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Perioperative hydrocortisone treatment reduces postoperative pancreatic fistula after distal pancreatectomy. A randomized controlled trial
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Abstracts / Pancreatology 17 (2017) S1eS142
Abstract ID: 1951. Perioperative hydrocortisone treatment reduces postoperative pancreatic fistula after distal pancreatectomy. A randomized controlled trial
analysis, age >55 years (HR¼6.14; p<0.001), size >20 mm (HR¼26.7; p<0.001) and biliary dilatation (HR¼29.9; p¼0.027) were found to be independent risk factors of PI malignancy and when associated, the likelihood of malignancy exceeded 90%. Conclusion: PI represent about 30% of indications for pancreatectomy and are malignant in 50% of cases.
Anne Antila, Antti Siiki, Juhani Sand, Johanna Laukkarinen Tampere University Hospital, Department of Gastroenterology and Alimentary Tract Surgery, Finland Introduction: Postoperative pancreatic fistula (POPF) is the major complication after distal pancreatectomy (DP). In our recent randomized trial we showed that perioperative hydrocortisone (HC) treatment reduces Clavien-Dindo 3-5 complications after pancreaticoduodenectomy (Laaninen et al, Annals of Surgery 2016). Aims: In this study we aimed to find out whether perioperative hydrocortisone treatment prevents the risk for POPF after DP. Patients & methods: 40 patients planned for DP at Tampere University Hospital were randomized to receive perioperative treatment with intravenous HC 100 mg or plasebo. The first dose was given at the induction of anaestesia. 31 patients underwent DP and continued in the study. All had a high-risk, soft pancreas (>40% acini in the pancreatic transsection line as analysed peroperatively). They continued to receive HC/plasebo every 8 hours for two days postoperatively. All complications were graded, the primary endpoint being POPF. Results: Median age was 68 (39-82) years and 35% were men. The groups were similar for age, sex and ASA class distribution. 90-day mortality was zero. With HC treatment the rate of clinically significant POPF (grades B/C) were significantly reduced compared to plasebo (5.9% vs 28.6%, p¼0.016). The rate of overall Clavien-Dindo III-V complications were 5.9% and 21.4% in the HC and placebo group, respectively (ns; p¼0.058) Conclusion: Perioperative HC treatment decreases the rate of clinically relevant POPF even after distal pancreatectomy.
Abstract ID: 1961. Pancreatectomy for pancreatic incidentalomas: what are the risks? Morgane Bouquot 1, S ebastien Gaujoux 1, François Cauchy 1, David Birnbaum 1, Safi Dokmak 1, Marie-Pierre Vullierme 2, Philippe L evy 3, 1 1 Olivier Soubrane , Alain Sauvanet 1
Department of HPB Surgery, Hopital Beaujon, University Paris Diderot, France 2 Department of Radiology, Hopital Beaujon, University Paris Diderot, France 3 Department of Pancreatology, Hopital Beaujon, University Paris Diderot, France Introduction: Pancreatic incidentaloma (PI) are increasingly common but the benefit-risk balance of surgery is often difficult to determine. PI encompasses a heterogeneous spectrum of neoplasms which, beyond their comforting presentation, can be benign, premalignant or even malignant. Aims: To describe PI selected for surgery from a large database of pancreatectomies performed at a single institution, to compare them with symptomatic patients, and to determine risk factors of malignancy Patients & methods: Monocentric retrospective study of 881 pancreatectomies comparing PI with symptomatic lesion. Univariate (UV) and multivariate (MV) analyses were done to identify risk factors of malignancy in PI. Results: Among the 881 patients, 32% (n¼283) had PI. Median size of PI was 30 mm (vs 28 mm, p¼0.15) and 49% were cystic (vs 42%, p¼0.197). Resected PI were mostly located in distal pancreas (61 vs 34%, p<0.001), less associated with malignancy (49% vs 59%, p¼0.004). NETs were more frequently present in PI (50% vs 21 %, p<0.001). Distal pancreatectomy (36% vs 23%, p<0.001) or parenchyma-sparing surgery (34% vs 13%, p<0.001) were more likely performed for PI. Overall mortality (1.1% vs 1.2%) and morbidity (70% vs 68%) were not significantly different between 2 groups but severe morbidity was lower for PI (15% vs 37%, p<0.001). In MV
Abstract ID: 1962. Assessment of CFTR, SPINK1 and PRSS1 mutations, smoking and alcohol abuse in adult chronic pancreatitis patients seen in Barcelona Hannah de Leon 1, Celia Badenas 2, Encarna Varela 3, Eva C. Vaquero 4, Xavier Molero 5 1
Servei de Gastroenterologia, Hospital Clínic, Barcelona, Spain Biochemistry and Molecular Genetics Unit, Hospital Clínic, IDIBAPS, CIBERER, Barcelona, Spain 3 Exocrine Pancreatic Diseases Research Group, Hospital Universitari Vall d'Hebron, CIBEREHD, Barcelona, Spain 4 Servei de Gastroenterologia, Hospital Clínic, IDIBAPS, CIBEREHD, Barcelona, Spain 5 Exocrine Pancreatic Diseases Research Group, Hospital Universitari Vall d'Hebron, CIBEREHD, Barcelona, Spain 2
Introduction: Genetic susceptibility for chronic pancreatitis (CrP) and impact of smoking/alcohol abuse show geographical variations. Non cystic fibrosis (CF)-causing CFTR mutations may have population, age and toxic dependent pathogenicity. Aims: To examine CFTR, SPINK1 and PRSS1 mutations, smoking/ alcohol abuse in adult CrP patients seen in Barcelona. Patients & methods: Unselected 149 CrP patients from two community hospitals and 77 controls were examined. 96 patients and 71 controls completed a 7-year follow-up. All coding regions were sequenced (only SPINK1 exon 3 in 48 patients). Results: Smoking, alcohol abuse or combinations of both were more prevalent in patients. No relevant PRSS1 mutations were detected. CFTR or SPINK1 mutations were present in 42.3% patients (6.5% controls; p<0.001). 30.2% had CFTR mutations, most being non CF-causing variants (73.3%). Sweat chloride was higher in patients than controls (42.6±2.1 vs 30.3±1.7 mM; p<0.0001) irrespective of smoking, age or mutational status. 15% patients had SPINK1 mutations (0 controls; p<0.001). CrP patients with specific mutation types had lesser rates of smoking or alcohol intake. CFTR/ SPINK1 mutations were related to early-onset disease (37.6±1.7 vs 45.9±1.6 years; p¼0.001). On follow-up, 22% patients had 25 malignancies (9.8% controls) regardless of genetic background. Mortality was higher (33.3% vs 11.2%) and occurred earlier (58.9±2.1 vs 70.2±7.1 years; p¼0.04) in CrP patients than in controls, mainly due to cancer (lung, pancreas, other GI), cardiovascular or lung disease. Conclusion: SPINK1 and CFTR mutations (most non-CF-causing) are frequent in adult CrP patients seen in Barcelona. Smoking/alcohol abuse may contribute to gene mutation pathogenicity. CrP is associated with significant comorbidities and high mortality.
Abstract ID: 1966. Patient-reported Long-term Outcomes after Duodenum-preserving Pancreatic Head Resection (Berne Modification) for Chronic Pancreatitis Willem Niesen 1, Thomas Hank 1, Yoana Angelova 2, Ulf Hinz 1, Christian €rg Kaiser 1, Thilo Hackert 1, Markus W. Büchler 1, Oliver Scheele 1, Jo Strobel 1 1
University Hospital Heidelberg, Department of Surgery, Germany University Hospital Heidelberg, Department of Gastroenterology, Germany 2
Abstracts / Pancreatology 17 (2017) S1eS142
Abstract ID: 1951. Perioperative hydrocortisone treatment reduces postoperative pancreatic fistula after distal pancreatectomy. A randomized controlled trial
analysis, age >55 years (HR¼6.14; p<0.001), size >20 mm (HR¼26.7; p<0.001) and biliary dilatation (HR¼29.9; p¼0.027) were found to be independent risk factors of PI malignancy and when associated, the likelihood of malignancy exceeded 90%. Conclusion: PI represent about 30% of indications for pancreatectomy and are malignant in 50% of cases.
Anne Antila, Antti Siiki, Juhani Sand, Johanna Laukkarinen Tampere University Hospital, Department of Gastroenterology and Alimentary Tract Surgery, Finland Introduction: Postoperative pancreatic fistula (POPF) is the major complication after distal pancreatectomy (DP). In our recent randomized trial we showed that perioperative hydrocortisone (HC) treatment reduces Clavien-Dindo 3-5 complications after pancreaticoduodenectomy (Laaninen et al, Annals of Surgery 2016). Aims: In this study we aimed to find out whether perioperative hydrocortisone treatment prevents the risk for POPF after DP. Patients & methods: 40 patients planned for DP at Tampere University Hospital were randomized to receive perioperative treatment with intravenous HC 100 mg or plasebo. The first dose was given at the induction of anaestesia. 31 patients underwent DP and continued in the study. All had a high-risk, soft pancreas (>40% acini in the pancreatic transsection line as analysed peroperatively). They continued to receive HC/plasebo every 8 hours for two days postoperatively. All complications were graded, the primary endpoint being POPF. Results: Median age was 68 (39-82) years and 35% were men. The groups were similar for age, sex and ASA class distribution. 90-day mortality was zero. With HC treatment the rate of clinically significant POPF (grades B/C) were significantly reduced compared to plasebo (5.9% vs 28.6%, p¼0.016). The rate of overall Clavien-Dindo III-V complications were 5.9% and 21.4% in the HC and placebo group, respectively (ns; p¼0.058) Conclusion: Perioperative HC treatment decreases the rate of clinically relevant POPF even after distal pancreatectomy.
Abstract ID: 1961. Pancreatectomy for pancreatic incidentalomas: what are the risks? Morgane Bouquot 1, S ebastien Gaujoux 1, François Cauchy 1, David Birnbaum 1, Safi Dokmak 1, Marie-Pierre Vullierme 2, Philippe L evy 3, 1 1 Olivier Soubrane , Alain Sauvanet 1
Department of HPB Surgery, Hopital Beaujon, University Paris Diderot, France 2 Department of Radiology, Hopital Beaujon, University Paris Diderot, France 3 Department of Pancreatology, Hopital Beaujon, University Paris Diderot, France Introduction: Pancreatic incidentaloma (PI) are increasingly common but the benefit-risk balance of surgery is often difficult to determine. PI encompasses a heterogeneous spectrum of neoplasms which, beyond their comforting presentation, can be benign, premalignant or even malignant. Aims: To describe PI selected for surgery from a large database of pancreatectomies performed at a single institution, to compare them with symptomatic patients, and to determine risk factors of malignancy Patients & methods: Monocentric retrospective study of 881 pancreatectomies comparing PI with symptomatic lesion. Univariate (UV) and multivariate (MV) analyses were done to identify risk factors of malignancy in PI. Results: Among the 881 patients, 32% (n¼283) had PI. Median size of PI was 30 mm (vs 28 mm, p¼0.15) and 49% were cystic (vs 42%, p¼0.197). Resected PI were mostly located in distal pancreas (61 vs 34%, p<0.001), less associated with malignancy (49% vs 59%, p¼0.004). NETs were more frequently present in PI (50% vs 21 %, p<0.001). Distal pancreatectomy (36% vs 23%, p<0.001) or parenchyma-sparing surgery (34% vs 13%, p<0.001) were more likely performed for PI. Overall mortality (1.1% vs 1.2%) and morbidity (70% vs 68%) were not significantly different between 2 groups but severe morbidity was lower for PI (15% vs 37%, p<0.001). In MV
Abstract ID: 1962. Assessment of CFTR, SPINK1 and PRSS1 mutations, smoking and alcohol abuse in adult chronic pancreatitis patients seen in Barcelona Hannah de Leon 1, Celia Badenas 2, Encarna Varela 3, Eva C. Vaquero 4, Xavier Molero 5 1
Servei de Gastroenterologia, Hospital Clínic, Barcelona, Spain Biochemistry and Molecular Genetics Unit, Hospital Clínic, IDIBAPS, CIBERER, Barcelona, Spain 3 Exocrine Pancreatic Diseases Research Group, Hospital Universitari Vall d'Hebron, CIBEREHD, Barcelona, Spain 4 Servei de Gastroenterologia, Hospital Clínic, IDIBAPS, CIBEREHD, Barcelona, Spain 5 Exocrine Pancreatic Diseases Research Group, Hospital Universitari Vall d'Hebron, CIBEREHD, Barcelona, Spain 2
Introduction: Genetic susceptibility for chronic pancreatitis (CrP) and impact of smoking/alcohol abuse show geographical variations. Non cystic fibrosis (CF)-causing CFTR mutations may have population, age and toxic dependent pathogenicity. Aims: To examine CFTR, SPINK1 and PRSS1 mutations, smoking/ alcohol abuse in adult CrP patients seen in Barcelona. Patients & methods: Unselected 149 CrP patients from two community hospitals and 77 controls were examined. 96 patients and 71 controls completed a 7-year follow-up. All coding regions were sequenced (only SPINK1 exon 3 in 48 patients). Results: Smoking, alcohol abuse or combinations of both were more prevalent in patients. No relevant PRSS1 mutations were detected. CFTR or SPINK1 mutations were present in 42.3% patients (6.5% controls; p<0.001). 30.2% had CFTR mutations, most being non CF-causing variants (73.3%). Sweat chloride was higher in patients than controls (42.6±2.1 vs 30.3±1.7 mM; p<0.0001) irrespective of smoking, age or mutational status. 15% patients had SPINK1 mutations (0 controls; p<0.001). CrP patients with specific mutation types had lesser rates of smoking or alcohol intake. CFTR/ SPINK1 mutations were related to early-onset disease (37.6±1.7 vs 45.9±1.6 years; p¼0.001). On follow-up, 22% patients had 25 malignancies (9.8% controls) regardless of genetic background. Mortality was higher (33.3% vs 11.2%) and occurred earlier (58.9±2.1 vs 70.2±7.1 years; p¼0.04) in CrP patients than in controls, mainly due to cancer (lung, pancreas, other GI), cardiovascular or lung disease. Conclusion: SPINK1 and CFTR mutations (most non-CF-causing) are frequent in adult CrP patients seen in Barcelona. Smoking/alcohol abuse may contribute to gene mutation pathogenicity. CrP is associated with significant comorbidities and high mortality.
Abstract ID: 1966. Patient-reported Long-term Outcomes after Duodenum-preserving Pancreatic Head Resection (Berne Modification) for Chronic Pancreatitis Willem Niesen 1, Thomas Hank 1, Yoana Angelova 2, Ulf Hinz 1, Christian €rg Kaiser 1, Thilo Hackert 1, Markus W. Büchler 1, Oliver Scheele 1, Jo Strobel 1 1
University Hospital Heidelberg, Department of Surgery, Germany University Hospital Heidelberg, Department of Gastroenterology, Germany 2