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Inter-Anastomosis Drainage Tube between the Pancreas and Jejunum: A Novel Technique for Preventing Pancreatic Fistula after Pancreaticoduodenectomy
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Scientific Poster Presentations: 2016 Clinical Congress
(FN) are major components of hepatic scar, with TGFb being the most potent stimulator for ECM production. Our data revealed that endogenous Coll.I and FN expression were suppressed by HJC0416 in a dose-dependent manner; TGFb-stimulated Coll.I and FN production were prevented by pretreatment with HJC0416. CONCLUSIONS: HJC0416 inhibits HSC activation via the STAT3 signaling pathway. HJC0416 represents a promising anti-hepatic fibrogenic agent.
Impact of Lymphadenectomy and Number of Positive Lymph Nodes in Resected NonFunctional Pancreatic Neuroendocrine Tumors: Size Matters Katelin A Mirkin, MD, Christopher S Hollenbeak, PhD, Joyce Wong, MD Penn State, Hershey, PA INTRODUCTION: Pancreatic neuroendocrine tumors (PNETs) are unique pancreatic neoplasms. Clear guidelines recommending extent of surgical resection are lacking. This study evaluates the impact of lymphadenectomy on patient outcomes. METHODS: The National Cancer Data Base (1998-2012) was reviewed for patients with stages 1-3, non-functional PNETs. Univariate and multivariate survival analyses were performed. RESULTS: A total of 5,861 patients were evaluated: 2,962 (50.5%) underwent surgery, 2,899 (49.5%) did not. Three hundred seventy-six tumors were 1cm, 1,046 1-2cm, and 4,438 were >2cm. In both tumors 2 or >2cm, patients who underwent surgery had fewer comorbidities, earlier clinical stage, lower chromogranin A levels (200 ng/mL), lower mitotic rate (4 mitoses/HPF), and lower grade tumors than non-surgical patients. Surgical resection was associated with improved survival; however, extent of lymphadenectomy (0, 1-10, 11-15, 16-20, 21-25, 26-30, >30 lymph nodes) did not impact survival, irrespective of tumor size. 14.4% of PNET 1cm had positive lymph nodes; 19.5% 1-2cm; 48.6% >2cm. Number of positive lymph nodes (0, 1-2, 3-6, >6), did not impact survival in PNET 2cm; however, this was significant in tumors >2cm, with more positive nodes negatively impacting survival (1-2: HR¼1.55 p¼.004, 3-6: HR¼2.35 p<0.001, >6: HR: 2.20 p¼.001). This was also observed on multivariate analysis. CONCLUSIONS: In PNETs 2cm, neither extent of lymphadenectomy or number of positive nodes was associated with an increase in mortality. However, in PNETs >2cm, number of positive nodes negatively impacts survival. Thus, enucleation may be sufficient in small tumors but lymphadenectomy is necessary in tumors >2cm in order to ascertain the number of positive nodes.
J Am Coll Surg
Inter-Anastomosis Drainage Tube between the Pancreas and Jejunum: A Novel Technique for Preventing Pancreatic Fistula after Pancreaticoduodenectomy Tatsuya Oda, MD, PhD, Shingi Hashimoto, Osamu Shimomura, MD, Masanao Kurata, Yukio Oshiro, MD, PhD, Nobuhiro Ohkohchi, MD, PhD University of Tsukuba, Tsukuba, Japan INTRODUCTION: Intending to prevent pancreatic fistula (PF) after pancreaticoduodenectomy (PD), we investigated a new method namely an inter-anastomosis drainage tube (IAD), that include placement of a suction drainage tube into the space between the pancreas and the jejunum. One concern has been that creating an additional hole in the bowel and placement of a foreign body might be harmful and could prevent the completion of anastomosis adhesion. We present here a 2-year experience of this new procedure. METHODS: We applied this IAD method for 51 PD patients starting from March 2014 to March 2016. The incidence of PF, drainage amylase level and postoperative hospital stay (POHS) were compared with our historical control reconstructed with only modified Blumgart method (n¼78). RESULTS: The IAD tubes drained 8.1 mL/day of amylase-rich (75,4075U/mL) discharge. As a result, the peritoneal drainage fluid amylase concentrations (median) at POD 1 and 3 were improved from 5469 and 1107 U/mL in control, to 2416, and 231 U/mL in IAD cohort. PF of ISGPF grade A, B, C occurred in 11 (21.5%), 7 (13.7%) and 0 (0%) patients, respectively. The clinically relevant grade B+C pancreatic fistula incidence was satisfactorily improved from 20.5% (16/78) in the control to 13.7% (7/51). The median POHSs were 16.0 in control and 15.0 days in IAD cohort. CONCLUSIONS: IAD confer satisfactory result without unfavorable effect. IAD method is a simple add-on without need of special instruments, therefore, may be applicable for various type of pancreatic anastomoses for PF prevention.
Is There an Optimal Timing for Same-Admission Laparoscopic Cholecystectomy for Acute Cholecystitis? A Matched Case-Control Study Comparing the “Golden 72 Hours” Joel CI Goh, Janice Wan Lin Lim, MBBS, Jarrod Tan, MBBS, Shridhar Iyer, MBBS, FRCS, Krishnakumar Madhavan, MBBS, FRCS, Alfred Wei Chieh Kow, MBBS, FRCS National University Health System, Singapore, Singapore INTRODUCTION: While the golden hour of <72 hours is sometimes considered ideal for same-admission laparoscopic cholecystectomy (SLC) for acute cholecystitis (AC), the optimal timing
Scientific Poster Presentations: 2016 Clinical Congress
(FN) are major components of hepatic scar, with TGFb being the most potent stimulator for ECM production. Our data revealed that endogenous Coll.I and FN expression were suppressed by HJC0416 in a dose-dependent manner; TGFb-stimulated Coll.I and FN production were prevented by pretreatment with HJC0416. CONCLUSIONS: HJC0416 inhibits HSC activation via the STAT3 signaling pathway. HJC0416 represents a promising anti-hepatic fibrogenic agent.
Impact of Lymphadenectomy and Number of Positive Lymph Nodes in Resected NonFunctional Pancreatic Neuroendocrine Tumors: Size Matters Katelin A Mirkin, MD, Christopher S Hollenbeak, PhD, Joyce Wong, MD Penn State, Hershey, PA INTRODUCTION: Pancreatic neuroendocrine tumors (PNETs) are unique pancreatic neoplasms. Clear guidelines recommending extent of surgical resection are lacking. This study evaluates the impact of lymphadenectomy on patient outcomes. METHODS: The National Cancer Data Base (1998-2012) was reviewed for patients with stages 1-3, non-functional PNETs. Univariate and multivariate survival analyses were performed. RESULTS: A total of 5,861 patients were evaluated: 2,962 (50.5%) underwent surgery, 2,899 (49.5%) did not. Three hundred seventy-six tumors were 1cm, 1,046 1-2cm, and 4,438 were >2cm. In both tumors 2 or >2cm, patients who underwent surgery had fewer comorbidities, earlier clinical stage, lower chromogranin A levels (200 ng/mL), lower mitotic rate (4 mitoses/HPF), and lower grade tumors than non-surgical patients. Surgical resection was associated with improved survival; however, extent of lymphadenectomy (0, 1-10, 11-15, 16-20, 21-25, 26-30, >30 lymph nodes) did not impact survival, irrespective of tumor size. 14.4% of PNET 1cm had positive lymph nodes; 19.5% 1-2cm; 48.6% >2cm. Number of positive lymph nodes (0, 1-2, 3-6, >6), did not impact survival in PNET 2cm; however, this was significant in tumors >2cm, with more positive nodes negatively impacting survival (1-2: HR¼1.55 p¼.004, 3-6: HR¼2.35 p<0.001, >6: HR: 2.20 p¼.001). This was also observed on multivariate analysis. CONCLUSIONS: In PNETs 2cm, neither extent of lymphadenectomy or number of positive nodes was associated with an increase in mortality. However, in PNETs >2cm, number of positive nodes negatively impacts survival. Thus, enucleation may be sufficient in small tumors but lymphadenectomy is necessary in tumors >2cm in order to ascertain the number of positive nodes.
J Am Coll Surg
Inter-Anastomosis Drainage Tube between the Pancreas and Jejunum: A Novel Technique for Preventing Pancreatic Fistula after Pancreaticoduodenectomy Tatsuya Oda, MD, PhD, Shingi Hashimoto, Osamu Shimomura, MD, Masanao Kurata, Yukio Oshiro, MD, PhD, Nobuhiro Ohkohchi, MD, PhD University of Tsukuba, Tsukuba, Japan INTRODUCTION: Intending to prevent pancreatic fistula (PF) after pancreaticoduodenectomy (PD), we investigated a new method namely an inter-anastomosis drainage tube (IAD), that include placement of a suction drainage tube into the space between the pancreas and the jejunum. One concern has been that creating an additional hole in the bowel and placement of a foreign body might be harmful and could prevent the completion of anastomosis adhesion. We present here a 2-year experience of this new procedure. METHODS: We applied this IAD method for 51 PD patients starting from March 2014 to March 2016. The incidence of PF, drainage amylase level and postoperative hospital stay (POHS) were compared with our historical control reconstructed with only modified Blumgart method (n¼78). RESULTS: The IAD tubes drained 8.1 mL/day of amylase-rich (75,4075U/mL) discharge. As a result, the peritoneal drainage fluid amylase concentrations (median) at POD 1 and 3 were improved from 5469 and 1107 U/mL in control, to 2416, and 231 U/mL in IAD cohort. PF of ISGPF grade A, B, C occurred in 11 (21.5%), 7 (13.7%) and 0 (0%) patients, respectively. The clinically relevant grade B+C pancreatic fistula incidence was satisfactorily improved from 20.5% (16/78) in the control to 13.7% (7/51). The median POHSs were 16.0 in control and 15.0 days in IAD cohort. CONCLUSIONS: IAD confer satisfactory result without unfavorable effect. IAD method is a simple add-on without need of special instruments, therefore, may be applicable for various type of pancreatic anastomoses for PF prevention.
Is There an Optimal Timing for Same-Admission Laparoscopic Cholecystectomy for Acute Cholecystitis? A Matched Case-Control Study Comparing the “Golden 72 Hours” Joel CI Goh, Janice Wan Lin Lim, MBBS, Jarrod Tan, MBBS, Shridhar Iyer, MBBS, FRCS, Krishnakumar Madhavan, MBBS, FRCS, Alfred Wei Chieh Kow, MBBS, FRCS National University Health System, Singapore, Singapore INTRODUCTION: While the golden hour of <72 hours is sometimes considered ideal for same-admission laparoscopic cholecystectomy (SLC) for acute cholecystitis (AC), the optimal timing