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Preoperative chemoradiation for pancreatic adenocarcinoma does not increase 90-day postoperative morbidity or mortality
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Electronic Poster Abstracts
Introduction: Enhanced recovery after surgery (ERAS) protocols aim to rapidly restore physiologic function after surgery through mitigation of the stress response. This has been shown to have beneficial effects on lengths of stay (LOS) in colorectal, oesophagogastric and hepatic surgery. This study aimed to investigate the effects of an ERAS protocol on the postoperative systemic inflammatory response following pancreaticoduodenectomy (PD). Methods: The perioperative management of consecutive patients undergoing PD between August 2012 and August 2014 (ERAS cohort) was guided by a locally developed ERAS protocol incorporating ERASTM Society recommendations. Patients between August 2010 and August 2012 who underwent PD with conventional perioperative management (pre-ERAS cohort) were utilised as a comparison. Demographic data, serum markers of systemic inflammation, and intra- and postoperative events including complications and LOS were collected prospectively. Results: 142 patients were included in the analysis (preERAS, N = 73; ERAS, N = 69). There was no significant difference in serum C-reactive protein, white cell count or neutrophil count in the postoperative period between the cohorts (all P > 0.05). Median LOS was reduced from 17 to 13 days (P = 0.001). There was a significant reduction in clinically-relevant wound complications (P = 0.019). There were no significant increases in postoperative morbidity or readmission rates. Inclusion in the ERAS protocol was an independent predictor of shorter LOS (HR1.59, P = 0.012). Conclusions: Enhanced recovery following pancreaticoduodenectomy is associated with a safe reduction in lengths of stay. This effect is not achieved through modulation of the postoperative systemic inflammatory response.
EP02D-009 PREOPERATIVE CHEMORADIATION FOR PANCREATIC ADENOCARCINOMA DOES NOT INCREASE 90-DAY POSTOPERATIVE MORBIDITY OR MORTALITY J. Denbo1, M. Bruno1, L. Prakash1, J. Lee1, M. Kim1, C. Crane2, E. Koay2, T. Aloia1, J. -N. Vauthey1, J. Fleming1 and M. Katz1 1 Surgical Oncology, and 2Radiation Oncology, MD Anderson Cancer Center, United States Background: The impact of preoperative chemoradiation upon postoperative morbidity and mortality of patients with pancreatic ductal adenocarcinoma (PDAC) remains controversial. Methods: Consecutive patients with PDAC who underwent pancreatectomy 2011e2015 were prospectively monitored for at least 90 days using a previously reported surveillance system to determine the association between preoperative chemoradiation and rates of ACCORDION adverse events, ISGPF postoperative pancreatic fistulae (POPF), readmission and mortality.
Results: Among 209 consecutive patients, 136 (65%) received preoperative chemoradiation. Patients who received chemoradiation had more advanced tumors (p < 0.01), were more likely to receive induction chemotherapy (p < 0.01), underwent concomitant vascular resection more frequently (53% vs. 34%, p = 0.01), had higher estimated blood loss (p = 0.02), and a lower rate of POPF (8% vs. 18%, p = 0.04). There was no significant difference in the rates of severe complications (22% vs. 21%), readmission (21% vs. 22%), or mortality (0% for both groups). Among the subgroup of patients who underwent pancreatoduodenectomy, the rate of POPF was similar between those who received preoperative chemoradiation and those who did not (7% vs. 7%, p = 0.99). In contrast, in the subgroup of patients who underwent distal pancreatectomy, those who received preoperative chemoradiation had a lower rate of POPF (12% vs. 53%, p < 0.01) and a lower readmission rate (15% vs. 41%, p = 0.058) than nonradiated patients. Conclusion: Although preoperative chemoradiation was administered more frequently to patients with advanced disease, it was not associated with an increase in 90-day morbidity or mortality. Preoperative chemoradiation reduces the rate of POPF and may decrease readmissions following distal pancreatectomy.
EP02D-010 THE RELATIONSHIP BETWEEN BODY MASS INDEX, PANCREATIC FISTULA AND POSTOPERATIVE COMPLICATIONS AND ITS ASSOCIATED COST IMPLICATIONS FOLLOWING PANCREATICODUODENECTOMY P. E. Serrano1,2, Y. Essaji1, D. Dath1, M. J. Marcaccio1, V. Tandan1 and L. Ruo1 1 Surgery, and 2Clinical Epidemiology and Biostatistics, Mcmaster University, Canada Introduction: Obesity is thought to be associated with increased risk of postoperative complications. This study aims to evaluate the effect of body mass index (BMI) on pancreatic fistula, postoperative complications and its associated overall cost following pancreaticoduodenectomy. Methods: This is a cohort of patients undergoing pancreaticoduodenectomy from 2009e2014 at a high volume institution. Risks factors associated with postoperative complications and pancreatic fistula (POPF defined by the International Study Group) were evaluated by univariable and multivariable analyses. Hospitalization and emergency room costs up to 90 days following surgery were analyzed. Results: The median BMI of all patients (n = 276) was 26.2 (range = 16.6e48.4); higher for those with POPF, 27.85 (range = 16.7e44.4) vs. 25.88 (range = 16.7e48.4), P = 0.069. Similarly, the median BMI for those with a postoperative complication was higher, 26.7 (range = 16.7e43.9) vs. 25.18 (range = 17.56e48.44),
HPB 2016, 18 (S1), e385ee601
Electronic Poster Abstracts
Introduction: Enhanced recovery after surgery (ERAS) protocols aim to rapidly restore physiologic function after surgery through mitigation of the stress response. This has been shown to have beneficial effects on lengths of stay (LOS) in colorectal, oesophagogastric and hepatic surgery. This study aimed to investigate the effects of an ERAS protocol on the postoperative systemic inflammatory response following pancreaticoduodenectomy (PD). Methods: The perioperative management of consecutive patients undergoing PD between August 2012 and August 2014 (ERAS cohort) was guided by a locally developed ERAS protocol incorporating ERASTM Society recommendations. Patients between August 2010 and August 2012 who underwent PD with conventional perioperative management (pre-ERAS cohort) were utilised as a comparison. Demographic data, serum markers of systemic inflammation, and intra- and postoperative events including complications and LOS were collected prospectively. Results: 142 patients were included in the analysis (preERAS, N = 73; ERAS, N = 69). There was no significant difference in serum C-reactive protein, white cell count or neutrophil count in the postoperative period between the cohorts (all P > 0.05). Median LOS was reduced from 17 to 13 days (P = 0.001). There was a significant reduction in clinically-relevant wound complications (P = 0.019). There were no significant increases in postoperative morbidity or readmission rates. Inclusion in the ERAS protocol was an independent predictor of shorter LOS (HR1.59, P = 0.012). Conclusions: Enhanced recovery following pancreaticoduodenectomy is associated with a safe reduction in lengths of stay. This effect is not achieved through modulation of the postoperative systemic inflammatory response.
EP02D-009 PREOPERATIVE CHEMORADIATION FOR PANCREATIC ADENOCARCINOMA DOES NOT INCREASE 90-DAY POSTOPERATIVE MORBIDITY OR MORTALITY J. Denbo1, M. Bruno1, L. Prakash1, J. Lee1, M. Kim1, C. Crane2, E. Koay2, T. Aloia1, J. -N. Vauthey1, J. Fleming1 and M. Katz1 1 Surgical Oncology, and 2Radiation Oncology, MD Anderson Cancer Center, United States Background: The impact of preoperative chemoradiation upon postoperative morbidity and mortality of patients with pancreatic ductal adenocarcinoma (PDAC) remains controversial. Methods: Consecutive patients with PDAC who underwent pancreatectomy 2011e2015 were prospectively monitored for at least 90 days using a previously reported surveillance system to determine the association between preoperative chemoradiation and rates of ACCORDION adverse events, ISGPF postoperative pancreatic fistulae (POPF), readmission and mortality.
Results: Among 209 consecutive patients, 136 (65%) received preoperative chemoradiation. Patients who received chemoradiation had more advanced tumors (p < 0.01), were more likely to receive induction chemotherapy (p < 0.01), underwent concomitant vascular resection more frequently (53% vs. 34%, p = 0.01), had higher estimated blood loss (p = 0.02), and a lower rate of POPF (8% vs. 18%, p = 0.04). There was no significant difference in the rates of severe complications (22% vs. 21%), readmission (21% vs. 22%), or mortality (0% for both groups). Among the subgroup of patients who underwent pancreatoduodenectomy, the rate of POPF was similar between those who received preoperative chemoradiation and those who did not (7% vs. 7%, p = 0.99). In contrast, in the subgroup of patients who underwent distal pancreatectomy, those who received preoperative chemoradiation had a lower rate of POPF (12% vs. 53%, p < 0.01) and a lower readmission rate (15% vs. 41%, p = 0.058) than nonradiated patients. Conclusion: Although preoperative chemoradiation was administered more frequently to patients with advanced disease, it was not associated with an increase in 90-day morbidity or mortality. Preoperative chemoradiation reduces the rate of POPF and may decrease readmissions following distal pancreatectomy.
EP02D-010 THE RELATIONSHIP BETWEEN BODY MASS INDEX, PANCREATIC FISTULA AND POSTOPERATIVE COMPLICATIONS AND ITS ASSOCIATED COST IMPLICATIONS FOLLOWING PANCREATICODUODENECTOMY P. E. Serrano1,2, Y. Essaji1, D. Dath1, M. J. Marcaccio1, V. Tandan1 and L. Ruo1 1 Surgery, and 2Clinical Epidemiology and Biostatistics, Mcmaster University, Canada Introduction: Obesity is thought to be associated with increased risk of postoperative complications. This study aims to evaluate the effect of body mass index (BMI) on pancreatic fistula, postoperative complications and its associated overall cost following pancreaticoduodenectomy. Methods: This is a cohort of patients undergoing pancreaticoduodenectomy from 2009e2014 at a high volume institution. Risks factors associated with postoperative complications and pancreatic fistula (POPF defined by the International Study Group) were evaluated by univariable and multivariable analyses. Hospitalization and emergency room costs up to 90 days following surgery were analyzed. Results: The median BMI of all patients (n = 276) was 26.2 (range = 16.6e48.4); higher for those with POPF, 27.85 (range = 16.7e44.4) vs. 25.88 (range = 16.7e48.4), P = 0.069. Similarly, the median BMI for those with a postoperative complication was higher, 26.7 (range = 16.7e43.9) vs. 25.18 (range = 17.56e48.44),
HPB 2016, 18 (S1), e385ee601