pancreatic resection followed by postoperative anticoagulation therapy with enoxaparin were enrolled from 2013 to 2016. The exclusion criteria were low renal function, active bleeding, clinical signs of VTE at screening, or evidence of thromboembolic disease before surgery. The primary endpoint was the incidence of postoperative VTE. The secondary endpoint was the incidence of postoperative complications. For the literature review, PubMed was searched for relevant articles and the PRISMA guidelines were used. Results: In total,103 patients were analyzed. Two patients (1.9%) developed asymptomatic VTE, and no patients developed symptomatic VTE. No in-hospital mortality occurred. Morbidities (ClavieneDindo grade IIIa) occurred in 29 patients (28.1%). Three patients (2.9%) developed intra-abdominal hemorrhage due to pseudoaneurysm formation after pancreaticoduodenectomy or distal pancreatectomy. The literature review included nine articles, and all indicated that the results of this study were feasible. Conclusion: This is the first prospective trial to focus on pharmacologic prophylaxis with enoxaparin after pancreatic surgery. Postoperative anticoagulant therapy with enoxaparin was used in patients who underwent pancreatic surgery with a low incidence of VTE and no increase in postoperative bleeding events compared with existing evidence.
Abstract ID: 1789. Prognostic nutrition index predict the recurrence of the patients who underwent curative surgery for pancreas ductal adenocarcinoma Shigeki Nakagawa, Daisuke Hashimoto, Yo-ichi Yamashita, Akira Chikamoto, Hideo Baba
Abstracts / Pancreatology 17 (2017) S1eS142
Conclusion: Long-term nonoperative management is safe for BD-IPMN without WF and HRS. Discontinuation of surveillance cannot be recommended since one out of six patients developed WF/HRS far beyond 5 years of surveillance and without previous relevant modifications. An intensification of follow-up should be considered after 5 years.
Abstract ID: 1784. Meta-analysis on Recurrence After Curative Surgery of Pancreatic Neuroendocrine Tumors Cansu Genc 1, Tara Mackay 1, Susan van Dieren 2, Casper van Eijck 3, Els Nieveen van Dijkum 1 1 Academic Medical Center Amsterdan, Department of Surgery, Netherlands 2 Academic Medical Center Amsterdan, Department of Methodology and Statistic CRU, Netherlands 3 Erasmus Medical Center Rotterdam, Department of Surgery, Netherlands
Introduction: Follow-up after curative surgery for pancreatic neuroendocrine tumors (pNET) is designed to detect recurrence, however reliable recurrence rates are difficult to deduct from literature. Aims: This meta-analysis provides insight into the prognosis of patients after curative resection of non-metastasized grade 1 or 2 pNET through investigation of recurrence rates, time to recurrence, predictors for recurrence and survival after recurrence. Patients & methods: Literature search was performed on studies reporting recurrence after complete resection of grade 1 or 2 pNET without distant metastases or hereditary syndromes. Excluded were studies with less than 20 patients, R2 resection, high grade neuroendocrine carcinoma or (neo) adjuvant therapy. Results: Eight studies were included. Between 1982 and 2013, curative resection was performed in 734 patients, 100 had a recurrence. Mean weighted follow-up was 46.1 months. Pooled recurrence rate was 13% (95% CI 9-18%). Sub-analyses showed a pooled recurrence rate of 11% for nonfunctional tumors (p¼0.297), 8% for grade 1 tumors (p¼0.0027) and 10% for R0-resections (p¼0.0030). Weighted time to recurrence was 39.4 months. Locoregional recurrence was seen in 6%, distant metastases in 9% (p¼0.0109). Factors associated with recurrence were: tumor size, tumor grade, lymph node metastases, perineural invasion and R1 resection. Mean weighted survival after recurrence was 39.4 months. Conclusion: The presented results show that recurrence after curative surgery for pNET is not rare. Based on these results, reliable and evidence based follow-up regimen for the early detection of recurrence after curative surgery can be developed.
Abstract ID: 1787. Double balloon enteroscopy in the diagnosis and treatment of chronic pancreatitis surgery complications Aliaksandr Varabei, Anatoli Shuleika, Yury Arlouski, Egi Vizhinis Belarusian Medical Academy of Postgraduate Education, Surgery Dept, Belarus Introduction: esectiTo assess double balloon enteroscopy for diagnostics and treatment of pancreatojejunostomy complications after pancreatic resection. Aims: To assess double balloon enteroscopy for diagnostics and treatment of pancreatojejunostomy complications after pancreatic resection.
Materials & methods: During 2010 till 2017 of 26 patients with suspected of pancreatojejunostomy complications was held transoral (antegrade) double balloon enteroscopy (Fujinon, Japan) inspection. Results: Pancreatojejunostomy inspection was performed in 19 cases (73%). We didn’t have complications after this procedure. In the 12 cases was identified postoperative pancreatojejunostomy complications (stricture and failure of pancreatojejunostomy, anastomotic stricture of intrapancreatic bilioenteric anastomosis, residual stone in pancreatic duct). It was performed 12 double balloon enteroscopy minimally invasive operations of pancreatojejunostomy using a surgical laser. In 4 cases double balloon enteroscopy examinations revealed indications for open surgery. Conclusion: Double balloon enteroscopy has allowed to diagnosis specific complications of pancreatojejunostomy after resection-drainage pancreatic operations. It is a useful tool in the survey of pancreatojejunostomy when we have pain recurrence.
Abstract ID: 1788. Efficacy and safety of postoperative anticoagulation therapy with enoxaparin in patients undergoing pancreatic surgery: a prospective clinical trial Daisuke Hashimoto, Shigeki Nakagawa, Naoki Umezaki, Takanobu Yamao, Yuki Kitano, Kensuke Yamamura, Kota Arima, Takayoshi Kaida, Katsunori Imai, Yo-ichi Yamashita, Akira Chikamoto, Takatoshi Ishiko, Hideo Baba Department of Gastroenterological Surgery, Kumamoto University, Japan Introduction: Enoxaparin is low-molecular-weight heparin that is used for postoperative thromboprophylaxis. Aims: The purpose of this study was to evaluate the efficacy and safety of enoxaparin after pancreatic resection. We additionally carried out a literature review regarding venous thromboembolism (VTE) and postoperative bleeding mainly after hepatobiliary-pancreatic surgery. Patients & methods: This was a prospective, single-arm study. Patients aged 20 to 79 years who planned to undergo pancreatic resection followed by postoperative anticoagulation therapy with enoxaparin were enrolled from 2013 to 2016. The exclusion criteria were low renal function, active bleeding, clinical signs of VTE at screening, or evidence of thromboembolic disease before surgery. The primary endpoint was the incidence of postoperative VTE. The secondary endpoint was the incidence of postoperative complications. For the literature review, PubMed was searched for relevant articles and the PRISMA guidelines were used. Results: In total,103 patients were analyzed. Two patients (1.9%) developed asymptomatic VTE, and no patients developed symptomatic VTE. No in-hospital mortality occurred. Morbidities (ClavieneDindo grade IIIa) occurred in 29 patients (28.1%). Three patients (2.9%) developed intra-abdominal hemorrhage due to pseudoaneurysm formation after pancreaticoduodenectomy or distal pancreatectomy. The literature review included nine articles, and all indicated that the results of this study were feasible. Conclusion: This is the first prospective trial to focus on pharmacologic prophylaxis with enoxaparin after pancreatic surgery. Postoperative anticoagulant therapy with enoxaparin was used in patients who underwent pancreatic surgery with a low incidence of VTE and no increase in postoperative bleeding events compared with existing evidence.
Abstract ID: 1789. Prognostic nutrition index predict the recurrence of the patients who underwent curative surgery for pancreas ductal adenocarcinoma Shigeki Nakagawa, Daisuke Hashimoto, Yo-ichi Yamashita, Akira Chikamoto, Hideo Baba