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Electronic Poster Abstracts
Direct costs of pancreatic cancer treatment were tabulated for each patient. Cost ratios (CR) were calculated, defined as the mean cost for the SDL group divided by the mean cost for the no-SDL group, with ratios calculated for overall cost and subcategories. Results: There were 100 patients with BRPC who were eligible for NAT. Nineteen of 75 SDLs performed (25%) revealed occult metastatic disease. For the SDL group compared to no-SDL group, there was a higher cost for port SDL (CR 7.00, 95% CI 4.22e13.78), but there was no difference in overall cost (CR 0.95, 95% CI 0.62e1.37), oncologic treatment (CR 0.66, 95% CI 0.32e1.23) or remaining surgical treatment (CR 1.14, 95% CI 0.77e 1.71). Patients with a positive SDL incurred a lower overall cost compared to negative SDL (CR 0.23, 95% CI 0.16e 0.32). Median survival was estimated to be 11.5, 6.8, and 16.6 months for the no-SDL, positive SDL, and negative SDL groups, respectively (log rank p < 0.001). Conclusion: SDL identified 25% of patients with BRPC who have occult metastatic disease at diagnosis, which resulted in decreased cost for these patients.
EP02C-021 HBV IS A POSSIBLE AGGRAVATING FACTOR FOR PANCREATIC ADENOCARCINOMA Y. Chen1, Q. Zhang1, X. Bai1 and T. Liang1,2 1 Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, and 2Collaborative Innovation Center for Cancer Medicine, Zhejiang University, China Introductions: Pancreatic adenocarcinoma (PAC) is a lethal cancer with poor prognosis. To date, the carcinogens and risk factors of PAC still remain largely unknown. Evidence from epidemiological researches suggested that the well-known oncogenic hepatitis B virus (HBV) was associated with a group of patients with PAC, having even worse prognosis. HBV X (HBx), a small 17-kDa soluble protein, is known to be essential for HBV induced carcinogenesis. We evaluated the hypothesis that HBV infection is a possible factor for promoting PAC. Methods: Using three pancreatic cancer cell lines (Panc-1, SW1990, and BxPC-3) with or without HBx-plasmid transfected, we evaluated the proliferation and migration abilities. We investigated the expression of more than 500 proteins using L-507 protein array. Several HBV- and PAC-related proteins were further studied by using realtime polymerase chain reaction, immunoblotting and enzyme-linked immunosorbent assays. Results: Transfection of HBx-plasmid significantly increased proliferation and migration ability of pancreatic cells, and showed epithelial-mesenchymal transition characteristics. Totally 12 proteins were found up-regulated for more than 5 times and 7 proteins down-regulated for at least 5 times after HBx transfection. According to the analysis of protein array and verification of the result, ERBB4 and TGFa were increased in parallel with HBx expression. Downstream pathways, such as AKT, ERK/MAPK, were elevated. Conclusion: HBx could increase the malignance of PAC. ERRB4 may play an important role in this effect. The results need further investigation to develop a better understanding of the underlying mechanism between HBV infection and PAC.
EP02C-022 VARIATIONS IN THE PERIOPERATIVE MANAGEMENT OF WHIPPLE OPERATION BETWEEN ACADEMIC AND COMMUNITY INSTITUTIONS: A IHPBA/AHPBA WEB-BASED SURVEY S. A. Sathyanrayana1, F. I. Macedo2, A. J. Race2, A. Singh2, V. K. Mittal2, J. Parikh2 and M. J. Jacobs2 1 Department of Surgery, Meharry Medical College, and 2 Department of Surgery, Providence Hospital & Medical Centers, United States Background: Whipple operation is the mainstay treatment for pancreatic head and periampullary cancer. Over time, pancreatic surgeons have varied perioperative practice patterns based on their training. We aim to evaluate these variations by comparing academic, community and hybrid institutions. Methods: A pilot 25-item survey questionnaire was electronically distributed using Survey Monkey to IHPBA and AHPBA members between May and August 2015 regarding practice patterns and perioperative care of Whipple operation. Results: We received 285 responses with participants from academic (56.1%), community (12.6%) or hybrid institutions (31.2%). Most participants performed 10-25 cases annually in each group (46.9%, 50%, 51.7%, respectively). Surgeons from academic institutions routinely culture bile intraoperatively more often than in community institutions (46.3% vs. 22.2%, p < 0.01, Fig 1A). However, surgeons from community programs tend to continue prophylactic antibiotics beyond 24 hours (30.6% vs. 44.4%, p < 0.01, Fig 1B) and are more likely to use antibiotic abdominal irrigation (2.5% vs. 11.1%, p < 0.01, Fig 1C) as compared to those from academic institution. Routine postoperative culture and measurement of amylase through drains, types of drains (self-suction or gravity), length of postoperative antibiotic regimen, type of skin closure and wound care were statistically similar. Conclusions: Our survey included a wide range of members from academic, community and hybrid centers. Practice patterns between these groups vary significantly regarding intraoperative bile culture, duration of prophylactic antibiotic usage and antibiotic peritoneal irrigation. Further studies are warranted to elucidate the impact of these variations on surgical outcomes of patients undergoing Whipple operation.
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HPB 2016, 18 (S1), e1ee384