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Insulinomas versus non-functioning neuroendocrine pancreatic tumors: aspects of diagnosis and outcome after pancreatic resection
Electronic Poster Abstracts
EP02D-053 INSULINOMAS VERSUS NONFUNCTIONING NEUROENDOCRINE PANCREATIC TUMORS: ASPECTS OF DIAGNOSIS AND OUTCOME AFTER PANCREATIC RESECTION E. R. Ramos Figueira1, T. Bacchella1, R. Jureidini1, A. G. V. Fernandes2, J. Okubo2, T. C. Ribeiro1, G. N. Namur1, U. Ribeiro Jr.1 and I. Cecconello1 1 Division of Digestive Surgery, Department of Gastroenterology, Hospital das Clinicas from University of Sao Paulo School of Medicine, and 2University of Sao Paulo School of Medicine, Brazil Background: Pancreatic neuroendocrine tumors (PNET) are rare neoplasms with various subtypes. Nonfunctioning tumors are usually incidental with increased incidence in the last decades. Insulinomas are the most frequent functional tumors that present benign behavior in up to 90% of cases. We aimed to evaluate aspects of diagnosis and results of pancreatic resection of nonfunctioning (NF) tumors compared to insulinomas. Methods: We retrospectively evaluated the medical records and electronic data from 103 patients submitted to pancreatic resection at our Institutuion. Patients with small liver metastasis resected during the same surgery were included. Results: Thirty-four patients had NF pancreatic tumors and 69 insulinomas, 56% were women with 44.51 17.27 years. Age was decreased and BMI increased in Insulinoma group compared to NF (p < 0.05). Enucleation was performed in 44.93% of insulinomas and pancreatoduodenectomy in 50.0% of NF tumors (p < 0.001). Tumor diameter was greater in NF group (p < 0.0001) with a trend to present positive lymphnodes (p = 0.0843). Insulinoma group showed higher number of patients with postoperative complications (p = 0.0025). Follow-up time was 7.71 6.39 years in NF and 14.0 10.52 years in Insulinoma (p = 0.0038). The 10-year actuarial survival was 94.95% in Insulinoma and 83.32% in NF group, without significance. Conclusions: Nonfunctioning tumors are diagnosed later than insulinomas showing greater size at surgery, however there was no significant difference in survival between these two groups of patients. Interestingly resection of insulinomas was associated with more complications, probably related to high incidence of pancreatic fistulae after tumor enucleation.
EP02D-054 ROBOTIC DISTAL PANCREATECTOMY FOR PANCREATIC NEUROENDOCRINE TUMORS (pNETS) IN ITALY: MULTICENTRIC SURVEY ON 54 PATIENTS S. Alfieri1, A. Pietrabissa2, C. Bassi3, U. Boggi4, M. Piccoli5, G. Spinoglio6, A. Coratti7, G. Quero1, R. Menghi1, C. Fiorillo1 and G. B. Doglietto1 1 Digestive Surgery Unit, Catholic University of Sacred Heart of Rome, 2San Matteo Hospital, 3Policlinico ’G.B.
HPB 2016, 18 (S1), e385ee601
e403
Rossi’, 4Azienda Ospedaliero-Universitaria Pisana, 5 Nuovo Ospedale Civile Sant’Agostino Estense, 6Azienda Ospedaliera Nazionale ’SS. Antonio e Biagio e C. Arrigo’ di Alessandria, and 7Azienda Ospedaliero Universitaria di Careggi, Italy Introduction: Robotic distal pancreatectomy is being used increasingly in specialized pancreatic surgery centers. The aim of our study is to report our multicentric experience on robotic assisted left pancreatectomy in pNET treatment to evaluate its feasibility and post-operative outcomes. Methods: A multicentric analysis of 54 robotic distal pancreatectomies for pNET performed between July 2006 and July 2014 was conducted among 9 Italian centers. We registered preoperative data, perioperative outcomes, 90 days morbidity and mortality. Results: The tumor was located in the body of the pancreas in 7 cases, in the tail of the pancreas in 17 patients, and between the body and tail of the pancreas in 30 cases. The mean operative room time for all of the procedures was 270.26 min (94.3), with a mean docking time duration of 21.62 min (13.5). Splenic preservation was performed in 28/54 patients (52%). Overall convertion rate was 7%. Morbidity rate was 60.25%. Twenty-five patients (44.7 %) developed a pancreatic fistula postoperatively. A total of 4 (7.4%) patients required reoperation. Mortality rate was 1% (1/54) for development of sepsis in response to a grade C pancreatic fistula. Six patients were re-admitted. Conclusions: Our data suggest that robotic distal pancreatectomy for pNET is a feasible and safe procedure, showing perioperative outcomes, comparable to the laparoscopic approach, letting the surgeon to safely perform challenging procedures thanks to its ergonomics. Further prospective, multicenter randomized trials are needed to confirm our results and to show robotic approach superiority over laparoscopic and traditional open pancreatic surgery.
EP02D-055 NSAID USE AND RISK OF POSTOPERATIVE PANCREATIC FISTULAS FOLLOWING PANCREATICODUODENECTOMY: A RETROSPECTIVE COHORT STUDY S. Rashid, P. Serrano, D. Dath, Y. Essaji, H. Kaka, M. Marcaccio, V. Tandan, F. Yuan and L. Ruo General Surgery, McMaster University, Canada Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used for pain control following pancreaticoduodenectomy. They are, however, thought to increase postoperative leak rate after certain types of intraabdominal operations like colorectal surgery. This study aims to evaluate the association between perioperative NSAIDs use and postoperative pancreatic fistula (POPF) following pancreaticoduodenectomy. Methods: This is a retrospective review of patients undergoing pancreaticoduodenectomy from January 2009 to March 2014. Risks factors for POPF, including use of NSAIDS, were evaluated using univariable and multivariable methods. Results: There were 276 patients analyzed during the study period (150/276, 54% of which had a diagnosis of
EP02D-053 INSULINOMAS VERSUS NONFUNCTIONING NEUROENDOCRINE PANCREATIC TUMORS: ASPECTS OF DIAGNOSIS AND OUTCOME AFTER PANCREATIC RESECTION E. R. Ramos Figueira1, T. Bacchella1, R. Jureidini1, A. G. V. Fernandes2, J. Okubo2, T. C. Ribeiro1, G. N. Namur1, U. Ribeiro Jr.1 and I. Cecconello1 1 Division of Digestive Surgery, Department of Gastroenterology, Hospital das Clinicas from University of Sao Paulo School of Medicine, and 2University of Sao Paulo School of Medicine, Brazil Background: Pancreatic neuroendocrine tumors (PNET) are rare neoplasms with various subtypes. Nonfunctioning tumors are usually incidental with increased incidence in the last decades. Insulinomas are the most frequent functional tumors that present benign behavior in up to 90% of cases. We aimed to evaluate aspects of diagnosis and results of pancreatic resection of nonfunctioning (NF) tumors compared to insulinomas. Methods: We retrospectively evaluated the medical records and electronic data from 103 patients submitted to pancreatic resection at our Institutuion. Patients with small liver metastasis resected during the same surgery were included. Results: Thirty-four patients had NF pancreatic tumors and 69 insulinomas, 56% were women with 44.51 17.27 years. Age was decreased and BMI increased in Insulinoma group compared to NF (p < 0.05). Enucleation was performed in 44.93% of insulinomas and pancreatoduodenectomy in 50.0% of NF tumors (p < 0.001). Tumor diameter was greater in NF group (p < 0.0001) with a trend to present positive lymphnodes (p = 0.0843). Insulinoma group showed higher number of patients with postoperative complications (p = 0.0025). Follow-up time was 7.71 6.39 years in NF and 14.0 10.52 years in Insulinoma (p = 0.0038). The 10-year actuarial survival was 94.95% in Insulinoma and 83.32% in NF group, without significance. Conclusions: Nonfunctioning tumors are diagnosed later than insulinomas showing greater size at surgery, however there was no significant difference in survival between these two groups of patients. Interestingly resection of insulinomas was associated with more complications, probably related to high incidence of pancreatic fistulae after tumor enucleation.
EP02D-054 ROBOTIC DISTAL PANCREATECTOMY FOR PANCREATIC NEUROENDOCRINE TUMORS (pNETS) IN ITALY: MULTICENTRIC SURVEY ON 54 PATIENTS S. Alfieri1, A. Pietrabissa2, C. Bassi3, U. Boggi4, M. Piccoli5, G. Spinoglio6, A. Coratti7, G. Quero1, R. Menghi1, C. Fiorillo1 and G. B. Doglietto1 1 Digestive Surgery Unit, Catholic University of Sacred Heart of Rome, 2San Matteo Hospital, 3Policlinico ’G.B.
HPB 2016, 18 (S1), e385ee601
e403
Rossi’, 4Azienda Ospedaliero-Universitaria Pisana, 5 Nuovo Ospedale Civile Sant’Agostino Estense, 6Azienda Ospedaliera Nazionale ’SS. Antonio e Biagio e C. Arrigo’ di Alessandria, and 7Azienda Ospedaliero Universitaria di Careggi, Italy Introduction: Robotic distal pancreatectomy is being used increasingly in specialized pancreatic surgery centers. The aim of our study is to report our multicentric experience on robotic assisted left pancreatectomy in pNET treatment to evaluate its feasibility and post-operative outcomes. Methods: A multicentric analysis of 54 robotic distal pancreatectomies for pNET performed between July 2006 and July 2014 was conducted among 9 Italian centers. We registered preoperative data, perioperative outcomes, 90 days morbidity and mortality. Results: The tumor was located in the body of the pancreas in 7 cases, in the tail of the pancreas in 17 patients, and between the body and tail of the pancreas in 30 cases. The mean operative room time for all of the procedures was 270.26 min (94.3), with a mean docking time duration of 21.62 min (13.5). Splenic preservation was performed in 28/54 patients (52%). Overall convertion rate was 7%. Morbidity rate was 60.25%. Twenty-five patients (44.7 %) developed a pancreatic fistula postoperatively. A total of 4 (7.4%) patients required reoperation. Mortality rate was 1% (1/54) for development of sepsis in response to a grade C pancreatic fistula. Six patients were re-admitted. Conclusions: Our data suggest that robotic distal pancreatectomy for pNET is a feasible and safe procedure, showing perioperative outcomes, comparable to the laparoscopic approach, letting the surgeon to safely perform challenging procedures thanks to its ergonomics. Further prospective, multicenter randomized trials are needed to confirm our results and to show robotic approach superiority over laparoscopic and traditional open pancreatic surgery.
EP02D-055 NSAID USE AND RISK OF POSTOPERATIVE PANCREATIC FISTULAS FOLLOWING PANCREATICODUODENECTOMY: A RETROSPECTIVE COHORT STUDY S. Rashid, P. Serrano, D. Dath, Y. Essaji, H. Kaka, M. Marcaccio, V. Tandan, F. Yuan and L. Ruo General Surgery, McMaster University, Canada Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used for pain control following pancreaticoduodenectomy. They are, however, thought to increase postoperative leak rate after certain types of intraabdominal operations like colorectal surgery. This study aims to evaluate the association between perioperative NSAIDs use and postoperative pancreatic fistula (POPF) following pancreaticoduodenectomy. Methods: This is a retrospective review of patients undergoing pancreaticoduodenectomy from January 2009 to March 2014. Risks factors for POPF, including use of NSAIDS, were evaluated using univariable and multivariable methods. Results: There were 276 patients analyzed during the study period (150/276, 54% of which had a diagnosis of