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Preoperative cognitive function predicts survival in patients with resectable pancreatic ductal adenocarcinoma
e846
E-AHPBA: Free Prize Papers
A. Gerritsen, A. Duflou, M. Ramali, O. R. Busch, D. J. Gouma, T. M. van Gulik, E. J. Nieveen van Dijkum, E. M. Mathus-Vliegen and M. G. Besselink Academic Medical Center, Amsterdam, The Netherlands Aims: Bedside electromagnetic (EM) guided nasojejunal feeding tube placement by nurses is a simple and safe technique which has replaced endoscopy in several patient categories. An altered anatomy such as after pancreatoduodenectomy is currently seen as relative contra-indication for this technique. The aim of this study was to determine the feasibility and safety of bedside EM-guided placement of nasojejunal feeding tubes as compared to endoscopy in patients after pancreatoduodenectomy. Methods: We performed a prospective monocenter pilot study in patients requiring enteral feeding after pancreatoduodenectomy (July 2012eMarch 2014). Nasojejunal tubes were placed under EM-guidance by two nurses with extensive experience with the technique, or by endoscopy when neither of the two nurses was available. Primary endpoint was the success rate of primary tube placement confirmed on plain abdominal X-ray followed by successful enteral feeding. Results: Overall, 53 of 126 (42%) patients who underwent pancreatoduodenectomy required a nasojejunal feeding tube. In 36 patients the tube was placed under EM-guidance and in 17 by endoscopy at a median of 8 (6e11) days after pancreatoduodenectomy. Initial tube placement was successful in 21 of 36 (58%) patients with EM-guidance and 9 of 17 (53%) patients with endoscopy (P = 0.71). No complications occurred during the placement procedures. Dislodgement and/or blockage of the tube occurred in 14 of 36 (39%) patients in the EM-guided group and 8 of 17 (47%) patients in the endoscopic group (P = 0.57). Conclusions: Bedside EM-guided placement of nasojejunal feeding tubes by nurses was equally successful as endoscopic placement in patients after pancreatoduodenectomy. Future, randomized studies should confirm these preliminary findings.
Health and Social Studies, Regional Research Support, 6 Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Norway Aims: Staging and prognosis of patients with pancreatic ductal adenocarcinoma (PDAC) are defined by tumor stages according to the AJCC Cancer Staging Manual (TNM staging system). Multiple previous studies have demonstrated that clinicopathological factors such as tumor size, histologic differentiation, margin status, and nodal involvement are statistically significant prognostic variables for survival in patients undergoing resection for pancreatic cancer. The purpose of this study was to evaluate whether pre-surgery health-related quality of life (HRQoL) and subjectively rated symptom scores are independent prognostic factors for survival in patients with resectable PDAC. Methods: A prospective study of patients undergoing pancreatic resection for PDAC was conducted from November 2008 to December 2011. Patients completed the Edmonton Symptom Assessment System (ESAS) and the European Organisation for Research and Treatment of Cancer QLQ-C30 and QLQ-PAN26 questionnaires prior to surgery. Patient, tumor and treatment characteristics, and recurrence and survival were registered. Results: A total of 66 consecutive patients (male n = 30/ female n = 36, median age 68 years) underwent R0/R1 resection for PDAC. Baseline ESAS and EORTC questionnaire compliance was 44/66 (66.7%). There were no statistically significant difference between compliers (n = 44) and non-compliers (n = 22) when comparing clinicopathological parameters and survival. The univariate analyses showed that three symptoms (nausea, dry mouth and cognitive function) and two clinicopathological factors (CA 19e9 >400 U/ml, lymph node ratio >0.1) were significantly associated with shorter survival. In the multivariate analysis, cognitive function was the only independent predictor for survival. Patients with low (<66.67%) and high (66.67%) cognitive function had a median survival of 11 and 21 months (p < 0.001), respectively. Conclusions: In the present sample, presurgery cognitive function was a significant independent predictor of survival in patients with resectable PDAC. Thus, presurgery HRQoL scores may provide as strong prognostic information as clinicopathological factors in patients with resectable PDAC and should be routinely assessed.
PANCREAS CANCER 490 PREOPERATIVE COGNITIVE FUNCTION PREDICTS SURVIVAL IN PATIENTS WITH RESECTABLE PANCREATIC DUCTAL ADENOCARCINOMA
PANCREAS CANCER 686 OUTCOME AND SURVIVAL AFTER DISTAL PANCREATECTOMY FOR PANCREATIC DUCTAL ADENOCARCINOMA: A NATIONWIDE COHORT STUDY
PANCREAS CANCER 482 ELECTROMAGNETIC GUIDED VERSUS ENDOSCOPIC PLACEMENT OF NASOJEJUNAL FEEDING TUBES AFTER PANCREATODUODENECTOMY: A PROSPECTIVE PILOT STUDY
B. Baekelandt1, M. J. Hjermstad2, T. Nordby3, M. W. Fagerland4, T. Heiberg5, T. A. Buanes6 and K. J. Labori6 1 Institute of Clinical Medicine, Faculty of Medicine, University of Oslo; 2Regional Centre for Excellence in Palliative Care, Department of Oncology, Oslo University Hospital; 3Department of Gastroenterological Surgery, Ãstfold Hospital Trust; 4Oslo Centre for Biostatistics and Epidemiology, Research Support Services; 5Faculty of
T. De Rooij1, J. Tol1, C. Van Eijck2, D. Boerma3, B. Bonsing4, K. Bosscha5, R. Van Dam6, M. Dijkgraaf1, M. Gerhards7, H. Van Goor8, E. Van Der Harst9, I. De Hingh10, G. Kazemier11, J. Klaase12, Q. Molenaar13, G. Patijn14, H. Van Santvoort1, J. Scheepers15, G. Van Der Schelling16, E. Sieders17, O. Busch1 and M. Besselink1 1 Academic Medical Center, Amsterdam; 2Erasmus Medical Center; 3St Antonius Hospital; 4Leids University
HPB 2016, 18 (S2), e845ee847
E-AHPBA: Free Prize Papers
A. Gerritsen, A. Duflou, M. Ramali, O. R. Busch, D. J. Gouma, T. M. van Gulik, E. J. Nieveen van Dijkum, E. M. Mathus-Vliegen and M. G. Besselink Academic Medical Center, Amsterdam, The Netherlands Aims: Bedside electromagnetic (EM) guided nasojejunal feeding tube placement by nurses is a simple and safe technique which has replaced endoscopy in several patient categories. An altered anatomy such as after pancreatoduodenectomy is currently seen as relative contra-indication for this technique. The aim of this study was to determine the feasibility and safety of bedside EM-guided placement of nasojejunal feeding tubes as compared to endoscopy in patients after pancreatoduodenectomy. Methods: We performed a prospective monocenter pilot study in patients requiring enteral feeding after pancreatoduodenectomy (July 2012eMarch 2014). Nasojejunal tubes were placed under EM-guidance by two nurses with extensive experience with the technique, or by endoscopy when neither of the two nurses was available. Primary endpoint was the success rate of primary tube placement confirmed on plain abdominal X-ray followed by successful enteral feeding. Results: Overall, 53 of 126 (42%) patients who underwent pancreatoduodenectomy required a nasojejunal feeding tube. In 36 patients the tube was placed under EM-guidance and in 17 by endoscopy at a median of 8 (6e11) days after pancreatoduodenectomy. Initial tube placement was successful in 21 of 36 (58%) patients with EM-guidance and 9 of 17 (53%) patients with endoscopy (P = 0.71). No complications occurred during the placement procedures. Dislodgement and/or blockage of the tube occurred in 14 of 36 (39%) patients in the EM-guided group and 8 of 17 (47%) patients in the endoscopic group (P = 0.57). Conclusions: Bedside EM-guided placement of nasojejunal feeding tubes by nurses was equally successful as endoscopic placement in patients after pancreatoduodenectomy. Future, randomized studies should confirm these preliminary findings.
Health and Social Studies, Regional Research Support, 6 Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Norway Aims: Staging and prognosis of patients with pancreatic ductal adenocarcinoma (PDAC) are defined by tumor stages according to the AJCC Cancer Staging Manual (TNM staging system). Multiple previous studies have demonstrated that clinicopathological factors such as tumor size, histologic differentiation, margin status, and nodal involvement are statistically significant prognostic variables for survival in patients undergoing resection for pancreatic cancer. The purpose of this study was to evaluate whether pre-surgery health-related quality of life (HRQoL) and subjectively rated symptom scores are independent prognostic factors for survival in patients with resectable PDAC. Methods: A prospective study of patients undergoing pancreatic resection for PDAC was conducted from November 2008 to December 2011. Patients completed the Edmonton Symptom Assessment System (ESAS) and the European Organisation for Research and Treatment of Cancer QLQ-C30 and QLQ-PAN26 questionnaires prior to surgery. Patient, tumor and treatment characteristics, and recurrence and survival were registered. Results: A total of 66 consecutive patients (male n = 30/ female n = 36, median age 68 years) underwent R0/R1 resection for PDAC. Baseline ESAS and EORTC questionnaire compliance was 44/66 (66.7%). There were no statistically significant difference between compliers (n = 44) and non-compliers (n = 22) when comparing clinicopathological parameters and survival. The univariate analyses showed that three symptoms (nausea, dry mouth and cognitive function) and two clinicopathological factors (CA 19e9 >400 U/ml, lymph node ratio >0.1) were significantly associated with shorter survival. In the multivariate analysis, cognitive function was the only independent predictor for survival. Patients with low (<66.67%) and high (66.67%) cognitive function had a median survival of 11 and 21 months (p < 0.001), respectively. Conclusions: In the present sample, presurgery cognitive function was a significant independent predictor of survival in patients with resectable PDAC. Thus, presurgery HRQoL scores may provide as strong prognostic information as clinicopathological factors in patients with resectable PDAC and should be routinely assessed.
PANCREAS CANCER 490 PREOPERATIVE COGNITIVE FUNCTION PREDICTS SURVIVAL IN PATIENTS WITH RESECTABLE PANCREATIC DUCTAL ADENOCARCINOMA
PANCREAS CANCER 686 OUTCOME AND SURVIVAL AFTER DISTAL PANCREATECTOMY FOR PANCREATIC DUCTAL ADENOCARCINOMA: A NATIONWIDE COHORT STUDY
PANCREAS CANCER 482 ELECTROMAGNETIC GUIDED VERSUS ENDOSCOPIC PLACEMENT OF NASOJEJUNAL FEEDING TUBES AFTER PANCREATODUODENECTOMY: A PROSPECTIVE PILOT STUDY
B. Baekelandt1, M. J. Hjermstad2, T. Nordby3, M. W. Fagerland4, T. Heiberg5, T. A. Buanes6 and K. J. Labori6 1 Institute of Clinical Medicine, Faculty of Medicine, University of Oslo; 2Regional Centre for Excellence in Palliative Care, Department of Oncology, Oslo University Hospital; 3Department of Gastroenterological Surgery, Ãstfold Hospital Trust; 4Oslo Centre for Biostatistics and Epidemiology, Research Support Services; 5Faculty of
T. De Rooij1, J. Tol1, C. Van Eijck2, D. Boerma3, B. Bonsing4, K. Bosscha5, R. Van Dam6, M. Dijkgraaf1, M. Gerhards7, H. Van Goor8, E. Van Der Harst9, I. De Hingh10, G. Kazemier11, J. Klaase12, Q. Molenaar13, G. Patijn14, H. Van Santvoort1, J. Scheepers15, G. Van Der Schelling16, E. Sieders17, O. Busch1 and M. Besselink1 1 Academic Medical Center, Amsterdam; 2Erasmus Medical Center; 3St Antonius Hospital; 4Leids University
HPB 2016, 18 (S2), e845ee847