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ASSOCIATION FOR ACADEMIC SURGERY AND SOCIETY OF UNIVERSITY SURGEONS—ABSTRACTS visit, 3 blood tests, 2 endoscopic procedures, 8 imaging studies) during years 1-5 after surgery. The motivation underlying their follow-up practices was analyzed using a menu of 12 possible factors and a Likert scale of 1 (lowest effect on motivation) to 10 (highest effect). We assessed the effect of surgeon age on follow-up intensity, controlling for TNM stage and year post-treatment, using repeated-measures ANOVA. One-way ANOVA was used to analyze the effect of surgeon age on motivation. Results: Of the 566 responses, 347 were considered evaluable. There were no significant differences among age strata (30-39, 40-49, 50-59, and ⱖ 60) in surveillance practices for any of the 4 vignettes. Only one motivating factor differed significantly among age strata: psychosocial support for the patient; surgeons ⱖ 60 were motivated more strongly (Likert score 6.9; p ⬍ .05) by this factor than younger surgeons (Likert score 5.8). Conclusions: CME contributes to homogenization of this important aspect of clinical management among ASCRS surgeons.

P167. LONG-TERM RESULTS OF A PHASE I TRIAL OF PANCREATIC ISLET TRANSPLANTATION USING A REMOTE ISOLATION CENTER. J. A. Rodriguez, N. R. Barshes, N. S. Becker, T. C. Lee, T. Zgabay, J. A. Goss; Baylor College of Medicine, Houston, TX Introduction: Pancreatic islet transplantation (PIT) has emerged as a less-invasive means of performing beta-cell replacement for patients with type I (insulin-dependent) diabetes mellitus. The ability of PIT to achieve short-term insulin independence has been demonstrated at several centers. An enormous challenge in setting up a PIT program is the expertise, FDA approval, and cost required for efficient pancreatic islet cell isolation. Transplantation programs stand to benefit from a collaboration with a remote center that specializes in islet cell isolation. We have previously shown that such a transplantation system provides viable and functional islet cells in the short-term. We now present long-term results of pancreatic islet transplants performed in collaboration with a remote isolation center. Methods: Between January 2002 and June 2004, 11 patients with type I diabetes mellitus recalcitrant to maximal medical therapy received a total of 26 PITs as part of an FDA-approved phase I trial. All pancreata were procured in Houston, TX. Pancreatic islets were isolated at the Diabetes Research Institute (Miami, FL) and, after achieving release criteria for viability, sterility and purity, islets were transplanted via percutaneous transhepatic portal vein infusion at The Methodist Hospital (Houston, TX). Induction immunosuppression consisted of baclizumab and maintenance immuno-suppression consisted of sirolimus and tacrolimus. During serial follow-up, all complications, both eary and late, were carefully documented. In addition, hemoglobin A 1 C levels, exogenous insulin requirements, serum c-peptide levels, and quality of life were measured. The median follow-up interval for these patients is 3.1 years (range 2.6-3.9 years). Results: All PIT procedures were well-tolerated and no immediate procedure-related complications were observed. Color-flow Doppler ultrasound performed after each PIT has shown no evidence of portal vein thrombosis or intrahepatic parenchymal hematoma. The median length of hospital stay after transplantation was one day (range 0.5 to 5 days). All eleven patients demonstrated initial graft function as evidenced by significant decreases in hemoglobin A 1 C and insulin requirements as well as increases in serum c-peptide (basal and stimulated). Nine patients achieved insulin independence following PIT, and quality-of-life (as per quantitative assessment) also improved significantly. During the second year of the trial, nine of the 11 patients demonstrated continued graft function. By the third year of the study, 5 patients demonstrated continued graft function. However, 2 of the 5 patients were removed from the study: one was removed secondary to a decreased glomerular filtration rate,

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and the other was removed secondary to West Nile viral encephalitis. Common late complications were mild and included hypercholesterolemia, aphthous ulcers and peripheral edema. Conclusions: Pancreatic islets remain viable following shipment from a remote isolation center and exhibit excellent short-term function. Long-term graft survival is encouraging, but additional strategies to prevent graft loss are needed.

P168. SURVIVAL FOR PATIENTS UNDERGOING SIDE-TOSIDE PORTACAVAL SHUNTING EXCEEDS THAT PREDICTED BY MELD SCORE. J. Bingener-Casey, K. R. Sirinek, E. W. Beale; University of Texas Health Science Center, San Antonio, TX Introduction: Survival analysis for patients undergoing TIPS was initially used to construct the MELD scoring system. This study compares the survival of patients undergoing Side-to Side Portacaval Shunts (SSPCS) as predicted by the MELD score with actual survival rates. Patients and Methods: Data for all patients who underwent SSPCS between 1978 and 2005 were prospectively collected. MELD score was computed for patients with available INR values. (0.957 ⫻ 1n creat ⫹ 0.378 ⫻ 1n bili ⫹ 1.12 ⫻ 1n INR ⫹ 0.643 ⫻ 10, using mg/dl) Survival curves were estimated with Kaplan-Meier product limit methodology and Cox proportional hazard methodology. The study was exempt by the IRB. Results: Data from 261 patients (median follow-up 18yrs) with SSPCS were analyzed. Overall survival was 80% at 6mos, 76% at 1yr, 40% at 5yrs and 18% at 10yrs with a mean survival of 5.7yrs. All patients was 61.1mos mean survival time was 71mos for Childs A patients(24), 61mos for Childs B patients(75) and 33mos for Childs C patients(51). Mean survival for Childs A and Childs B patients(99) was 63 mos. For 36 patients a MELD score (mean score 11.3 ⫹ 0.5) was available. Continuous MELD score analysis by Cox proportional hazard methodology yielded hazard ration of 1.12:1 (Wald statistic, p⫽0.049). Low risk (⬍13) versus medium risk MELD strata (13-17) yielded no statistically significant difference (p⫽0.093). The actual survival rates for those patients exceeded those predicted by MELD score at 1, 3, 6, 12 and 24 months, with a mean difference of 17% (range of 12% to 22%). Conclusion: While the proportional hazard analysis indicates and increasing postoperative mortality with increasing MELD score, the survival predicted by the MELD score was exceeded by patients undergoing SSPCS. A possible factor is that the data for patients undergoing SSPCS in this study surpasses the published survival rates for TIPS, which was utilized to establish the MELD scoring system.

P169. EQUAL ONCOLOGIC OUTCOMES FOR ADRENAL METASTASES WITH LAPAROSCOPIC AND OPEN RESECTION. J. T. Adler, E. Mack, H. Chen; University of Wisconsin, Madison, WI Background: Cancerous lesions of the adrenal gland have typically been treated by an open adrenalectomy. Only recently has laparoscopic adrenalectomy been used to remove metastases less than 10 cm that do not invade surrounding tissue. Although short-term benefits of laparoscopic adrenalectomy are well established, questions persist about its long-term outcomes. This study was intended to compare surgical and oncologic outcomes of laparoscopic with open adrenalectomy in patients with isolated adrenal metastases. Methods: From March 1993 to April 2006, 143 patients underwent adrenalectomy at a single institution. Of these, 20 adults had metastases to the adrenal gland. 2 patients were excluded due to a concomitant nephrectomy, and 1 was excluded because the tumor was unresectable. Surgical and oncologic outcomes of 17 patients with isolated metastases to the adrenal gland were retrospectively measured and analyzed. Re-