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Primary treatment response based on tumor explant morphology in HCC following DEB-TACE
S134
ePoster Abstracts
Conclusion: Fast track pathways in hepatectomies have acceptable outcomes. Direct ward care does not appear to negatively impact resection outcomes. Cost analysis to be included in future.
Figure 1
ICU (n [ 30)
WARD (n [ 15)
P
Clavien complication rate (%)
23
20
.888
Days in SICU (mean)
1.5
0
<.001
LOS, days (mean)
8.3
5.7
.060
30 day readmission rate (%)
13.3
13.3
.689
90 day survival (%)
100
100
P38 PRIMARY TREATMENT RESPONSE BASED ON TUMOR EXPLANT MORPHOLOGY IN HCC FOLLOWING DEB-TACE T. Sandow, P. Gulotta, A. Albar, G. Galliano, D. DeVun, D. Kirsch, H. Bohorquez and D. Kay Ochsner Clinic Foundation, New Orleans, LA, USA Objective: Using liver explant findings for tumor morphology, the study seeks to compare treatment response with treatment dose and tumor characteristics. Methods: Retrospective analysis was performed on all patients who were treated for HCC with DEB-TACE (100e300 m LC Beads„¢ mixed with 50e75 mg doxorubicin) and subsequently transplanted (n = 105). The end-point of each treatment was near-complete stasis or filling of the vascular tree. Of these 105 patients, 93 had post-treatment imaging performed prior to transplantation, and treatment response was based on modified RECIST criteria. Complete necrosis was seen in 9 patients. Treatment dose (Dose Delivered/Tumor Size) and tumor grade were compared to the primary treatment response. Results: Low grade tumors were noted in 75 patients (G1, n = 11, G2, n = 64), and 9 were poorly differentiated (G3, n = 6, G4, n = 3). Of the 84 patients, higher treatment doses were seen in tumors with a favorable treatment response, 24 mg/cm in Complete Response (CR), 23 mg/cm in Partial Response (PR), and 14 mg/cm in Stable Disease (SD), p = 0.0002. Higher treatment doses were also more likely to be delivered to lower grade tumors, 22 mg/cm in G1/G2 lesions vs 14 mg/cm in G3/G4 lesions (p = 0.009). Low grade tumors (G1/G2) showed a favorable treatment response in 83%, (CR, 38%, PR, 45%, SD, 17%) as opposed to 11% of poorly differentiated (G3/G4) tumors (CR, 0%, PR, 11%, SD, 89%), p < 0.0001. Similarly, patients with a favorable treatment response (CR or PR) on imaging were more likely to be G1/G2 as opposed to G3/ G4 (98% vs 2%, p < 0.0001). Conclusion: Lower doxorubicin treatment doses suggest poor treatment response and aggressive tumor pathology.
P39 SURGICAL MANAGEMENT OF BILIODIGESTIVE DYSFUNCTION IS SUPERIOR OVER PERCUTANEOUS MANAGEMENT. SIX YEAR EXPERIENCE OF AN HPB CENTER IN COLOMBIA L. Barrera, F. Vergara, C. Tarazona, D. Tamayo and J. Ramirez IPS universitaria e Universidad de Antioquia, Medellin, Colombia Objective: The rate of success in biliodigestive anastomosis BDA- (choledochoduodenostomy CD- or Hepaticojejunostomy HJ-) in patients with biliary injuries postcholecystectomy or benign biliary strictures is above 90%. However, the dysfunction of this diversion leads to complication such as: recurrent pyogenic cholangitis, hepatolithiasis, secondary sclerosing cholangitis or cirrhosis. Its management has become a challenging topic for surgeons nowadays. Describe the social, demographic and clinic characteristics of patients with biliodigestive anastomosis dysfunction and their prognosis after surgical management. Methods: We performed an observational and retrospective study from September of 2010 to May of 2016, it included all patients with biliodigestive anastomosis made at our institution or at other hospitals presenting with complications after the reconstruction. The outcomes evaluated were: rate of cholangitis per year, re-stricture rate and mortality. Results: We identified 60 patients with BDA (5 CD and 55 HY). 24 had a dysfunctional diversion: 5 CD and 19 HY. Seven of them where managed with internal-external percutaneous diversion and 17 needed a new Hepp e Couinaud hepaticojejunostomy. Five patients demanded hepatectomy after the reconstruction. Of the 7 patients managed by percutaneous diversion, 4 ended in liver transplantation. Of the 17 patients managed surgically, just two called for a new percutaneous management. None patients have a Dindo Clavien grade V complication. Conclusion: Surgical management of biliodigestives dysfunction are safe and superior compared with percutaneuos management.
P40 POSTOPERATIVE CHARACTERISTIC ISSUES OF CONGENITAL DILATATION OF THE INTRA- AND EXTRAHEPATIC BILE DUCT Yohsuke Yagawa, Ryota Higuchi, Takehisa Yazawa, Shuichiro Uemura, Yutaro Matsunaga, Nobuhiro Takeshita and Masakazu Yamamoto Tokyo Women’s Medical University, Tokyo, Japan Objective: This study aimed to elucidate the postoperative particular issues of congenital dilatation of the intra- and extrahepatic bile duct (Todani type IV-A congenital choledochal cyst (CCC)) with pancreaticobiliary maljunction. Methods: 17 patients with intrahepatic stones (IHS) developed after flow-diversion surgery (excision of the
HPB 2017, 19 (S1), S120eS192
ePoster Abstracts
Conclusion: Fast track pathways in hepatectomies have acceptable outcomes. Direct ward care does not appear to negatively impact resection outcomes. Cost analysis to be included in future.
Figure 1
ICU (n [ 30)
WARD (n [ 15)
P
Clavien complication rate (%)
23
20
.888
Days in SICU (mean)
1.5
0
<.001
LOS, days (mean)
8.3
5.7
.060
30 day readmission rate (%)
13.3
13.3
.689
90 day survival (%)
100
100
P38 PRIMARY TREATMENT RESPONSE BASED ON TUMOR EXPLANT MORPHOLOGY IN HCC FOLLOWING DEB-TACE T. Sandow, P. Gulotta, A. Albar, G. Galliano, D. DeVun, D. Kirsch, H. Bohorquez and D. Kay Ochsner Clinic Foundation, New Orleans, LA, USA Objective: Using liver explant findings for tumor morphology, the study seeks to compare treatment response with treatment dose and tumor characteristics. Methods: Retrospective analysis was performed on all patients who were treated for HCC with DEB-TACE (100e300 m LC Beads„¢ mixed with 50e75 mg doxorubicin) and subsequently transplanted (n = 105). The end-point of each treatment was near-complete stasis or filling of the vascular tree. Of these 105 patients, 93 had post-treatment imaging performed prior to transplantation, and treatment response was based on modified RECIST criteria. Complete necrosis was seen in 9 patients. Treatment dose (Dose Delivered/Tumor Size) and tumor grade were compared to the primary treatment response. Results: Low grade tumors were noted in 75 patients (G1, n = 11, G2, n = 64), and 9 were poorly differentiated (G3, n = 6, G4, n = 3). Of the 84 patients, higher treatment doses were seen in tumors with a favorable treatment response, 24 mg/cm in Complete Response (CR), 23 mg/cm in Partial Response (PR), and 14 mg/cm in Stable Disease (SD), p = 0.0002. Higher treatment doses were also more likely to be delivered to lower grade tumors, 22 mg/cm in G1/G2 lesions vs 14 mg/cm in G3/G4 lesions (p = 0.009). Low grade tumors (G1/G2) showed a favorable treatment response in 83%, (CR, 38%, PR, 45%, SD, 17%) as opposed to 11% of poorly differentiated (G3/G4) tumors (CR, 0%, PR, 11%, SD, 89%), p < 0.0001. Similarly, patients with a favorable treatment response (CR or PR) on imaging were more likely to be G1/G2 as opposed to G3/ G4 (98% vs 2%, p < 0.0001). Conclusion: Lower doxorubicin treatment doses suggest poor treatment response and aggressive tumor pathology.
P39 SURGICAL MANAGEMENT OF BILIODIGESTIVE DYSFUNCTION IS SUPERIOR OVER PERCUTANEOUS MANAGEMENT. SIX YEAR EXPERIENCE OF AN HPB CENTER IN COLOMBIA L. Barrera, F. Vergara, C. Tarazona, D. Tamayo and J. Ramirez IPS universitaria e Universidad de Antioquia, Medellin, Colombia Objective: The rate of success in biliodigestive anastomosis BDA- (choledochoduodenostomy CD- or Hepaticojejunostomy HJ-) in patients with biliary injuries postcholecystectomy or benign biliary strictures is above 90%. However, the dysfunction of this diversion leads to complication such as: recurrent pyogenic cholangitis, hepatolithiasis, secondary sclerosing cholangitis or cirrhosis. Its management has become a challenging topic for surgeons nowadays. Describe the social, demographic and clinic characteristics of patients with biliodigestive anastomosis dysfunction and their prognosis after surgical management. Methods: We performed an observational and retrospective study from September of 2010 to May of 2016, it included all patients with biliodigestive anastomosis made at our institution or at other hospitals presenting with complications after the reconstruction. The outcomes evaluated were: rate of cholangitis per year, re-stricture rate and mortality. Results: We identified 60 patients with BDA (5 CD and 55 HY). 24 had a dysfunctional diversion: 5 CD and 19 HY. Seven of them where managed with internal-external percutaneous diversion and 17 needed a new Hepp e Couinaud hepaticojejunostomy. Five patients demanded hepatectomy after the reconstruction. Of the 7 patients managed by percutaneous diversion, 4 ended in liver transplantation. Of the 17 patients managed surgically, just two called for a new percutaneous management. None patients have a Dindo Clavien grade V complication. Conclusion: Surgical management of biliodigestives dysfunction are safe and superior compared with percutaneuos management.
P40 POSTOPERATIVE CHARACTERISTIC ISSUES OF CONGENITAL DILATATION OF THE INTRA- AND EXTRAHEPATIC BILE DUCT Yohsuke Yagawa, Ryota Higuchi, Takehisa Yazawa, Shuichiro Uemura, Yutaro Matsunaga, Nobuhiro Takeshita and Masakazu Yamamoto Tokyo Women’s Medical University, Tokyo, Japan Objective: This study aimed to elucidate the postoperative particular issues of congenital dilatation of the intra- and extrahepatic bile duct (Todani type IV-A congenital choledochal cyst (CCC)) with pancreaticobiliary maljunction. Methods: 17 patients with intrahepatic stones (IHS) developed after flow-diversion surgery (excision of the
HPB 2017, 19 (S1), S120eS192