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Laparoscopic distal pancreatectomy – Its application in clinical practice
E-HPBA: Poster Abstracts Conclusions: This study provides a detailed overview of the patients’ journey from diagnosis to death. It shows the multiple admissions and a range of specialties caring for these patients and highlights the need for one specialty to coordinate their care.
PANCREAS CANCER 0464 LAPAROSCOPIC DISTAL PANCREATECTOMY e ITS APPLICATION IN CLINICAL PRACTICE E. Dorrian, C. Jones, M. A. Taylor and G. Kirk Mater Hospital, UK Aims: With advancements in laparoscopic surgery, an increasing number of operative procedures are safe to perform laparoscopically. Recently NICE guidance has suggested that laparoscopic pancreatectomy is indicated in neuroendocrine tumours, adenocarinoma of the tail of pancreas and chronic pancreatitis. This study aims to review the initial experience of laparoscopic distal pancreatectomy, compared with the standard open technique. Methods: A retrospective review of all patients who underwent distal pancreatectomy from 2013 to 2014, by a single surgeon, both open and laparoscopic, was performed. Patient demographics, co-morbidities, operative and post-operative details including operative time, blood loss, analgesia and drain management; admission and discharge date, along with histology results were collected. The two groups were analysed and compared using SPSS. Results: 14 patients were included, 7 in each group. One patient was excluded from the open group due to inoperable disease. The patient demographics were comparable in both groups, with 4 male patients and a mean age of 67.6 years (laparoscopic) versus 68 years (open). Both groups had 4 male patients. The pathology in both groups was similar including adenocarcinoma, IPMN and neuroendocrine tumours. The operative time was shorter in the laparoscopic group (119 mins v 142 mins), and the recorded intra-operative blood loss was less (0mls v 443.8 mls). Less analgesia was required in the laparoscopic group, only 2 laparoscopic patients requied PCA versus all open patients. The median time to drain removal was 4 days in both groups. Histolpathology revealed a high nodal yield in the laparoscopic group, with a mean of 19 nodes. The overall hospital stay was also shorter in the laparoscopic group (5.4 days versus 7.7 days). Conclusions: This study demonstrates that laparoscopic distal pancreatectomy compares favorably with the open technique. It is both safe and effective, resulting in an adequate oncological resection and a zero conversion rate.
PANCREAS CANCER 0479 DEVELOPING A CORE SET OF PATIENT-REPORTED OUTCOMES IN PANCREATIC CANCER: A DELPHI SURVEY A. Gerritsen1, M. Jacobs1, I. Henselmans1, J. van Hattum1, G. J. Creemers2, I. H. de Hingh2, M. Kooperman3, I. Q. Molenaar3, J. W. Wilmink1, O. R. Busch1, M. G. Besselink1 and H. W. van Laarhoven1 1 Academic Medical Center Amsterdam; 2Catharina Hospital Eindhoven; 3University Medical Center Utrecht, Netherlands
HPB 2016, 18 (S2), e747ee781
e765
Aims: Patient-reported outcomes (PROs) are amongst the most relevant outcome measures in pancreatic cancer care and research. However, it is unknown which out of the numerous PROs are most important in this setting. The aim of this study was to identify a core set of PROs to be incorporated in a nationwide prospective multidisciplinary pancreatic cancer registry. Methods: We performed a two-round Delphi survey among 150 patients diagnosed with pancreatic or periampullary cancer (treated either in curative or palliative setting) and 78 health care professionals (HCPs: surgeons, oncologists, gastroenterologists, radiotherapists, nurses, and dietitians) in the Netherlands. In round 1, participants were invited to rate the importance of 53 PRO-topics, which were extracted from 17 different PRO measures and grouped into global domains, on a 1e9 Likert scale. Topics rated as very important (score 7e9) by the majority ( = 80%) of curative and/or palliative patients as well as HCPs were considered sufficiently important to be incorporated in the core set. Topics not fulfilling these criteria in round 1, were re-presented to the participants in round 2 along with individual and group feedback. Results: A total of 97 patients (94%) in curative setting, 38 patients (81%) in palliative setting and 73 HCPs (94%) completed both round 1 and 2. After both rounds, 17 PRO domains were included in the core set: general quality of life, general health, physical ability, ability to work/do usual activities, medication, pancreatic enzyme replacement therapy, appetite, weight changes, defecation, fatigue, negative feelings, positive feelings, coping, fear of recurrence, relationship with partner/family, satisfaction with caregivers, and satisfaction with services and care organization. Conclusions: This study provides a core set of PROs selected by patients and HCPs which may be incorporated in pancreatic cancer care and research. Validation outside the Dutch context is recommended.
PANCREAS CANCER 0495 EVALUATION OF A REFINED HISTOPATHOLOGIC STAGING SYSTEM FOR RESECTABLE PANCREATIC ADENOCARCINOMA O. Strobel, T. Hank, U. Hinz, L. Schneider, S. Fritz, F. Bergmann, M. W. Buchler and T. Hackert University Hospital Heidelberg, Germany Aims: Most resectable pancreatic ductal adenocarcinomas (PDA) belong to the UICC/AJCC-stage groups IIa (T3N0M0, w20%) or IIb (T1-3N1M0, w66%). Therefore, current staging systems are imprecise for surgical series and for questions concerning adjuvant therapy. We have recently shown that the number of positive lymph nodes (PLN) allows to distinguish several categories of lymph node involvement in PDA. Grading is another prognostic factor associated with survival. Aim: To develop a refined histopathologic staging system for resectable PDA by inclusion of PLN and tumor grade (G). Methods: From a prospective database 1213 patients with resection of a stage II PDA between 10/2001 and 12/2012 were identified. Assessed parameters included lymph node status (N0/N1), PLN, lymph node ratio, G, and resection status (R). Uni- and multivariate survival analyses were performed.
PANCREAS CANCER 0464 LAPAROSCOPIC DISTAL PANCREATECTOMY e ITS APPLICATION IN CLINICAL PRACTICE E. Dorrian, C. Jones, M. A. Taylor and G. Kirk Mater Hospital, UK Aims: With advancements in laparoscopic surgery, an increasing number of operative procedures are safe to perform laparoscopically. Recently NICE guidance has suggested that laparoscopic pancreatectomy is indicated in neuroendocrine tumours, adenocarinoma of the tail of pancreas and chronic pancreatitis. This study aims to review the initial experience of laparoscopic distal pancreatectomy, compared with the standard open technique. Methods: A retrospective review of all patients who underwent distal pancreatectomy from 2013 to 2014, by a single surgeon, both open and laparoscopic, was performed. Patient demographics, co-morbidities, operative and post-operative details including operative time, blood loss, analgesia and drain management; admission and discharge date, along with histology results were collected. The two groups were analysed and compared using SPSS. Results: 14 patients were included, 7 in each group. One patient was excluded from the open group due to inoperable disease. The patient demographics were comparable in both groups, with 4 male patients and a mean age of 67.6 years (laparoscopic) versus 68 years (open). Both groups had 4 male patients. The pathology in both groups was similar including adenocarcinoma, IPMN and neuroendocrine tumours. The operative time was shorter in the laparoscopic group (119 mins v 142 mins), and the recorded intra-operative blood loss was less (0mls v 443.8 mls). Less analgesia was required in the laparoscopic group, only 2 laparoscopic patients requied PCA versus all open patients. The median time to drain removal was 4 days in both groups. Histolpathology revealed a high nodal yield in the laparoscopic group, with a mean of 19 nodes. The overall hospital stay was also shorter in the laparoscopic group (5.4 days versus 7.7 days). Conclusions: This study demonstrates that laparoscopic distal pancreatectomy compares favorably with the open technique. It is both safe and effective, resulting in an adequate oncological resection and a zero conversion rate.
PANCREAS CANCER 0479 DEVELOPING A CORE SET OF PATIENT-REPORTED OUTCOMES IN PANCREATIC CANCER: A DELPHI SURVEY A. Gerritsen1, M. Jacobs1, I. Henselmans1, J. van Hattum1, G. J. Creemers2, I. H. de Hingh2, M. Kooperman3, I. Q. Molenaar3, J. W. Wilmink1, O. R. Busch1, M. G. Besselink1 and H. W. van Laarhoven1 1 Academic Medical Center Amsterdam; 2Catharina Hospital Eindhoven; 3University Medical Center Utrecht, Netherlands
HPB 2016, 18 (S2), e747ee781
e765
Aims: Patient-reported outcomes (PROs) are amongst the most relevant outcome measures in pancreatic cancer care and research. However, it is unknown which out of the numerous PROs are most important in this setting. The aim of this study was to identify a core set of PROs to be incorporated in a nationwide prospective multidisciplinary pancreatic cancer registry. Methods: We performed a two-round Delphi survey among 150 patients diagnosed with pancreatic or periampullary cancer (treated either in curative or palliative setting) and 78 health care professionals (HCPs: surgeons, oncologists, gastroenterologists, radiotherapists, nurses, and dietitians) in the Netherlands. In round 1, participants were invited to rate the importance of 53 PRO-topics, which were extracted from 17 different PRO measures and grouped into global domains, on a 1e9 Likert scale. Topics rated as very important (score 7e9) by the majority ( = 80%) of curative and/or palliative patients as well as HCPs were considered sufficiently important to be incorporated in the core set. Topics not fulfilling these criteria in round 1, were re-presented to the participants in round 2 along with individual and group feedback. Results: A total of 97 patients (94%) in curative setting, 38 patients (81%) in palliative setting and 73 HCPs (94%) completed both round 1 and 2. After both rounds, 17 PRO domains were included in the core set: general quality of life, general health, physical ability, ability to work/do usual activities, medication, pancreatic enzyme replacement therapy, appetite, weight changes, defecation, fatigue, negative feelings, positive feelings, coping, fear of recurrence, relationship with partner/family, satisfaction with caregivers, and satisfaction with services and care organization. Conclusions: This study provides a core set of PROs selected by patients and HCPs which may be incorporated in pancreatic cancer care and research. Validation outside the Dutch context is recommended.
PANCREAS CANCER 0495 EVALUATION OF A REFINED HISTOPATHOLOGIC STAGING SYSTEM FOR RESECTABLE PANCREATIC ADENOCARCINOMA O. Strobel, T. Hank, U. Hinz, L. Schneider, S. Fritz, F. Bergmann, M. W. Buchler and T. Hackert University Hospital Heidelberg, Germany Aims: Most resectable pancreatic ductal adenocarcinomas (PDA) belong to the UICC/AJCC-stage groups IIa (T3N0M0, w20%) or IIb (T1-3N1M0, w66%). Therefore, current staging systems are imprecise for surgical series and for questions concerning adjuvant therapy. We have recently shown that the number of positive lymph nodes (PLN) allows to distinguish several categories of lymph node involvement in PDA. Grading is another prognostic factor associated with survival. Aim: To develop a refined histopathologic staging system for resectable PDA by inclusion of PLN and tumor grade (G). Methods: From a prospective database 1213 patients with resection of a stage II PDA between 10/2001 and 12/2012 were identified. Assessed parameters included lymph node status (N0/N1), PLN, lymph node ratio, G, and resection status (R). Uni- and multivariate survival analyses were performed.