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Extra hepatic portal venous obstruction [EHPVO] with or without portal biliopathy – Intra operative portal pressure measurements: A comparative study
e306
Electronic Poster Abstracts
EP01E-062 RESECTION OF HEPATIC COLORECTAL METASTASES: MOVING FROM A LOW VOLUME TO HIGH VOLUME UNIT N. Wylie, K. Rajkomar, A. Brown, M. Rodgers and J. Koea Department of Surgery, North Shore Hospital, New Zealand Introduction: New Zealand has a population of 4.5 million and since 2005 North Shore Hospital has served 5,83,000 which is the largest catchment population in New Zealand. This district has the highest incidence of colorectal cancer and the busiest colorectal unit in New Zealand. This created a need and an opportunity to develop a high volume, multidisciplinary hepatobiliary service for the region. Methods: Information on patient demographics, pathology, surgical procedures and outcomes were extracted from a prospectively maintained database for patients undergoing hepatectomy for metastatic colorectal cancer between January 2005 and December 2014 and quality indicators were reviewed. Results: One hundred and thirty nine hepatectomies were carried out in 125 patients with increasing annual volumes (table 1) with a mean of 2 metastases (range 1e9) resected at each operation. 62 (49%) patients underwent major hepatectomy. Fourteen patients had repeat resections and 13 underwent concomitant lung resection. The bile leak rate was 0.7%. Mean hospital stay was 9 days, and 47 (37%) patients had at least 1 readmission within 90 days. The 1, 3, and 5 year survival rates were 95%, 69%, and 46% respectively, from time of liver resection. Conclusion: Development of a high volume, high quality service to treat patients with metastatic colorectal cancer is feasible when driven by the needs of the local population.
Introduction: While portal biliopathy [PB] is common in patients of EHPVO, clinical or biochemical, i.e. symptomatic PB is seen in only 20e30% of cases. We herein compare portal pressure in patients of EHPVO with or without portal biliopathy. Methods: Retrospective analysis of prospectively collected data of all patients with EHPVO who underwent elective PSRS where intra-operative pressures were available between January 2008 to December 2014. Patients were classified into two group: Group A: Portal Biliopathy [PB] and Group B: Non-Portal biliopathy [NPB]. Intra-operative pre and post shunt pressures in the gastro-epiploic vein recorded using transducers were analysed. Post surgical outcomes including resolution of PB and need for subsequent biliary intervention was assessed. Results: While 116 patients underwent PSRS for EHPVO during the study period, 55 patients in whom intraoperative pressure data were available formed the study group (NPB: 33 and PB: 22). Preshunt pressure(in mmHg) and mean decrement in NPB group was 31.3 6.3 and 9.06 4.55 respectively as compared to 29.9 8.4 and 8.8 6.07 in PB group [p = 0.4833 and p = 0.577]. During a median follow up of 48 months, 6 (27.3%) of 22 PB patients needed biliary intervention including bilioenteric bypass in 4 and endoscopic stenting in 2. Conclusion: Intra-operative portal pressures and post shunt decrement did not differ between the portal biliopathy and non-portal biliopathy groups.
EP01E-062 - Table
Years
Average Age
Number of hepatectomies
Major resections
2005/06
73.8
6
3
0
2
1
2007/08
72.25
13
4
0
4
1
2009/10
65
21
8
0
4
0
2011/12
68.5
49
21
0
16
5
2013/14
67
50
26
0
20
2
[Table 1]
EP01E-064 EXTRA HEPATIC PORTAL VENOUS OBSTRUCTION [EHPVO] WITH OR WITHOUT PORTAL BILIOPATHY e INTRA OPERATIVE PORTAL PRESSURE MEASUREMENTS: A COMPARATIVE STUDY V. Varshney, M. N. Saravanan, A. Agarwal and N. Prithiviraj GI Surgery & Liver Transplant, GB Pant Hospital & MAM College, India
30 day mortality
90 day readmission
Margin positivity
EP01E-065 PATHOLOGICAL COMPLETE REMISSION WITH LONG TERM SURVIVAL AFTER HEPATIC ARTERIAL CHEMOTHERAPY IN ADVANCED HEPATOCELLUAR CARCINOMA WITH MAIN PORTAL VEIN THROMBOSIS S. S. Yun, D. S. Lee and H. J. Kim Surgery, Yeungnam University Hospital, Republic of Korea Introduction: The prognosis of advanced hepatocellular carcinoma (HCC) patients with portal vein thrombosis is very poor even after surgery.
HPB 2016, 18 (S1), e1ee384
Electronic Poster Abstracts
EP01E-062 RESECTION OF HEPATIC COLORECTAL METASTASES: MOVING FROM A LOW VOLUME TO HIGH VOLUME UNIT N. Wylie, K. Rajkomar, A. Brown, M. Rodgers and J. Koea Department of Surgery, North Shore Hospital, New Zealand Introduction: New Zealand has a population of 4.5 million and since 2005 North Shore Hospital has served 5,83,000 which is the largest catchment population in New Zealand. This district has the highest incidence of colorectal cancer and the busiest colorectal unit in New Zealand. This created a need and an opportunity to develop a high volume, multidisciplinary hepatobiliary service for the region. Methods: Information on patient demographics, pathology, surgical procedures and outcomes were extracted from a prospectively maintained database for patients undergoing hepatectomy for metastatic colorectal cancer between January 2005 and December 2014 and quality indicators were reviewed. Results: One hundred and thirty nine hepatectomies were carried out in 125 patients with increasing annual volumes (table 1) with a mean of 2 metastases (range 1e9) resected at each operation. 62 (49%) patients underwent major hepatectomy. Fourteen patients had repeat resections and 13 underwent concomitant lung resection. The bile leak rate was 0.7%. Mean hospital stay was 9 days, and 47 (37%) patients had at least 1 readmission within 90 days. The 1, 3, and 5 year survival rates were 95%, 69%, and 46% respectively, from time of liver resection. Conclusion: Development of a high volume, high quality service to treat patients with metastatic colorectal cancer is feasible when driven by the needs of the local population.
Introduction: While portal biliopathy [PB] is common in patients of EHPVO, clinical or biochemical, i.e. symptomatic PB is seen in only 20e30% of cases. We herein compare portal pressure in patients of EHPVO with or without portal biliopathy. Methods: Retrospective analysis of prospectively collected data of all patients with EHPVO who underwent elective PSRS where intra-operative pressures were available between January 2008 to December 2014. Patients were classified into two group: Group A: Portal Biliopathy [PB] and Group B: Non-Portal biliopathy [NPB]. Intra-operative pre and post shunt pressures in the gastro-epiploic vein recorded using transducers were analysed. Post surgical outcomes including resolution of PB and need for subsequent biliary intervention was assessed. Results: While 116 patients underwent PSRS for EHPVO during the study period, 55 patients in whom intraoperative pressure data were available formed the study group (NPB: 33 and PB: 22). Preshunt pressure(in mmHg) and mean decrement in NPB group was 31.3 6.3 and 9.06 4.55 respectively as compared to 29.9 8.4 and 8.8 6.07 in PB group [p = 0.4833 and p = 0.577]. During a median follow up of 48 months, 6 (27.3%) of 22 PB patients needed biliary intervention including bilioenteric bypass in 4 and endoscopic stenting in 2. Conclusion: Intra-operative portal pressures and post shunt decrement did not differ between the portal biliopathy and non-portal biliopathy groups.
EP01E-062 - Table
Years
Average Age
Number of hepatectomies
Major resections
2005/06
73.8
6
3
0
2
1
2007/08
72.25
13
4
0
4
1
2009/10
65
21
8
0
4
0
2011/12
68.5
49
21
0
16
5
2013/14
67
50
26
0
20
2
[Table 1]
EP01E-064 EXTRA HEPATIC PORTAL VENOUS OBSTRUCTION [EHPVO] WITH OR WITHOUT PORTAL BILIOPATHY e INTRA OPERATIVE PORTAL PRESSURE MEASUREMENTS: A COMPARATIVE STUDY V. Varshney, M. N. Saravanan, A. Agarwal and N. Prithiviraj GI Surgery & Liver Transplant, GB Pant Hospital & MAM College, India
30 day mortality
90 day readmission
Margin positivity
EP01E-065 PATHOLOGICAL COMPLETE REMISSION WITH LONG TERM SURVIVAL AFTER HEPATIC ARTERIAL CHEMOTHERAPY IN ADVANCED HEPATOCELLUAR CARCINOMA WITH MAIN PORTAL VEIN THROMBOSIS S. S. Yun, D. S. Lee and H. J. Kim Surgery, Yeungnam University Hospital, Republic of Korea Introduction: The prognosis of advanced hepatocellular carcinoma (HCC) patients with portal vein thrombosis is very poor even after surgery.
HPB 2016, 18 (S1), e1ee384