Preoperative Prognostic Nutritional Index Predicts Both Short and Long-Term Outcomes after Liver Resection for Hepatocellular Carcinoma

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Scientific Poster Presentations: 2017 Clinical Congress

with the open approach. This study aims to assess the rate and predictors of conversion and its effect on perioperative outcomes. METHODS: We used the pancreas-targeted NSQIP dataset between 2014 and 2015 to identify patients who underwent MIDP (robotic/laparoscopic) and converted cases. We compared patients’ characteristics, perioperative parameters and outcomes in the MIDP and conversion groups. Multivariate analysis (MVA) was used to determine the predictors of conversion and its association with postoperative outcomes. RESULTS: We identified 1,512 MIDP of which 92 (18.0%) were converted. On MVA, the predictors of conversion were BMI (odds ratio [OR]¼1.03; 95% CI: 1.01, 1.06), T3/T4 malignant disease (OR¼2.46; 95% CI: 1.55, 3.89), pancreatitis (OR¼2.83; 95% CI: 1.52, 5.27) compared to benign disease, albumin level (OR¼0.60; 95% CI: 0.43, 0.86). Robotic cases were associated with lower risk of conversion compared to laparoscopic (OR¼0.32; 95% CI: 0.19, 0.52). Unadjusted outcomes showed that converted cases had higher 30-day mortality compared to MIDP (2.2% vs 0.3%, p¼0.001), higher rates of major complications (48.5% vs 29.0%, p<0.001), organ space SSI (14.3% vs 6.7%, p<0.001), bleeding requiring transfusion (20.3% vs 3.0%, p<0.001), sepsis/septic shock (8.2% vs 4.8%, p¼0.035) and delayed gastric emptying (7.6% vs 2.2%, p<0.001). There was no difference in the rate of pancreatic fistula. On MVA, conversion was associated with major complications (OR¼2.03; 95% CI: 1.46, 2.83) and delayed gastric emptying (OR¼2.59; 95% CI: 1.22, 5.52). CONCLUSIONS: Conversion is associated with higher morbidity and mortality than completed MIPD. Understanding the risks and predictors of conversion may improve patient counseling, selection and outcomes. Preoperative Prognostic Nutritional Index Predicts Both Short and Long-Term Outcomes after Liver Resection for Hepatocellular Carcinoma Yu Saito, MD, PhD, Satoru Imura, MD, PhD, FACS, Yuji Morine, MD, PhD, FACS, Tetsuya Ikemoto, MD, PhD, FACS, Shuichi Iwahashi, MD, Masato Yoshikawa, Toshiaki Yoshimoto, Mitsuo Shimada Tokushima University, Tokushima, Japan INTRODUCTION: The prognostic nutritional index (PNI) is one of immune parameters calculated based on the serum albumin concentration and the total lymphocyte count. The aim of this study was to investigate the prognostic significance of the PNI for both short- and long-term outcomes after liver resection (Hx) for hepatocellular carcinoma (HCC) and correlation between PNI and other immune parameters. METHODS: Between 2006 and 2014, 162 (without any previous treatment) of 229 surgically treated HCC patients were retrospectively analyzed. The cut off value of the preoperative PNI was 45.0. Patients were divided into two groups, PNI low (n¼76) and high (n¼86) group. Clinicopathological factors were compared between the 2 groups.

J Am Coll Surg

RESULTS: Preoperative PNI significantly correlated with age, ICG and serum GOT levels. PNI significantly correlated with other parameters such as neutrophil/lymphocyte ratio (NLR) and aspartate aminotransferase to neutrophil ratio index (ALRI). In short term outcomes, PNI low group had significantly more blood loss, and a longer hospital stays than patients in the PNI-high group. PNI low group were more likely to have postoperative complications. The overall survival rate in PNI low group tended to be worse than that in the PNI high group. The disease-free survival rate in PNI low group was significantly worse than that in the PNI high group. On multivariate analysis, Low PNI was an independent prognostic factor for disease-free survival (hazard ratio 1.71, p¼ 0.035). CONCLUSIONS: The preoperative PNI might be a significant prognostic factor for evaluating both short and long-term outcomes after Hx for HCC. Prognostic Relevance of KRAS Mutational Status in Patients with Resectable Colorectal Liver Metastases and Concurrent Extrahepatic Disease Georgios Antonios Margonis, MD, PhD, Neda Amini, MD, Nikolaos Andreatos, MD, Amar Deshwar, MD, Neda Rezaee, Stefan Buettner, Jane Wang, Kazunari Sasaki, MD, Christopher L Wolfgang, MD, FACS, Matthew J Weiss, MD, FACS Johns Hopkins University, Sinai Hospital, Baltimore, MD INTRODUCTION: Several investigators have reported on the negative prognostic impact of Kirsten rat sarcoma (KRAS) mutations in patients with colorectal cancer liver metastases (CRLM). However, the prognostic value of KRAS status in medically treated patients with CRLM and concurrent extrahepatic disease has been challenged. We sought to investigate whether KRAS mutational status remains prognostic in potential operative candidates with limited extrahepatic disease. METHODS: Patients with CRLM and concurrent extra-hepatic disease were identified from an institutional database of patients that underwent CRLM resection. Only patients with available KRAS mutational status were considered. Relevant clinicopathologic characteristics and long-term survival data were collected and analyzed. RESULTS: A total of 520 patients were included: 480 with liver-only disease (group A) and 40 with concurrent hepatic and extra-hepatic disease (group B). Median overall survival (OS) was 61.0 months in group A and 44.1 months in group B (p¼0.009). In the entire cohort (groups A and B), the presence of KRAS mutated tumors was associated with worse OS on multivariable analysis (hazard ratio [HR]:1.4, p¼0.02). Perhaps more importantly, among patients with concurrent extrahepatic disease, positive surgical margin (HR:4.54, p¼0.008) and the presence of a KRAS mutation (HR: 2.86, p¼0.04) were shown to be independently associated with worse OS. CONCLUSIONS: The present analysis confirmed that KRAS status constitutes an important prognostic factor among patients with CRLM. Perhaps more importantly, KRAS mutational status remained prognostic in the presence of concurrent extrahepatic