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Impact of neoadjuvant therapy on pathological features and survival of resected pancreatic adenocarcinoma
Abstracts / Pancreatology 17 (2017) S1eS142
Introduction: Duodenum-preserving pancreatic head resection (DPPHR) is one possible option for the surgical treatment of chronic pancreatitis (CP). Chronic pain significantly impairs the quality of life in CP. Aims: We aimed to determine long-term outcome in a large series of DPPHR (Berne) with a focus on patient-reported outcomes. Patients & methods: Patients undergoing DPPHR (Berne) were identified from a prospective pancreatic database maintained since 10/2001. Long-term outcome was assessed using a specifically designed questionnaire and the EORTC QLQ-PAN26/30. Results: From 10/2001 to 10/2014 332 patients underwent DPPHR for CP, including n¼265 (79.8%) Berne modifications. Surgical morbidity and mortality were 31.1% and 1.9%, respectively. With a median follow-up (FU) of 75.6 months 5 and 10-year survival rates were 89.1% and 80.2%, respectively. 138 (62.4%) of 221 patients alive participated in the survey. 106 (78.5%) patients reported improved, 17 (12.6%) stable, and 12 (8.9%) worse quality of life after the operation. While 95.5% of patients had severe pain before the operation, 50% of patients remained pain-free and 12.7% reported only mild pain at FU after surgery. Median pain intensity on a 0100 scale decreased from 90 before to 5 after the operation. However, 31 (23.1%) patients required a second operation during long-term FU. 17.0% of patients had pre-existing diabetes and 59.9% of patients eventually developed diabetes. Conclusion: DPPHR (Berne) offers a safe and effective surgical therapy for CP. While the perceived effects on quality of life and pain relief are durable in the majority of patients, the long-term deterioration of endocrine function cannot be stopped.
Abstract ID: 1967. Role of contrast- enhanced endoscopic ultrasonography in the diagnosis and differentiation of pancreatic cysts Miruna Olar, Ofelia Mosteanu, Teodora Pop, Ioana Rusu, Andrada Seicean IRGH Prof. Dr. O. Fodor Cluj-Napoca, Romania Introduction: It is a great challenge to differentiate between the type and the malignant potential of a newly diagnosed pancreatic cyst Aims: To assess the role of contrast-enhanced endoscopic ultrasonography (EUS) for increasing diagnostic accuracy. Patients & methods: The prospective study included 32 patients with pancreatic cysts. Inclusion criteria were: age over 18, presence of a pancreatic cyst larger than 10mm, informed consent. Exclusion criteria were: history chronic pancreatitis, platelet count <50.000/cm3. We analyzed the cyst wall, the septa and the solid components of the pancreatic cyst with and without contrast enhancer(CE)(2,4ml SonoVueBracco,Italy).The examinations were performed using an Olympus echoendoscope and Aloka ultrasound machine.The final diagnosis was based on fine needle aspiration result, surgery or follow-up. Results: There were 32 patients (20 females, 12 males) included. Cyst size was between 12mm-80mm. The pancreatic location of the lesions were the head (n¼7), the uncinate process (n¼3), neck (n¼8), body (n¼10), and tai l(n¼4). The types of cysts were mucinous cystadenocarcinoma (n¼1); mucinous cystadenoma (n¼5); IPMN (n¼12); serous cystadenoma (n¼5); Von Hippel Lindau disease (n¼1); pseudocyst (n¼7). For the mucinous cystadenomas, a hyperenhancement of the cyst wall and septa with a slow wash-out and honeycomb aspect was observed. In case of mucinous cystadenomas hyperenhanced thick walls, septa and fast wash-out was characteristic. For IPMN’s, the hyperenhancement of the cyst wall and fast wash-out was found. From 8 pancreatic cysts with solid components in standard EUS, hyperenhanced mural nodules were present in 7of them and malignancy was confirmed for all these cases (surgery n¼ 4; EUS-FNA n¼3) Conclusion: The enhancing pattern was useful to differentiate malignant nodules from mucus or debris and mucinous from nonmucinous pancreatic cystic lesions.
S89
Abstract ID: 1972. Impact of neoadjuvant therapy on pathological features and survival of resected pancreatic adenocarcinoma Laura Maggino 1, Giuseppe Malleo 1, Andrea Montresor 1, Alessandra Binco 1, Giovanni Marchegiani 1, Elena Viviani 1, Marta Sandini 2, Paola Capelli 3, Luca Landoni 1, Alessandro Esposito 1, Luca Casetti 1, Claudio Bassi 1, Roberto Salvia 1 1 General and Pancreatic Surgery, The Pancreas Institute, University of Verona, Italy 2 Milano-Bicocca University, Department of Surgery, San Gerardo Hospital, Monza, Italy 3 Department of Pathology and Diagnostics, University of Verona, Italy
Introduction: The influence of neoadjuvant therapy (NAT) on the pathological characteristics and long-term survival of resected pancreatic adenocarcinoma (PDAC) is unclear. Aims: First, to compare histopathological features between patients undergoing upfront surgery (US) or surgery after NAT. Second, to investigate the impact of NAT on survival in resectable/borderline-resectable (BR) PDAC. Patients & methods: 422 pancreatectomies for PDAC (2013-2015) were retrospectively reviewed and clinical-pathological characteristics of patients receiving US or surgery after NAT were analyzed. Disease-specific (DSS) and recurrence-free survival (RFS) of patients who were resectable/ BR at diagnosis were compared among the groups through propensityscore matching. Results: 104 patients (24.6%) underwent pancreatectomy after NAT. In comparison with US, NAT was associated with smaller tumor size at pathology (23 versus 28mm), lower rates of lymphovascular (73.1% versus 96.9%), perineural (80.8% versus 98.1%) and peripancreatic fat invasion (71.2% versus 91.2%), and lower pathological disease stages, all p<0.001. Also margin-positive resections were fewer (37.5% versus 46.2%, p¼0.042). Despite a similar median number of harvested LNs (41 versus 42. p¼0.711), the proportion of N1 patients (60.6% versus 79.4%), the number of positive LNs (1 versus 4), and the LN ratio (0.031 versus 0.097) were decreased, all p<0.001. However, in a propensity-score matched cohort of resectable/BR patients, NAT was not associated to a significant survival benefit in comparison with US (median DSS from diagnosis 36 versus 31 months, p¼ 0.329; median RFS 16 versus 13 months, p¼0.342). Conclusion: NAT favorably impacts all adverse histopathological features of resected PDAC. However, this does not necessarily coincide with a survival benefit in resectable/BR patients.
Abstract ID: 1979. Ten years of Post-Operative Pancreatic Fistula (POPF) definition (2005-2016). Does the new classification really change something? Gennaro Nappo, Fara Uccelli, Francesca Gavazzi, Cristina Ridolfi, Giovanni Capretti, Alessandro Zerbi Humanitas Research Hospital, Milan, Italy Introduction: In 2005 International Study Group of Pancreatic Surgery (ISGPS) classified POPF into 3 different grades of severity (A, B, C) and it has been universally adopted. Recently, ISGPS updated this classification. Aims: The aim of this study was to compare the incidence and severity of POPF in our series of Pancreatico-Duodenectomies (PDs) using the two classifications. Materials & methods: All consecutive PDs performed from 2010 to 2016 were retrospectively evaluated from a prospective database. Incidence and grade of POPF strictly adopting the two classifications were recorded.
Introduction: Duodenum-preserving pancreatic head resection (DPPHR) is one possible option for the surgical treatment of chronic pancreatitis (CP). Chronic pain significantly impairs the quality of life in CP. Aims: We aimed to determine long-term outcome in a large series of DPPHR (Berne) with a focus on patient-reported outcomes. Patients & methods: Patients undergoing DPPHR (Berne) were identified from a prospective pancreatic database maintained since 10/2001. Long-term outcome was assessed using a specifically designed questionnaire and the EORTC QLQ-PAN26/30. Results: From 10/2001 to 10/2014 332 patients underwent DPPHR for CP, including n¼265 (79.8%) Berne modifications. Surgical morbidity and mortality were 31.1% and 1.9%, respectively. With a median follow-up (FU) of 75.6 months 5 and 10-year survival rates were 89.1% and 80.2%, respectively. 138 (62.4%) of 221 patients alive participated in the survey. 106 (78.5%) patients reported improved, 17 (12.6%) stable, and 12 (8.9%) worse quality of life after the operation. While 95.5% of patients had severe pain before the operation, 50% of patients remained pain-free and 12.7% reported only mild pain at FU after surgery. Median pain intensity on a 0100 scale decreased from 90 before to 5 after the operation. However, 31 (23.1%) patients required a second operation during long-term FU. 17.0% of patients had pre-existing diabetes and 59.9% of patients eventually developed diabetes. Conclusion: DPPHR (Berne) offers a safe and effective surgical therapy for CP. While the perceived effects on quality of life and pain relief are durable in the majority of patients, the long-term deterioration of endocrine function cannot be stopped.
Abstract ID: 1967. Role of contrast- enhanced endoscopic ultrasonography in the diagnosis and differentiation of pancreatic cysts Miruna Olar, Ofelia Mosteanu, Teodora Pop, Ioana Rusu, Andrada Seicean IRGH Prof. Dr. O. Fodor Cluj-Napoca, Romania Introduction: It is a great challenge to differentiate between the type and the malignant potential of a newly diagnosed pancreatic cyst Aims: To assess the role of contrast-enhanced endoscopic ultrasonography (EUS) for increasing diagnostic accuracy. Patients & methods: The prospective study included 32 patients with pancreatic cysts. Inclusion criteria were: age over 18, presence of a pancreatic cyst larger than 10mm, informed consent. Exclusion criteria were: history chronic pancreatitis, platelet count <50.000/cm3. We analyzed the cyst wall, the septa and the solid components of the pancreatic cyst with and without contrast enhancer(CE)(2,4ml SonoVueBracco,Italy).The examinations were performed using an Olympus echoendoscope and Aloka ultrasound machine.The final diagnosis was based on fine needle aspiration result, surgery or follow-up. Results: There were 32 patients (20 females, 12 males) included. Cyst size was between 12mm-80mm. The pancreatic location of the lesions were the head (n¼7), the uncinate process (n¼3), neck (n¼8), body (n¼10), and tai l(n¼4). The types of cysts were mucinous cystadenocarcinoma (n¼1); mucinous cystadenoma (n¼5); IPMN (n¼12); serous cystadenoma (n¼5); Von Hippel Lindau disease (n¼1); pseudocyst (n¼7). For the mucinous cystadenomas, a hyperenhancement of the cyst wall and septa with a slow wash-out and honeycomb aspect was observed. In case of mucinous cystadenomas hyperenhanced thick walls, septa and fast wash-out was characteristic. For IPMN’s, the hyperenhancement of the cyst wall and fast wash-out was found. From 8 pancreatic cysts with solid components in standard EUS, hyperenhanced mural nodules were present in 7of them and malignancy was confirmed for all these cases (surgery n¼ 4; EUS-FNA n¼3) Conclusion: The enhancing pattern was useful to differentiate malignant nodules from mucus or debris and mucinous from nonmucinous pancreatic cystic lesions.
S89
Abstract ID: 1972. Impact of neoadjuvant therapy on pathological features and survival of resected pancreatic adenocarcinoma Laura Maggino 1, Giuseppe Malleo 1, Andrea Montresor 1, Alessandra Binco 1, Giovanni Marchegiani 1, Elena Viviani 1, Marta Sandini 2, Paola Capelli 3, Luca Landoni 1, Alessandro Esposito 1, Luca Casetti 1, Claudio Bassi 1, Roberto Salvia 1 1 General and Pancreatic Surgery, The Pancreas Institute, University of Verona, Italy 2 Milano-Bicocca University, Department of Surgery, San Gerardo Hospital, Monza, Italy 3 Department of Pathology and Diagnostics, University of Verona, Italy
Introduction: The influence of neoadjuvant therapy (NAT) on the pathological characteristics and long-term survival of resected pancreatic adenocarcinoma (PDAC) is unclear. Aims: First, to compare histopathological features between patients undergoing upfront surgery (US) or surgery after NAT. Second, to investigate the impact of NAT on survival in resectable/borderline-resectable (BR) PDAC. Patients & methods: 422 pancreatectomies for PDAC (2013-2015) were retrospectively reviewed and clinical-pathological characteristics of patients receiving US or surgery after NAT were analyzed. Disease-specific (DSS) and recurrence-free survival (RFS) of patients who were resectable/ BR at diagnosis were compared among the groups through propensityscore matching. Results: 104 patients (24.6%) underwent pancreatectomy after NAT. In comparison with US, NAT was associated with smaller tumor size at pathology (23 versus 28mm), lower rates of lymphovascular (73.1% versus 96.9%), perineural (80.8% versus 98.1%) and peripancreatic fat invasion (71.2% versus 91.2%), and lower pathological disease stages, all p<0.001. Also margin-positive resections were fewer (37.5% versus 46.2%, p¼0.042). Despite a similar median number of harvested LNs (41 versus 42. p¼0.711), the proportion of N1 patients (60.6% versus 79.4%), the number of positive LNs (1 versus 4), and the LN ratio (0.031 versus 0.097) were decreased, all p<0.001. However, in a propensity-score matched cohort of resectable/BR patients, NAT was not associated to a significant survival benefit in comparison with US (median DSS from diagnosis 36 versus 31 months, p¼ 0.329; median RFS 16 versus 13 months, p¼0.342). Conclusion: NAT favorably impacts all adverse histopathological features of resected PDAC. However, this does not necessarily coincide with a survival benefit in resectable/BR patients.
Abstract ID: 1979. Ten years of Post-Operative Pancreatic Fistula (POPF) definition (2005-2016). Does the new classification really change something? Gennaro Nappo, Fara Uccelli, Francesca Gavazzi, Cristina Ridolfi, Giovanni Capretti, Alessandro Zerbi Humanitas Research Hospital, Milan, Italy Introduction: In 2005 International Study Group of Pancreatic Surgery (ISGPS) classified POPF into 3 different grades of severity (A, B, C) and it has been universally adopted. Recently, ISGPS updated this classification. Aims: The aim of this study was to compare the incidence and severity of POPF in our series of Pancreatico-Duodenectomies (PDs) using the two classifications. Materials & methods: All consecutive PDs performed from 2010 to 2016 were retrospectively evaluated from a prospective database. Incidence and grade of POPF strictly adopting the two classifications were recorded.