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Postoperative recurrence in patients operated on for benign intraductal papillary mucinous neoplasms (IPMN)
S88
Abstracts / Pancreatology 13 (2013) S2–S98
Aims: Aim of the study was to evaluate the impact of pylorus resection on DGE following PD. Patients & methods: 40 consecutive patients undergoing PD were treated with resection of the pylorus under complete preservation of the stomach (prPD). They were compared with a pair-matched control group of patients undergoing PD with pylorus preservation (ppPD) as the current surgical standard in a 1:1 ratio (age, gender, histopathology). Objectives were operative parameters, incidence of DGE, morbidity and length of hospital stay. Results: Overall DGE incidence was significantly lower after prPD (15.0% vs. 42.5%, p¼0.0066) with DGE grade A 7.5% vs. 20%, grade B 5.0% vs. 12.5% and grade C 2.5% vs. 10%. Operative parameters (blood loss, operation time) and surgical morbidity (other than DGE) were not different between the groups (27.5% prPD vs. 30.0% ppPD, p¼1.000). There was a trend towards a shorter hospital stay in the prPD group compared to the ppPD group. Conclusion: Resection of the pylorus with stomach preservation significantly reduces the frequency of DGE after PD without showing any disadvantage compared to standard ppPD. This finding could be of high relevance for the clinical practice in routine PD and should consequently be investigated in a large randomized multicenter trial to create further evidence.
PII-121 Abstract id: 142. Postoperative recurrence in patients operated on for benign intraductal papillary mucinous neoplasms (IPMN) ^me Cros, Safi Dokmak, Sebastien Olivier Roux, Marie-Pierre Vullierme, J ero Gaujoux, Beatrice Aussilhou, Vinciane Rebours, Olivia HenitcDhom e, Fr ed erique Maire, Maxime Palazzo, Laurent Palazzo, Alain Aubert, Anne Couvelard, Alain Sauvanet, Pascal Hammel, Philippe Ruszniewski, Philippe Levy. Denis Diderot, France Hopital Beaujon, APHP, Faculte Introduction: Risk of postoperative recurrence in patients operated on for exclusively benign IPMN has not been extensively studied. Published studies mixed benign and invasive type, and data did not distinguish true recurrence from lesions left in place. Aims: To evaluate the recurrence rate of IPMN after partial pancreatectomy for benign IPMN and to assess the need for reoperation. Patients & methods: Data were collected for patients operated on in a single centre between 1998 and 2008. Recurrence of IPMN was evaluated on MRI performed during follow-up. Recurrence was defined as new cystic lesions communicating with main pancreatic duct. The evolution of IPMN cysts not resected during surgery was documented. Results: 125 patients (63 males, median age 60 (20-77) years, low, moderate, high grade dysplasia in 47, 43 and 35 pts, respectively) were included. IPMN involved branch ducts (n¼69), main pancreatic duct (n¼5) or mixed-type (n¼ 51). Median postoperative follow-up was 4(2-13) years. 83 pts had no residual lesion (group 1, median F/U: 4yrs (2-13)), while 42 had some residual lesions deliberately left in place(group 2, median F/U: 4 yrs (2-8)). 3 recurrences were observed in Group 1, all of them were invasive leading to total pancreatectomy. In group 2, no new lesion occurred 1changes in persistent lesions were observed in 5 pts (0 invasive) leading to total pancreatectomy indication. Conclusion: Postoperative relapse rate of benign IPMN is low (3.6%) after a 4-year F/U. Occurence of invasive recurrence warrants carefull F/U in all operable patients. Residual lesions should be followed like de novo IPMN.
Claudio 11, Pietrabissa Andrea 12, Intini Sergio 13, Filauro Marco 14, Mezzatesta Pietro 15, Gerunda Giorgio Enrico 16, Fronda Gian Ruggero 17, Di Sebastiano Pierluigi 18, Doglietto Giovanni Battista 19, Melotti Gianluigi 20, Pezzilli Raffaele 21. 1
Pancreas Unit, Dept of Surgery, S. Raffaele Scientific Institute, Milan, Italy 2 Dept. of Surgery, Policlinico G.B. Rossi, Verona, Italy 3 Dept. of Surgery, Santa Chiara Hospital, Pisa, Italy 4 Dept. of Surgery, Ospedale S. Orsola-Malpighi, Bologna, Italy 5 Dept. of Surgery, Istituto Humanitas, Milan, Italy 6 Dept. of Surgery, Ospedale di Ancona, Italy 7 Dept. of Surgery, Ospedale Maggiore, Bologna, Italy 8 Dept. of Surgery, Ospedale Mauriziano Umberto I, Torino, Italy 9 Dept. of Surgery, Ospedale Campus Bio-Medico, Roma, Italy 10 Dept. of Surgery, Ospedale Civile, Rimini, Italy 11 Dept. of Surgery, Ospedale Policlinico, Padova, Italy 12 Dept. of Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy 13 Azienda Ospedaliero Universitaria S. maria della Misericordia, Udine, Italy 14 Dept. of Surgery, Ospedale Galliera, Genova, Italy 15 Dept. of Surgery, Ospedale La Maddalena, Palermo, Italy 16 Dept. of Surgery, Policlinoc di Modena, Italy 17 Dept. of Surgery, AOU Molinette- Torino, Italy 18 Dept. of Surgery, Casa Sollievo della Sofferenza, S. Govanni Rotondo, Italy 19 Dept. of Surgery, Policlinico Gemelli, Roma, Italy 20 dept of Surgery, NOCSAE, Modena, Italy 21 Dept of Medicine, Ospedale S. Orsola Malpighi, Bologna, Italy Introduction: No data are available about distal pancreatectomy in Italy, regarding homogeneity of care among centers, or diffusion and results of minimally invasive distal pancreatectomy (MIDP). Aims: To investigate current practice for DP in Italy. Patients & methods: A survey was conducted among 20 institutions by the Italian Association for Study of Pancreas (AISP). Centers were asked to fill in two questionnaires about: 1. perioperative protocols for DP; 2. operative results of MIDP in the period 2010-2011. Results: 1. Variability in clinical practice was observed among centers. Octreotide was used in 46% of centers, enzyme supplementation in 35%, nasogastric decompression in 85%, oral liquids on day 1 in 63%. All hospitals used at least one drain, removed between day 3-5 in absence of fistula. In case of splenectomy variability in type and timing of vaccinations was recorded. 2. In 2011-2012 18/20 centers performed at least one MIDP, accounting for overall 179 patients (148 laparoscopic, 31 robotic). Among different centers MIDP rate ranged between 0-51%. Overall MIDP rate doubled from 2007(15%) to 2011(28%). Main contraindications for MIDP were: organ invasion (83%), malignancy (33%), diameter>5cm (28%); previous surgery (28%). Conversion rate was 16%. Mean operative time was 231 minutes, blood loss 288 ml. Morbidity was 57%, with 5% relaparotomy rate. Pancreatic fistula occurred in 51% (grade A 35%, B 16%). Mean postoperative stay was 9.9 days with 8% readmission rate. Conclusion: There is a marked variability in clinical practice among Italian centers. MIDP is becoming more popular, but postoperative stay is longer than expected.
PII-123 Abstract id: 90. Resection of locally advanced pancreatic cancer after neoadjuvant chemotherapy with modified FOLFIRINOX: A prospective phase II study PII-122 Abstract id: 190. Distal pancreatectomy in Italy: Results of a multicenter survey ~ 21, Butturini Giovanni 2, Boggi Gianpaolo Balzano 1, Pecorelli NicolA Ugo 3, Casadei Riccardo 4, Zerbi Alessandro 5, Falconi Massimo 6, Jovine Elio 7, Capussotti Lorenzo 8, Coppola Roberto 9, Veneroni Luigi 10, Pasquali
Nelide De Lio 1, Enrico Vasile 2, Mario Antonio Belluomini 1, Francesca Costa 1, Carla Cappelli 3, Daniela Campani 4, Alfredo Falcone 2, Ugo Boggi 1. 1
Division of General and Transplant Surgery, University of Pisa, Pisa, Italy 2 Division of Oncology, University of Pisa, Pisa, Italy
Abstracts / Pancreatology 13 (2013) S2–S98
Aims: Aim of the study was to evaluate the impact of pylorus resection on DGE following PD. Patients & methods: 40 consecutive patients undergoing PD were treated with resection of the pylorus under complete preservation of the stomach (prPD). They were compared with a pair-matched control group of patients undergoing PD with pylorus preservation (ppPD) as the current surgical standard in a 1:1 ratio (age, gender, histopathology). Objectives were operative parameters, incidence of DGE, morbidity and length of hospital stay. Results: Overall DGE incidence was significantly lower after prPD (15.0% vs. 42.5%, p¼0.0066) with DGE grade A 7.5% vs. 20%, grade B 5.0% vs. 12.5% and grade C 2.5% vs. 10%. Operative parameters (blood loss, operation time) and surgical morbidity (other than DGE) were not different between the groups (27.5% prPD vs. 30.0% ppPD, p¼1.000). There was a trend towards a shorter hospital stay in the prPD group compared to the ppPD group. Conclusion: Resection of the pylorus with stomach preservation significantly reduces the frequency of DGE after PD without showing any disadvantage compared to standard ppPD. This finding could be of high relevance for the clinical practice in routine PD and should consequently be investigated in a large randomized multicenter trial to create further evidence.
PII-121 Abstract id: 142. Postoperative recurrence in patients operated on for benign intraductal papillary mucinous neoplasms (IPMN) ^me Cros, Safi Dokmak, Sebastien Olivier Roux, Marie-Pierre Vullierme, J ero Gaujoux, Beatrice Aussilhou, Vinciane Rebours, Olivia HenitcDhom e, Fr ed erique Maire, Maxime Palazzo, Laurent Palazzo, Alain Aubert, Anne Couvelard, Alain Sauvanet, Pascal Hammel, Philippe Ruszniewski, Philippe Levy. Denis Diderot, France Hopital Beaujon, APHP, Faculte Introduction: Risk of postoperative recurrence in patients operated on for exclusively benign IPMN has not been extensively studied. Published studies mixed benign and invasive type, and data did not distinguish true recurrence from lesions left in place. Aims: To evaluate the recurrence rate of IPMN after partial pancreatectomy for benign IPMN and to assess the need for reoperation. Patients & methods: Data were collected for patients operated on in a single centre between 1998 and 2008. Recurrence of IPMN was evaluated on MRI performed during follow-up. Recurrence was defined as new cystic lesions communicating with main pancreatic duct. The evolution of IPMN cysts not resected during surgery was documented. Results: 125 patients (63 males, median age 60 (20-77) years, low, moderate, high grade dysplasia in 47, 43 and 35 pts, respectively) were included. IPMN involved branch ducts (n¼69), main pancreatic duct (n¼5) or mixed-type (n¼ 51). Median postoperative follow-up was 4(2-13) years. 83 pts had no residual lesion (group 1, median F/U: 4yrs (2-13)), while 42 had some residual lesions deliberately left in place(group 2, median F/U: 4 yrs (2-8)). 3 recurrences were observed in Group 1, all of them were invasive leading to total pancreatectomy. In group 2, no new lesion occurred 1changes in persistent lesions were observed in 5 pts (0 invasive) leading to total pancreatectomy indication. Conclusion: Postoperative relapse rate of benign IPMN is low (3.6%) after a 4-year F/U. Occurence of invasive recurrence warrants carefull F/U in all operable patients. Residual lesions should be followed like de novo IPMN.
Claudio 11, Pietrabissa Andrea 12, Intini Sergio 13, Filauro Marco 14, Mezzatesta Pietro 15, Gerunda Giorgio Enrico 16, Fronda Gian Ruggero 17, Di Sebastiano Pierluigi 18, Doglietto Giovanni Battista 19, Melotti Gianluigi 20, Pezzilli Raffaele 21. 1
Pancreas Unit, Dept of Surgery, S. Raffaele Scientific Institute, Milan, Italy 2 Dept. of Surgery, Policlinico G.B. Rossi, Verona, Italy 3 Dept. of Surgery, Santa Chiara Hospital, Pisa, Italy 4 Dept. of Surgery, Ospedale S. Orsola-Malpighi, Bologna, Italy 5 Dept. of Surgery, Istituto Humanitas, Milan, Italy 6 Dept. of Surgery, Ospedale di Ancona, Italy 7 Dept. of Surgery, Ospedale Maggiore, Bologna, Italy 8 Dept. of Surgery, Ospedale Mauriziano Umberto I, Torino, Italy 9 Dept. of Surgery, Ospedale Campus Bio-Medico, Roma, Italy 10 Dept. of Surgery, Ospedale Civile, Rimini, Italy 11 Dept. of Surgery, Ospedale Policlinico, Padova, Italy 12 Dept. of Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy 13 Azienda Ospedaliero Universitaria S. maria della Misericordia, Udine, Italy 14 Dept. of Surgery, Ospedale Galliera, Genova, Italy 15 Dept. of Surgery, Ospedale La Maddalena, Palermo, Italy 16 Dept. of Surgery, Policlinoc di Modena, Italy 17 Dept. of Surgery, AOU Molinette- Torino, Italy 18 Dept. of Surgery, Casa Sollievo della Sofferenza, S. Govanni Rotondo, Italy 19 Dept. of Surgery, Policlinico Gemelli, Roma, Italy 20 dept of Surgery, NOCSAE, Modena, Italy 21 Dept of Medicine, Ospedale S. Orsola Malpighi, Bologna, Italy Introduction: No data are available about distal pancreatectomy in Italy, regarding homogeneity of care among centers, or diffusion and results of minimally invasive distal pancreatectomy (MIDP). Aims: To investigate current practice for DP in Italy. Patients & methods: A survey was conducted among 20 institutions by the Italian Association for Study of Pancreas (AISP). Centers were asked to fill in two questionnaires about: 1. perioperative protocols for DP; 2. operative results of MIDP in the period 2010-2011. Results: 1. Variability in clinical practice was observed among centers. Octreotide was used in 46% of centers, enzyme supplementation in 35%, nasogastric decompression in 85%, oral liquids on day 1 in 63%. All hospitals used at least one drain, removed between day 3-5 in absence of fistula. In case of splenectomy variability in type and timing of vaccinations was recorded. 2. In 2011-2012 18/20 centers performed at least one MIDP, accounting for overall 179 patients (148 laparoscopic, 31 robotic). Among different centers MIDP rate ranged between 0-51%. Overall MIDP rate doubled from 2007(15%) to 2011(28%). Main contraindications for MIDP were: organ invasion (83%), malignancy (33%), diameter>5cm (28%); previous surgery (28%). Conversion rate was 16%. Mean operative time was 231 minutes, blood loss 288 ml. Morbidity was 57%, with 5% relaparotomy rate. Pancreatic fistula occurred in 51% (grade A 35%, B 16%). Mean postoperative stay was 9.9 days with 8% readmission rate. Conclusion: There is a marked variability in clinical practice among Italian centers. MIDP is becoming more popular, but postoperative stay is longer than expected.
PII-123 Abstract id: 90. Resection of locally advanced pancreatic cancer after neoadjuvant chemotherapy with modified FOLFIRINOX: A prospective phase II study PII-122 Abstract id: 190. Distal pancreatectomy in Italy: Results of a multicenter survey ~ 21, Butturini Giovanni 2, Boggi Gianpaolo Balzano 1, Pecorelli NicolA Ugo 3, Casadei Riccardo 4, Zerbi Alessandro 5, Falconi Massimo 6, Jovine Elio 7, Capussotti Lorenzo 8, Coppola Roberto 9, Veneroni Luigi 10, Pasquali
Nelide De Lio 1, Enrico Vasile 2, Mario Antonio Belluomini 1, Francesca Costa 1, Carla Cappelli 3, Daniela Campani 4, Alfredo Falcone 2, Ugo Boggi 1. 1
Division of General and Transplant Surgery, University of Pisa, Pisa, Italy 2 Division of Oncology, University of Pisa, Pisa, Italy