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Quality of life (QoL) in patients with pancreatic ductal adenocarcinoma (PDA) undergoing pancreaticoduodenectomy (PD)
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Abstracts / Pancreatology 15 (2015) S1eS141
potential factors correlated to the malignant potential of the IPMNs could be useful for planning further required treatments. Aims: The aim of our study was to examine independent factors (gender, presence of chronic pancreatitis, anatomic localization, and mucin expression) as potential risk factors for malignancy. Patients & methods: We collected clinical data of 56 patients, who underwent surgical resection with the diagnosis of IPMN. Samples were grouped according to type of the tumor as main duct-(MD), branch duct(BD) or mixed-type (MX). We also created subgroups based on the mucin expression profile (intestinal (I), pancreatobiliary (PB) and gastric-type (G)). We examined the presence of chronic pancreatitis and the correlation with the presence of malignancy. Results: 16 BD-, 16 MD- and 24 MX- type IPMNs were found. There was no correlation between the duct e origin of the tumor and presence of invasive carcinoma. Based on the mucin expression profile significant (p Conclusion: The mucin expression profile, the tumor localization and the presence of chronic pancreatitis proved to be important prognostic factors increasing the malignant potential of the IPMNs.
997.
Aims: The aim of this study was to evaluate the prevalence of IPMN in a population of patients who had an abdominal magnetic resonance imaging (MRI) for a non-pancreatic disease. Patients & methods: Retrospective, single-center study. All patients waiting for liver transplantation who had MRI (non-dedicated for the pancreas) between 2009 and 2013 were included. Only pancreatic cysts clearly communicating with the main pancreatic duct or branch ducts were selected. Data collected: age at MRI, cause of liver disease. Radiological findings: number of cystic lesions, localization, presence of worrisomes. Results: Among the 315 patients transplanted, 212 patients had an MRI. PCL with ductal communication, consistent with the diagnosis of IPMN, were diagnosed in 14 patients (6.6%; 6 women, 8 men, median age 62 years [45-70]). Liver disease was caused by a virus in 7 cases, alcohol in 3 cases, other in 5 cases (multiple causes were possible). Four patients had hepatocellular carcinoma. No patient had sign of chronic pancreatitis. The median diameter of the largest lesion was 14 mm [7-22]. The number of pancreatic cystic lesions was 1 (n ¼ 4), 2 (n ¼ 2), 4 (n ¼ 3),5 (n¼2), > 5 (n ¼3).There was no worrisome on MRI. Conclusion: Prevalence of IPMN was 6.6% in patients waiting for liver transplantation, which confirms the results in the general population outside France. Evolution of these lesions with chronic immunosuppression use is unknown. These results justify a special monitoring.
Quality of life (QoL) in patients with pancreatic ductal adenocarcinoma (PDA) undergoing pancreaticoduodenectomy (PD) Ismo Laitinen, Juhani Sand, Pipsa Peromaa, Isto Nordback, Johanna Laukkarinen Dept of Gastroenterology and Alimentary tract surgery, Tampere University Hospital, Tampere, Finland Introduction: Survival for PDA is relatively short despite of PD, which carries a high risk for postoperative morbidity. The effect of PD on QoL is unclear. Aims: We aimed to study QoL in PDA patients undergoing PD. Patients & methods: 60 patients with suspected PDA and planned PD were asked to fill EORTC:s QoL questionnaires QLQ-C30 and QLQ-PAN26 preoperatively and at 3-6-12-18-24 months postoperatively. Results: Final diagnosis was PDA in 48 patients (64 (21-84) years, 52% men) and follow-up after PD completed in 90% (6 months) and 48% (24 months) of the survived patients. Compared to preoperative level, overall QoL tended to improve or remained the same in 63% of the patients during the follow-up. At 3 months after surgery a significant decrease in hepatic symptoms was seen (100%; p<0.001), pancreatic pain and sexuality symptoms tended to decrease by 33% and global and functional QoL tended to slightly improve. These parameters remained at the achieved level during the longer follow-up. A temporary rising tendency was seen in the digestive symptoms at 3 months but this returned back to the preoperative level later. However, altered bowel movements and sexuality symptoms tended to deteriorate during the longer follow-up. In multivariate analysis no correlation between QoL and length of survival was seen. Conclusion: PD does not worsen the QoL in most of the patients with PDA. The potentially beneficial effect on QoL is seen already at 3 months after surgery. This information may be helpful for the clinician and patient, when discussing and deciding on the operative treatment for PDA.
998. Estimation of the prevalence of intraductal papillary mucinous neoplasm of the pancreas in the French population through patients waiting for liver transplantation Lucie Laurent 1, Marie-Pierre Vullierme 2, Vinciane Rebours 1, Fr ed erique Maire 1, Olivia Hentic 1, Pascal Hammel 1, Claire Francoz 3, Francois Durand 3, Philippe Ruszniewski 1, Philippe Levy 1
1255. Dealys to pancreatic cancer surgery; does it make a difference? Nicholas Mowbray, Matthew Horner, Amir Kambal, Bilal Al-Sarireh, Timothy Brown Abertawe BroMorgannwg University Health Board, Pancreaticobiliary Unit, United Kingdom Introduction: The indolent nature of Pancreatic Ductal Adenocarcinoma (PDAC) contributes to its poor prognosis. The cancer referral waiting times should therefore be kept to an absolute minimum and be reviewed regularly. Aims: The aim of this study was to identify delays to the specialist regional Pancreatic Multi-disciplinary Team (MDT) and assess any impact on survival rates. Patients & methods: The case notes of all patients who underwent resectional surgery since 2009 were reviewed retrospectively. The presenting symptoms and referral timeline was recorded including; the time from initial presentation to the referral to the MDT (T1), time from referral until the MDT meeting (T2), and the time from the MDT until surgery (T3). Results: In total, 143 patients underwent resectional surgery for PDAC. The disease specific survival at 1 year, 3 years and 5 years was 69.7%,32.7% and 15.4% respectively. Complete records were available in 101 patients. The commonest presenting complaints were painless (52%), and painful jaundice (30%). Other presentations included abdominal pain, pancreatitis, hyperglycaemia, and gastric outlet obstruction. In patients presenting acutely with obstructive jaundice the median T1 was 13.5 days range (1144), T2 was 7 days (range 0-27) and T3 was 45 (16-122). There was no significant difference in the survival of those operated on within 62 days compared with those who waited over 62 days (p¼0.786). Conclusion: This study highlights the challenges faced by a regional centre in meeting the cancer waiting time targets. The lack of significant findings agree with other studies but may indicate that we are still operating too late on PDAC.
1001. U s e f u l n e s s o f p a n c r e a t i c d u c t - t ot a l d i v e r s i o n m e t h o d i n pancreaticojejunostomy
1
Pancreatology, France Radiology, France 3 Hepatology, France 2
Introduction: No study has explored the prevalence of intraductal papillary mucinous neoplasms of the pancreas (IPMN) in France.
Takahide Itabashi, Hiromune Shimamura, Kazunori Takeda Sendai Medical Center, Department of Surgery, Japan Introduction: It can be said that most careful procedure in pancreatecoduodenectomy (PD) or middle pancreatectomy (MP) should be
Abstracts / Pancreatology 15 (2015) S1eS141
potential factors correlated to the malignant potential of the IPMNs could be useful for planning further required treatments. Aims: The aim of our study was to examine independent factors (gender, presence of chronic pancreatitis, anatomic localization, and mucin expression) as potential risk factors for malignancy. Patients & methods: We collected clinical data of 56 patients, who underwent surgical resection with the diagnosis of IPMN. Samples were grouped according to type of the tumor as main duct-(MD), branch duct(BD) or mixed-type (MX). We also created subgroups based on the mucin expression profile (intestinal (I), pancreatobiliary (PB) and gastric-type (G)). We examined the presence of chronic pancreatitis and the correlation with the presence of malignancy. Results: 16 BD-, 16 MD- and 24 MX- type IPMNs were found. There was no correlation between the duct e origin of the tumor and presence of invasive carcinoma. Based on the mucin expression profile significant (p Conclusion: The mucin expression profile, the tumor localization and the presence of chronic pancreatitis proved to be important prognostic factors increasing the malignant potential of the IPMNs.
997.
Aims: The aim of this study was to evaluate the prevalence of IPMN in a population of patients who had an abdominal magnetic resonance imaging (MRI) for a non-pancreatic disease. Patients & methods: Retrospective, single-center study. All patients waiting for liver transplantation who had MRI (non-dedicated for the pancreas) between 2009 and 2013 were included. Only pancreatic cysts clearly communicating with the main pancreatic duct or branch ducts were selected. Data collected: age at MRI, cause of liver disease. Radiological findings: number of cystic lesions, localization, presence of worrisomes. Results: Among the 315 patients transplanted, 212 patients had an MRI. PCL with ductal communication, consistent with the diagnosis of IPMN, were diagnosed in 14 patients (6.6%; 6 women, 8 men, median age 62 years [45-70]). Liver disease was caused by a virus in 7 cases, alcohol in 3 cases, other in 5 cases (multiple causes were possible). Four patients had hepatocellular carcinoma. No patient had sign of chronic pancreatitis. The median diameter of the largest lesion was 14 mm [7-22]. The number of pancreatic cystic lesions was 1 (n ¼ 4), 2 (n ¼ 2), 4 (n ¼ 3),5 (n¼2), > 5 (n ¼3).There was no worrisome on MRI. Conclusion: Prevalence of IPMN was 6.6% in patients waiting for liver transplantation, which confirms the results in the general population outside France. Evolution of these lesions with chronic immunosuppression use is unknown. These results justify a special monitoring.
Quality of life (QoL) in patients with pancreatic ductal adenocarcinoma (PDA) undergoing pancreaticoduodenectomy (PD) Ismo Laitinen, Juhani Sand, Pipsa Peromaa, Isto Nordback, Johanna Laukkarinen Dept of Gastroenterology and Alimentary tract surgery, Tampere University Hospital, Tampere, Finland Introduction: Survival for PDA is relatively short despite of PD, which carries a high risk for postoperative morbidity. The effect of PD on QoL is unclear. Aims: We aimed to study QoL in PDA patients undergoing PD. Patients & methods: 60 patients with suspected PDA and planned PD were asked to fill EORTC:s QoL questionnaires QLQ-C30 and QLQ-PAN26 preoperatively and at 3-6-12-18-24 months postoperatively. Results: Final diagnosis was PDA in 48 patients (64 (21-84) years, 52% men) and follow-up after PD completed in 90% (6 months) and 48% (24 months) of the survived patients. Compared to preoperative level, overall QoL tended to improve or remained the same in 63% of the patients during the follow-up. At 3 months after surgery a significant decrease in hepatic symptoms was seen (100%; p<0.001), pancreatic pain and sexuality symptoms tended to decrease by 33% and global and functional QoL tended to slightly improve. These parameters remained at the achieved level during the longer follow-up. A temporary rising tendency was seen in the digestive symptoms at 3 months but this returned back to the preoperative level later. However, altered bowel movements and sexuality symptoms tended to deteriorate during the longer follow-up. In multivariate analysis no correlation between QoL and length of survival was seen. Conclusion: PD does not worsen the QoL in most of the patients with PDA. The potentially beneficial effect on QoL is seen already at 3 months after surgery. This information may be helpful for the clinician and patient, when discussing and deciding on the operative treatment for PDA.
998. Estimation of the prevalence of intraductal papillary mucinous neoplasm of the pancreas in the French population through patients waiting for liver transplantation Lucie Laurent 1, Marie-Pierre Vullierme 2, Vinciane Rebours 1, Fr ed erique Maire 1, Olivia Hentic 1, Pascal Hammel 1, Claire Francoz 3, Francois Durand 3, Philippe Ruszniewski 1, Philippe Levy 1
1255. Dealys to pancreatic cancer surgery; does it make a difference? Nicholas Mowbray, Matthew Horner, Amir Kambal, Bilal Al-Sarireh, Timothy Brown Abertawe BroMorgannwg University Health Board, Pancreaticobiliary Unit, United Kingdom Introduction: The indolent nature of Pancreatic Ductal Adenocarcinoma (PDAC) contributes to its poor prognosis. The cancer referral waiting times should therefore be kept to an absolute minimum and be reviewed regularly. Aims: The aim of this study was to identify delays to the specialist regional Pancreatic Multi-disciplinary Team (MDT) and assess any impact on survival rates. Patients & methods: The case notes of all patients who underwent resectional surgery since 2009 were reviewed retrospectively. The presenting symptoms and referral timeline was recorded including; the time from initial presentation to the referral to the MDT (T1), time from referral until the MDT meeting (T2), and the time from the MDT until surgery (T3). Results: In total, 143 patients underwent resectional surgery for PDAC. The disease specific survival at 1 year, 3 years and 5 years was 69.7%,32.7% and 15.4% respectively. Complete records were available in 101 patients. The commonest presenting complaints were painless (52%), and painful jaundice (30%). Other presentations included abdominal pain, pancreatitis, hyperglycaemia, and gastric outlet obstruction. In patients presenting acutely with obstructive jaundice the median T1 was 13.5 days range (1144), T2 was 7 days (range 0-27) and T3 was 45 (16-122). There was no significant difference in the survival of those operated on within 62 days compared with those who waited over 62 days (p¼0.786). Conclusion: This study highlights the challenges faced by a regional centre in meeting the cancer waiting time targets. The lack of significant findings agree with other studies but may indicate that we are still operating too late on PDAC.
1001. U s e f u l n e s s o f p a n c r e a t i c d u c t - t ot a l d i v e r s i o n m e t h o d i n pancreaticojejunostomy
1
Pancreatology, France Radiology, France 3 Hepatology, France 2
Introduction: No study has explored the prevalence of intraductal papillary mucinous neoplasms of the pancreas (IPMN) in France.
Takahide Itabashi, Hiromune Shimamura, Kazunori Takeda Sendai Medical Center, Department of Surgery, Japan Introduction: It can be said that most careful procedure in pancreatecoduodenectomy (PD) or middle pancreatectomy (MP) should be