- Email: [email protected]
Exploration of preoperative risk factors for early recurrence in patients with resectable pancreatic ductal adenocarcinoma after curative intent surgical resection
Abstracts / Pancreatology 17 (2017) S1eS68
S12
0064. Exploration of preoperative risk factors for early recurrence in patients with resectable pancreatic ductal adenocarcinoma after curative intent surgical resection Hong Joo kim Sungkyunkwan University Kangbuk Sammsung Hospital, Republic of Korea Introduction: Although surgical resection is the only established curative treatment for pancreatic ductal adenocarcinoma (PDAC), postoperative early recurrence (ER) is frequently encountered. The ability to predict patients at risk of ER before surgical resection would be valuable for determining the best candidate for upfront surgery or neoadjuvant therapy. Aim: The aim of this study was to determine the preoperative predictive risk factors for ER in patients with PDAC after upfront surgery. Method: Medical records were collected from 119 consecutive patients with PDAC who underwent curative intent surgical resection at our institution between January 2004 and May 2015. of these, 28 whose recurrence statuses were unknown due to follow-up loss, 3 who underwent neoadjuvant therapy, and 7 who died from causes other than PDAC, were excluded from the study. As a result, 81 patients were analyzed retrospectively. They were divided into ER and non-ER group. ER was defined as tumor relapse within 6 months after surgery determined by measurement of serum tumor markers and follow-up imaging study of multi-detector computed tomography (MDCT) and/or magnetic resonance imaging (MRI). Results: ER occurred in 26 patients (32.1%), whereas 55 patients (67.9%) had late recurrence (¼6 months after surgery, n¼49, 60.5%) or no recurrence (n¼6, 7.4%). By univariate analysis, C-reactive protein (CRP) >3.0 mg/ dL, modified Glasgow prognostic score (mGPS) ¼ 2, decrease of total lymphocyte count by >50% of baseline value in the preoperative period, prognostic nutritional index (PNI) <45, neutrophil-to-lymphocyte ratio (NLR) ¼150, total operation time >300 min, and preoperative maximum standardized uptake value (SUVmax) were significantly associated with the occurrence of ER. Multivariate logistic regression analysis revealed that CRP >3.0 mg/dL, decrease of total lymphocyte count by >50% of baseline value, and preoperative SUVmax were significant and independent contributors to ER in patients with resectable (R-) PDAC who underwent curative intent surgery. Conclusion: Postoperative ER for R-PDAC occurred frequently with poor prognosis after curative intent upfront surgery. It is reasonable to suggest that there is a subgroup of R-PDAC patients at high risk of ER and neoadjuvant therapy should be considered in these patients in a clinical trial setting.
for the extent of ES and its correlation with the incidence of complications. We retrospectively evaluated the safety and efficacy of limited ES before SEMS insertion. We have proved in this study that limited ES dose not increase the risk of post-procedure complications such as post-ERCP pancreatitis and bleeding. Also, it is advantageous in facilitating the more complex stenting procedures. Therefore, limited ES can be a safe, feasible, and effective therapeutic strategy in the placement of self-expandable metal stent. Method: This was a retrospective analysis of 244 consecutive patients with unresectable malignant biliary obstruction, who underwent placement of SEMSs following limited ES from December 2008 to February 2015. The diagnosis of malignant biliary obstruction and assessment of patient eligibility for the study was established by a combination of clinical findings, laboratory investigations, imaging and pathological results. All patients were monitored in the hospital for at least 24 hours following ERCP. The incidence of immediate or early post-ERCP complications such as PEP and bleeding related to limited ES were considered as primary outcomes. Also, characteristics and complications according to the cancer type were classified. Results: Among the 244 patients included, the underlying diagnosis was cholangiocarcinoma in 118 patients, pancreatic cancer in 79, and nonpancreatic or non-biliary malignancies in the remaining 47 patients. Early post-ERCP complications occurred in 9 patients (3.7%), with PEP in 7 patients (2.9%; mild, 6; moderate, 1) and mild bleeding in 2 patients (0.8%). There was no significant association between the incidence of post-ERCP complications and the type of malignancy (cholangiocarcinoma versus pancreatic cancer versus others, p ¼ 0.696) or the type of SEMS used (uncovered versus covered, p ¼ 1.000). Patients who had more than one SEMS placed at the first instance were at a significantly higher risk of postERCP complications (one SEMS versus two SEMS, p ¼ 0.031). No other factors were predictive of post-ERCP complications. Discussion: Our data demonstrated a lower rate of PEP in patients with cholangiocarcinoma compared to previous studies. Limited ES, therefore, could be an effective and useful technique to prevent PEP following stenting for cholangiocarcinoma, especially hilar tumors. Stent migration is a late complications of biliary stenting with ES. Covered SEMS are not fully embedded in bile duct, and therefore, are associated with the potential risk of stent migration. In our study, stent migration occurred in only 1 patient (0.4%) and limited ES did not seem to be a significant factor associated with migration, regardless of the stent type Conclusion: Limited ES is feasible and safe, and effectively facilitates the placement of SEMS, without any significant risk of PEP or severe bleeding.
0067. 0065.
Endoscopic ultrasound-guided drainage without fluoroscopic assist for extraluminal cysts
Effect of limited endoscopic sphincterotomy before self-expandable metal stent insertion for malignant biliary obstruction
Ji Hwan Ko, Hyeong Seok Nam, Hyung Wook Kim, Dae Hwan Kang, Cheol Woong Choi, Dae Gon Ryu, Il Eok Jo, Su Jin Kim
Dae Hwan Kang, Il Eok Jo, Hyeong Seok Nam, Hyung Wook Kim, Su Jin Kim, Cheol Woong Choi, Dae Gon Ryu
Pusan National University Yangsan Hospital, Republic of Korea
Pusan National University Yangsan Hospital, Republic of Korea Introduction: Many endoscopists routinely perform ES before SEMS placement. However, an accurate assessment of the incidence of complications based on the extent of ES is difficult to make owing to the lack of such data in previous studies. Herein, we studied the incidence of early post-ERCP complications, such as PEP and bleeding following limited ES accompanying SEMS placement for biliary drainage in patients with malignant biliary obstruction. Aim: To evaluate the safety and efficacy of limited endoscopic sphincterotomy (ES) before placement of self-expandable metal stent (SEMS). Background: The role of routine endoscopic sphincterotomy (ES) is still controversial in biliary stenting and there is a lack of systematic study
Introduction: Many studies have investigated EUS-guided therapy of extraluminal complicated cysts, especially pseudocysts and WOPN, and this minimally invasive technique is now regarded as a feasible option for definitive endoscopic treatment. Aim: In this study, we aimed to retrospectively evaluate the safety and efficacy of EUS-guided drainage without fluoroscopic control for extraluminal complicated cysts such as PFCs as well as pelvic abscess. Background: Fluoroscopic observation is mainly practical and helpful for estimating a fistula or abscess cavity and confirming proper guidewire coiling in cysts. However, X-ray assistance may expose patients and endoscopists to radiation. Additionally, in many centers, fluoroscopy and EUS examinations are performed in separate rooms, which might prevent continuative procedures. With improvements in endoscopic techniques and experience, questions have been raised regarding the necessity and
S12
0064. Exploration of preoperative risk factors for early recurrence in patients with resectable pancreatic ductal adenocarcinoma after curative intent surgical resection Hong Joo kim Sungkyunkwan University Kangbuk Sammsung Hospital, Republic of Korea Introduction: Although surgical resection is the only established curative treatment for pancreatic ductal adenocarcinoma (PDAC), postoperative early recurrence (ER) is frequently encountered. The ability to predict patients at risk of ER before surgical resection would be valuable for determining the best candidate for upfront surgery or neoadjuvant therapy. Aim: The aim of this study was to determine the preoperative predictive risk factors for ER in patients with PDAC after upfront surgery. Method: Medical records were collected from 119 consecutive patients with PDAC who underwent curative intent surgical resection at our institution between January 2004 and May 2015. of these, 28 whose recurrence statuses were unknown due to follow-up loss, 3 who underwent neoadjuvant therapy, and 7 who died from causes other than PDAC, were excluded from the study. As a result, 81 patients were analyzed retrospectively. They were divided into ER and non-ER group. ER was defined as tumor relapse within 6 months after surgery determined by measurement of serum tumor markers and follow-up imaging study of multi-detector computed tomography (MDCT) and/or magnetic resonance imaging (MRI). Results: ER occurred in 26 patients (32.1%), whereas 55 patients (67.9%) had late recurrence (¼6 months after surgery, n¼49, 60.5%) or no recurrence (n¼6, 7.4%). By univariate analysis, C-reactive protein (CRP) >3.0 mg/ dL, modified Glasgow prognostic score (mGPS) ¼ 2, decrease of total lymphocyte count by >50% of baseline value in the preoperative period, prognostic nutritional index (PNI) <45, neutrophil-to-lymphocyte ratio (NLR) ¼150, total operation time >300 min, and preoperative maximum standardized uptake value (SUVmax) were significantly associated with the occurrence of ER. Multivariate logistic regression analysis revealed that CRP >3.0 mg/dL, decrease of total lymphocyte count by >50% of baseline value, and preoperative SUVmax were significant and independent contributors to ER in patients with resectable (R-) PDAC who underwent curative intent surgery. Conclusion: Postoperative ER for R-PDAC occurred frequently with poor prognosis after curative intent upfront surgery. It is reasonable to suggest that there is a subgroup of R-PDAC patients at high risk of ER and neoadjuvant therapy should be considered in these patients in a clinical trial setting.
for the extent of ES and its correlation with the incidence of complications. We retrospectively evaluated the safety and efficacy of limited ES before SEMS insertion. We have proved in this study that limited ES dose not increase the risk of post-procedure complications such as post-ERCP pancreatitis and bleeding. Also, it is advantageous in facilitating the more complex stenting procedures. Therefore, limited ES can be a safe, feasible, and effective therapeutic strategy in the placement of self-expandable metal stent. Method: This was a retrospective analysis of 244 consecutive patients with unresectable malignant biliary obstruction, who underwent placement of SEMSs following limited ES from December 2008 to February 2015. The diagnosis of malignant biliary obstruction and assessment of patient eligibility for the study was established by a combination of clinical findings, laboratory investigations, imaging and pathological results. All patients were monitored in the hospital for at least 24 hours following ERCP. The incidence of immediate or early post-ERCP complications such as PEP and bleeding related to limited ES were considered as primary outcomes. Also, characteristics and complications according to the cancer type were classified. Results: Among the 244 patients included, the underlying diagnosis was cholangiocarcinoma in 118 patients, pancreatic cancer in 79, and nonpancreatic or non-biliary malignancies in the remaining 47 patients. Early post-ERCP complications occurred in 9 patients (3.7%), with PEP in 7 patients (2.9%; mild, 6; moderate, 1) and mild bleeding in 2 patients (0.8%). There was no significant association between the incidence of post-ERCP complications and the type of malignancy (cholangiocarcinoma versus pancreatic cancer versus others, p ¼ 0.696) or the type of SEMS used (uncovered versus covered, p ¼ 1.000). Patients who had more than one SEMS placed at the first instance were at a significantly higher risk of postERCP complications (one SEMS versus two SEMS, p ¼ 0.031). No other factors were predictive of post-ERCP complications. Discussion: Our data demonstrated a lower rate of PEP in patients with cholangiocarcinoma compared to previous studies. Limited ES, therefore, could be an effective and useful technique to prevent PEP following stenting for cholangiocarcinoma, especially hilar tumors. Stent migration is a late complications of biliary stenting with ES. Covered SEMS are not fully embedded in bile duct, and therefore, are associated with the potential risk of stent migration. In our study, stent migration occurred in only 1 patient (0.4%) and limited ES did not seem to be a significant factor associated with migration, regardless of the stent type Conclusion: Limited ES is feasible and safe, and effectively facilitates the placement of SEMS, without any significant risk of PEP or severe bleeding.
0067. 0065.
Endoscopic ultrasound-guided drainage without fluoroscopic assist for extraluminal cysts
Effect of limited endoscopic sphincterotomy before self-expandable metal stent insertion for malignant biliary obstruction
Ji Hwan Ko, Hyeong Seok Nam, Hyung Wook Kim, Dae Hwan Kang, Cheol Woong Choi, Dae Gon Ryu, Il Eok Jo, Su Jin Kim
Dae Hwan Kang, Il Eok Jo, Hyeong Seok Nam, Hyung Wook Kim, Su Jin Kim, Cheol Woong Choi, Dae Gon Ryu
Pusan National University Yangsan Hospital, Republic of Korea
Pusan National University Yangsan Hospital, Republic of Korea Introduction: Many endoscopists routinely perform ES before SEMS placement. However, an accurate assessment of the incidence of complications based on the extent of ES is difficult to make owing to the lack of such data in previous studies. Herein, we studied the incidence of early post-ERCP complications, such as PEP and bleeding following limited ES accompanying SEMS placement for biliary drainage in patients with malignant biliary obstruction. Aim: To evaluate the safety and efficacy of limited endoscopic sphincterotomy (ES) before placement of self-expandable metal stent (SEMS). Background: The role of routine endoscopic sphincterotomy (ES) is still controversial in biliary stenting and there is a lack of systematic study
Introduction: Many studies have investigated EUS-guided therapy of extraluminal complicated cysts, especially pseudocysts and WOPN, and this minimally invasive technique is now regarded as a feasible option for definitive endoscopic treatment. Aim: In this study, we aimed to retrospectively evaluate the safety and efficacy of EUS-guided drainage without fluoroscopic control for extraluminal complicated cysts such as PFCs as well as pelvic abscess. Background: Fluoroscopic observation is mainly practical and helpful for estimating a fistula or abscess cavity and confirming proper guidewire coiling in cysts. However, X-ray assistance may expose patients and endoscopists to radiation. Additionally, in many centers, fluoroscopy and EUS examinations are performed in separate rooms, which might prevent continuative procedures. With improvements in endoscopic techniques and experience, questions have been raised regarding the necessity and