- Email: [email protected]
L on the third post-operative day effectively predicts the absence of a high-impact postoperative pancreatic fistula following pancreaticoduodenectomy?
Electronic Poster Abstracts receive stents. Overall, CR-POPFs occurred in 145 (11.7%) patients. The median FRS of patients who received external stents was significantly higher compared with patients who received no stents (6 vs. 3, p < 0.0001) or internal stents (6 vs. 3, p < 0.0001). Patients with negligible, low, or moderate CR-POPF risk (FRS 0-6; 92.2% of patients) did not demonstrate improved outcomes with either internal or external stents (Figure); however, among high-risk patients (FRS 7-10; 7.8%), external stents were associated with significantly reduced rates of CR-POPF, severe complications (Accordion 3), and hospital stay compared with internal stents and no stents (Table). Conclusion: This multicenter study is the largest comparative analysis of trans-anastomotic stents for PD. It demonstrates that external stents are beneficial for patients with high CR-POPF risk, but they confer no benefit to patients with negligible, low, or moderate risk.
e111
Methods: We performed analysis of 95 patients who underwent PD at our institution between January 2009 to December 2012, with focus on preoperative and perioperative parameters that might predict POPF (ISGPF criteria). Results: Of 67 males and 28 females with mean age of 57 12 (range 16e77) years, POPF developed in 35 (36.8%) patients with grade A, B and C in 12 (12.6%), 17 (17.9%) and 6 (6.3%), respectively. On univariate analysis, serum amylase on POD-3 (p = 0.012), POD-5 (p = 0.017) and tumor-positive CBD margin (p = 0.047) were significant. But on multivariate analysis, only serum amylase value at POD-3 was independent predictor of POPF (p = 0.039, OR = 1.014, 95% CI: 1.001e1.028). On ROC curve analysis, AUC = 0.728, 95% Cl: 0.571e0.885, p = 0.004. Serum amylase on POD-3 60 IU/L predicts POPF with sensitivity, specificity, PPV, NPV and accuracy of 61.1%, 83.3%, 73.3%, 74.1% and 73.8%, respectively. Drain amylase 666 IU/L on POD-3 was proposed as cut-off to predict clinically relevant high-impact fistula (grade B and C) by ROC curve (AUC = 0.585, 95% Cl: 0.363e0.807, p < 0.001), with sensitivity, specificity, PPV, NPV and accuracy of 62.5%, 91.5%, 71.4%, 87.8% and 84.1%, respectively. Conclusions: Serum amylase 60 IU/L on POD-3 is an independent predictor of POPF. Drain amylase 666 IU/L on POD-3 is a significant predictor of clinically relevant high-impact fistula (grade B and C).
[CR-POPF rates across FRS risk zones] FP34-02 - Table
Variable, N (%)
Overall
No Stent (NS)
External Stent (ES)
Internal Stent (IS)
p-value ES vs. NS
p-value ES vs. IS
High risk patients (FRS 7-10)
97 (7.8)
22 (3.7)
50 (38.8)
25 (4.9)
< 0.0001
< 0.0001
CR-POPF
27 (27.8)
8 (36.4)
7 (14.0)
12 (48.0)
0.031
0.001
Grade B
21 (21.6)
6 (27.3)
7 (14.0)
8 (32.0)
0.197
0.066
Grade C
6 (6.2)
2 (9.1)
0 (0)
4 (16.0)
0.090
0.010
Any complication (Accordion 1)
76 (78.4)
19 (86.4)
36 (72.0)
21 (84.0)
0.186
0.251
Severe complication (Accordion 3)
32 (33.0)
9 (40.9)
9 (18.0)
14 (56.0)
0.039
0.001
Mean (SD)
13.7 (10.9)
15.4 (8.6)
11.0 (5.9)
17.6 (17.5)
0.034
0.032
Median (IQR)
10 (8–15)
12.5 (8.8–23.5)
9 (7–12.3)
10 (8–23)
0.014
0.133
Duration of hospital stay (days)
[Outcomes Among Patients with High CR-POPF Risk]
FP34-03 DOES DRAIN AMYLASE < 666 IU/L ON THE THIRD POST-OPERATIVE DAY EFFECTIVELY PREDICTS THE ABSENCE OF A HIGH-IMPACT POSTOPERATIVE PANCREATIC FISTULA FOLLOWING PANCREATICODUODENECTOMY?
FP34-05 USING THE PANCREATIC DEMONSTRATION PROJECT TO DERIVE A FISTULA RISK SCORE FOR PREOPERATIVE RISK STRATIFICATION IN PATIENTS UNDERGOING PANCREATICODUODENECTOMY
M. Srivastava, V. Kumaran and S. Nundy Dertment of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, India Introduction: We aimed to identify factors which might predict Postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD).
O. Kantor1, M. S. Talamonti2,3, H. A. Pitt4, C. M. Vollmer5, T. S. Riall6, B. L. Hall7, C. -H. Wang8 and M. S. Baker2,3 1 Department of Surgery, University of Chicago, 2 Department of Surgery, NorthShore University HealthSystem, 3Pritzker School of Medicine, University of
HPB 2016, 18 (S1), e1ee384
e111
Methods: We performed analysis of 95 patients who underwent PD at our institution between January 2009 to December 2012, with focus on preoperative and perioperative parameters that might predict POPF (ISGPF criteria). Results: Of 67 males and 28 females with mean age of 57 12 (range 16e77) years, POPF developed in 35 (36.8%) patients with grade A, B and C in 12 (12.6%), 17 (17.9%) and 6 (6.3%), respectively. On univariate analysis, serum amylase on POD-3 (p = 0.012), POD-5 (p = 0.017) and tumor-positive CBD margin (p = 0.047) were significant. But on multivariate analysis, only serum amylase value at POD-3 was independent predictor of POPF (p = 0.039, OR = 1.014, 95% CI: 1.001e1.028). On ROC curve analysis, AUC = 0.728, 95% Cl: 0.571e0.885, p = 0.004. Serum amylase on POD-3 60 IU/L predicts POPF with sensitivity, specificity, PPV, NPV and accuracy of 61.1%, 83.3%, 73.3%, 74.1% and 73.8%, respectively. Drain amylase 666 IU/L on POD-3 was proposed as cut-off to predict clinically relevant high-impact fistula (grade B and C) by ROC curve (AUC = 0.585, 95% Cl: 0.363e0.807, p < 0.001), with sensitivity, specificity, PPV, NPV and accuracy of 62.5%, 91.5%, 71.4%, 87.8% and 84.1%, respectively. Conclusions: Serum amylase 60 IU/L on POD-3 is an independent predictor of POPF. Drain amylase 666 IU/L on POD-3 is a significant predictor of clinically relevant high-impact fistula (grade B and C).
[CR-POPF rates across FRS risk zones] FP34-02 - Table
Variable, N (%)
Overall
No Stent (NS)
External Stent (ES)
Internal Stent (IS)
p-value ES vs. NS
p-value ES vs. IS
High risk patients (FRS 7-10)
97 (7.8)
22 (3.7)
50 (38.8)
25 (4.9)
< 0.0001
< 0.0001
CR-POPF
27 (27.8)
8 (36.4)
7 (14.0)
12 (48.0)
0.031
0.001
Grade B
21 (21.6)
6 (27.3)
7 (14.0)
8 (32.0)
0.197
0.066
Grade C
6 (6.2)
2 (9.1)
0 (0)
4 (16.0)
0.090
0.010
Any complication (Accordion 1)
76 (78.4)
19 (86.4)
36 (72.0)
21 (84.0)
0.186
0.251
Severe complication (Accordion 3)
32 (33.0)
9 (40.9)
9 (18.0)
14 (56.0)
0.039
0.001
Mean (SD)
13.7 (10.9)
15.4 (8.6)
11.0 (5.9)
17.6 (17.5)
0.034
0.032
Median (IQR)
10 (8–15)
12.5 (8.8–23.5)
9 (7–12.3)
10 (8–23)
0.014
0.133
Duration of hospital stay (days)
[Outcomes Among Patients with High CR-POPF Risk]
FP34-03 DOES DRAIN AMYLASE < 666 IU/L ON THE THIRD POST-OPERATIVE DAY EFFECTIVELY PREDICTS THE ABSENCE OF A HIGH-IMPACT POSTOPERATIVE PANCREATIC FISTULA FOLLOWING PANCREATICODUODENECTOMY?
FP34-05 USING THE PANCREATIC DEMONSTRATION PROJECT TO DERIVE A FISTULA RISK SCORE FOR PREOPERATIVE RISK STRATIFICATION IN PATIENTS UNDERGOING PANCREATICODUODENECTOMY
M. Srivastava, V. Kumaran and S. Nundy Dertment of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, India Introduction: We aimed to identify factors which might predict Postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD).
O. Kantor1, M. S. Talamonti2,3, H. A. Pitt4, C. M. Vollmer5, T. S. Riall6, B. L. Hall7, C. -H. Wang8 and M. S. Baker2,3 1 Department of Surgery, University of Chicago, 2 Department of Surgery, NorthShore University HealthSystem, 3Pritzker School of Medicine, University of
HPB 2016, 18 (S1), e1ee384