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Pancreatoduodenectomy with venous or arterial resection: Are the outcomes comparable?
e72
Electronic Poster Abstracts
FP21-04 - Table
Northeast
South Atlantic
East Central
West Central
Pacific/West Coast
(CT,MA,ME, NH, RI,VT, NJ,NY,PA)
(DC,DE,FL, GA,MD, NC, SC,VA,WV)
(IL,IN,MI, OH,WI, AL, KY,MS,TN)
(IA,KS,MN, MO,ND,NE, SD, AR,LA,OK,TX)
(AZ,CO,ID,MT, NM, NV,UT,WY,AK CA, HI,OR,WA)
Stage I
14.8
11.7
12.0
12.5
12.3
Stage II
11.7
11.0
10.0
10.3
11.4
Stage III
9.8
8.4
8.4
8.8
9.0
Stage IV
3.8
3.6
3.5
3.5
3.6
[Median Survival (months) by Stage and Region]
Conclusion: Regional variations exist in pancreatic cancer treatment and survival. Surgery and multimodality therapy remain grossly underutilized. These results suggest that multimodality treatment may be key to reducing disparities.
FP21-05 PANCREATODUODENECTOMY WITH VENOUS OR ARTERIAL RESECTION: ARE THE OUTCOMES COMPARABLE? J. Beane1, M. House1, S. Pitt2, E. M. Kilbane3, T. Riall4, B. Hall5 and H. Pitt6 1 Indiana University School of Medicine, 2University of Wisconson, School of Medicine, 3Indiana Univesity Health, 4University of Arizona, School of Medicine, 5 Washington University School of Medicine in St. Louis, and 6Temple University School of Medicine, United States Introduction: The morbidity of pancreatoduodenectomy remains unacceptably high. Vascular resection is being performed more frequently, and small, single institution series suggest that outcomes are comparable. Most studies focus on venous, not arterial, resections. The aim of this report is to analyze the outcomes of pancreatoduodenectomy with and without venous or arterial vascular resection in a large, multicenter cohort. Methods: The American College of Surgeons-National Surgical Quality Improvement Program Pancreatectomy Demonstration Project was performed at 43 institutions. Over 14 months, 1,573 patients underwent pancreatoduodenectomy without (1,322, 84.1%) or with major venous (194, 12.3%) or arterial (57, 3.6%) vascular resection. pancreatoduodenectomies (PD) without and with venous (PD+VR) or arterial (PD+AR) resection were similar with respect to age, race, BMI, serum albumin, ASA class, operative approach, gland texture, duct size or pathology. Outcomes were compared by Fisher’s Exact and Student’s t tests. Results: The mean age was 64 years. 53.5% were women, and 84.7% were Caucasian. Vascular resection did not increase the incidence of surgical site infections, pancreatic
fistulas or delayed gastric emptying. Both venous and arterial resection were associated with significant increases (p < 0.03) in deep venous thromboembolism, postoperative septic shock and acute kidney injury. Other outcomes are presented in the Table. Conclusions: Both major venous and arterial vascular resection during pancreatoduodenectomy are associated with increased operative time, perioperative transfusions, serious and overall morbidity as well as length of stay. The decision to undertake vascular resection during pancreatoduodenectomy should be undertaken with knowledge and communication of the increased risk.
FP21-06 SUPERCHARGED VERSUS CONVENTIONAL APPLEBY OPERATION FOR LOCALLY ADVANCED PANCREATIC TUMORS P. Bachellier, P. Addeo, G. Simone, E. Oussoultzoglou, F. Faitot and V. De Blasi University of Strasbourg, HPB Surgery and Liver Transplantation, France Introduction: Preoperative common hepatic artery embolization has been described in order to decrease the ischemic complication associated with the suppression of the coeliac trunk flow during the Appleby operation. Systematic reconstruction of the common hepatic artery (called such as “supercharged” Appleby) has been proposed as a more physiologic mean in order to maintain an optimal arterial flow to the liver. We evaluated the short term outcomes of the supercharged versus conventional Appleby operation. Methods: Data regarding 32 consecutive patients undergoing Appleby operation between January 2001 and December 2014 were analysed. Among them 12 patients underwent conventional Appleby operation (Group 1) and 20 a supercharged Appleby operation (including 17 with
FP21-05 - Table 1
Procedure
Operative Time (hrs)
Transfusion (%)
Serious Morbidity (%)
Overall Morbidity (%)
Length of Stay (mean days)
60-day Mortality (%)
PD
6:05
21.0
35.5
54.8
11.1
1.6
PD+VR
7:32*
43.8*
55.2*
68.0*
12.7†
3.6
PD+AR
7:33*
35.1*
52.6*
71.9*
11.9†
2.6
*p<0.001, † p<0.02 vs PD
HPB 2016, 18 (S1), e1ee384
Electronic Poster Abstracts
FP21-04 - Table
Northeast
South Atlantic
East Central
West Central
Pacific/West Coast
(CT,MA,ME, NH, RI,VT, NJ,NY,PA)
(DC,DE,FL, GA,MD, NC, SC,VA,WV)
(IL,IN,MI, OH,WI, AL, KY,MS,TN)
(IA,KS,MN, MO,ND,NE, SD, AR,LA,OK,TX)
(AZ,CO,ID,MT, NM, NV,UT,WY,AK CA, HI,OR,WA)
Stage I
14.8
11.7
12.0
12.5
12.3
Stage II
11.7
11.0
10.0
10.3
11.4
Stage III
9.8
8.4
8.4
8.8
9.0
Stage IV
3.8
3.6
3.5
3.5
3.6
[Median Survival (months) by Stage and Region]
Conclusion: Regional variations exist in pancreatic cancer treatment and survival. Surgery and multimodality therapy remain grossly underutilized. These results suggest that multimodality treatment may be key to reducing disparities.
FP21-05 PANCREATODUODENECTOMY WITH VENOUS OR ARTERIAL RESECTION: ARE THE OUTCOMES COMPARABLE? J. Beane1, M. House1, S. Pitt2, E. M. Kilbane3, T. Riall4, B. Hall5 and H. Pitt6 1 Indiana University School of Medicine, 2University of Wisconson, School of Medicine, 3Indiana Univesity Health, 4University of Arizona, School of Medicine, 5 Washington University School of Medicine in St. Louis, and 6Temple University School of Medicine, United States Introduction: The morbidity of pancreatoduodenectomy remains unacceptably high. Vascular resection is being performed more frequently, and small, single institution series suggest that outcomes are comparable. Most studies focus on venous, not arterial, resections. The aim of this report is to analyze the outcomes of pancreatoduodenectomy with and without venous or arterial vascular resection in a large, multicenter cohort. Methods: The American College of Surgeons-National Surgical Quality Improvement Program Pancreatectomy Demonstration Project was performed at 43 institutions. Over 14 months, 1,573 patients underwent pancreatoduodenectomy without (1,322, 84.1%) or with major venous (194, 12.3%) or arterial (57, 3.6%) vascular resection. pancreatoduodenectomies (PD) without and with venous (PD+VR) or arterial (PD+AR) resection were similar with respect to age, race, BMI, serum albumin, ASA class, operative approach, gland texture, duct size or pathology. Outcomes were compared by Fisher’s Exact and Student’s t tests. Results: The mean age was 64 years. 53.5% were women, and 84.7% were Caucasian. Vascular resection did not increase the incidence of surgical site infections, pancreatic
fistulas or delayed gastric emptying. Both venous and arterial resection were associated with significant increases (p < 0.03) in deep venous thromboembolism, postoperative septic shock and acute kidney injury. Other outcomes are presented in the Table. Conclusions: Both major venous and arterial vascular resection during pancreatoduodenectomy are associated with increased operative time, perioperative transfusions, serious and overall morbidity as well as length of stay. The decision to undertake vascular resection during pancreatoduodenectomy should be undertaken with knowledge and communication of the increased risk.
FP21-06 SUPERCHARGED VERSUS CONVENTIONAL APPLEBY OPERATION FOR LOCALLY ADVANCED PANCREATIC TUMORS P. Bachellier, P. Addeo, G. Simone, E. Oussoultzoglou, F. Faitot and V. De Blasi University of Strasbourg, HPB Surgery and Liver Transplantation, France Introduction: Preoperative common hepatic artery embolization has been described in order to decrease the ischemic complication associated with the suppression of the coeliac trunk flow during the Appleby operation. Systematic reconstruction of the common hepatic artery (called such as “supercharged” Appleby) has been proposed as a more physiologic mean in order to maintain an optimal arterial flow to the liver. We evaluated the short term outcomes of the supercharged versus conventional Appleby operation. Methods: Data regarding 32 consecutive patients undergoing Appleby operation between January 2001 and December 2014 were analysed. Among them 12 patients underwent conventional Appleby operation (Group 1) and 20 a supercharged Appleby operation (including 17 with
FP21-05 - Table 1
Procedure
Operative Time (hrs)
Transfusion (%)
Serious Morbidity (%)
Overall Morbidity (%)
Length of Stay (mean days)
60-day Mortality (%)
PD
6:05
21.0
35.5
54.8
11.1
1.6
PD+VR
7:32*
43.8*
55.2*
68.0*
12.7†
3.6
PD+AR
7:33*
35.1*
52.6*
71.9*
11.9†
2.6
*p<0.001, † p<0.02 vs PD
HPB 2016, 18 (S1), e1ee384