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SUN-P269: Enhanced Recovery Programs after Thoracic Esophageal Cancer Surgery for High Risk Patients
Perioperative care 1
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control group were very motivated to increase their nutritional intake (P = 0,036). Conclusion: The NNI did improve nutritional intake and it is an effective tool to decrease undernutrition in patients planned for surgery. The NNI is feasible in patients planned for surgery, but the intervention performance needs improvement. Table 1: Outcomes for intervention and control group. Control group N = 73 Energy Intake in Kcal/day Mean (SD) Protein intake in gram/day Mean (SD) Length of stay Mean (SD) Change in Weight in kg Mean (SD)
Intervention group N = 60
Independent Sample T-Test (p-value)
1,499 (665)
2,368 (865)
0.000
57 (28)
93 (31)
0.000
5.2 (8.9)
5.2 (5.8)
0.963
−0.5 (2.6)
−0.3 (2.6)
0.754
Disclosure of Interest: None declared.
SUN-P269 ENHANCED RECOVERY PROGRAMS AFTER THORACIC ESOPHAGEAL CANCER SURGERY FOR HIGH RISK PATIENTS H. Sato1 *, Y. Miyawaki1, M. Aikawa1, K. Okamoto1, S. Sakuramoto1, S. Yamaguchi1, I. Koyama1. 1Gastrointestinal Surgery, Saitama International Medical Center, Saitama Medical University, Hidaka-shi, Saitama, Japan Rationale: Data on enhanced recovery programs after thoracic esophageal cancer surgery for high risk patients are sparse. The aim of this study was to evaluate the impact of an enhanced recovery after surgery (ERAS) program in patients with high risk who underwent a transthoracic esophagectomy. Methods: 33 patients who underwent a transthoracic esophagectomy were put enrolled into ERAS program for high risk patients (Group H). This group was then compared with a group of 99 patients who had a standard risk (Group S). The outcome measures comprised the morbidity rate, the average postoperative days when the patients started walking and enteral nutrition, postoperative pneumonia, anastomotic leak, and length of postoperative hospital stay and readmission rates within 30 days. This was a retrospective study. Results: The morbidity, anastomotic leak, postoperative pneumonia and readmission rates were 52%, 21%, 9% and 0%, and 39%, 13%, 6% and 1%, in Groups H and S, respectively ( p < 0.01, n.s, n.s, and n.s). The average postoperative days when the patients started walking and enteral nutrition in Groups H and S were 1.0, 1.4 and 1.2, 1.0 days, respectively ( p < 0.01, and n.s). The length of postoperative hospital stay was reduced in Group S in comparison to that in Group H (average 21.7 versus 32.3 days; p < 0.01). Conclusion: Groups H was inferior in starting walking, hospital stay and mortality rate, compared with group S. However, there were no statistical differences in morbidity rates including postoperative pneumonia. Even in high risk patients, an ERAS protocol is managed safely and is effective for the prevention of postoperative complications. Disclosure of Interest: None declared.
SUN-P270 IMPACT OF SARCOPENIA ON PREOPERATIVE PULMONARY FUNCTION IN HEPATO-BILLIARY PANCREATIC CANCER H. Shirai1 *, T. Kaido1, S. Okumura1, S. Yao1, A. Kobayashi1, Y. Hamaguchi1, S. Yagi1, N. Kamo1, H. Okajima1, S. Uemoto1. 1 Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Kyoto University, Kyoto, Japan Rationale: The impact of sarcopenia on preoperative pulmonary function in hepato-billiary pancreatic (HBP) cancer patients remains unclear. Methods: This study comprised 461 patients with hepatocellular carcinoma (HCC), 180 patients with bile duct cancer (BDC) and 297 patients with pancreatic cancer who underwent resection between 2003 and 2015. Using preoperative CT imaging at the L3 level, the quantity and quality of skeletal muscle were evaluated by psoas muscle mass index (PMI) and intramuscular adipose tissue content (IMAC), respectively. (1) The correlation between preoperative pulmonary function and sarcopenic factors. (2) Preoperative pulmonary function according to preoperative sarcopenia status based on the sexcut-off values for PMI and IMAC. Results: (1) In males, PMI was significantly correlated with preoperative VC and FEV1.0 in HCC patients, VC and FEV1.0 in BDC patients, and %VC, VC, and FEV1.0 in pancreatic cancer patients. IMAC was significantly correlated with preoperative VC and FEV1.0 in HCC patients, %VC, VC and FEV1.0 in BDC patients, and FEV1.0% and FEV1.0 in pancreatic cancer patients. In females, IMAC was significantly correlated with preoperative VC and FEV1.0 in HCC patients and VC and FEV1.0 in pancreatic cancer patients. (2) In males, preoperative %VC, VC, FEV1.0 in HCC patients, VC and FEV1.0 in BDC patients and %VC, VC in pancreatic cancer patients were significantly lower in the preoperative sarcopenia group than in the normal group. In females, preoperative pulmonary function had no significant difference between the two groups. Conclusion: Preoperative sarcopenia has a strong negative impact on pulmonary function in HBP cancer patients. Disclosure of Interest: None declared.
SUN-P271 PERCUTANEOUS ENDOSCOPIC DERIVATION STOMA (PEDS) VS VACUUM THERAPY IN ENTERO-ATMOSPHERIC FISTULA PATIENTS J. Sobocki1 *. 1Department of General Surgery and Clinical Nutrition, Medical Universty of Warsaw, Warsaw, Poland Rationale: Patients with entero-atmospheric fistula (EAF) are characterized with high nutritional loses from fistula, long hospital stay and high mortality. The aim of the study was to evaluate effects of percutaneous endoscopic derivation stoma (PEDS) vs vacuum therapy with regard to nutritional improvement and time to hospital discharge. Methods: Twenty patients with EAF were included into the study and divided into two groups: A- PEDS and B – vacuum. All patients were fed totally parenteraly. The following parameters were evaluated: time to patient mobilization, vigour improvement in one week time (self estimation scale −3 to +3),
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control group were very motivated to increase their nutritional intake (P = 0,036). Conclusion: The NNI did improve nutritional intake and it is an effective tool to decrease undernutrition in patients planned for surgery. The NNI is feasible in patients planned for surgery, but the intervention performance needs improvement. Table 1: Outcomes for intervention and control group. Control group N = 73 Energy Intake in Kcal/day Mean (SD) Protein intake in gram/day Mean (SD) Length of stay Mean (SD) Change in Weight in kg Mean (SD)
Intervention group N = 60
Independent Sample T-Test (p-value)
1,499 (665)
2,368 (865)
0.000
57 (28)
93 (31)
0.000
5.2 (8.9)
5.2 (5.8)
0.963
−0.5 (2.6)
−0.3 (2.6)
0.754
Disclosure of Interest: None declared.
SUN-P269 ENHANCED RECOVERY PROGRAMS AFTER THORACIC ESOPHAGEAL CANCER SURGERY FOR HIGH RISK PATIENTS H. Sato1 *, Y. Miyawaki1, M. Aikawa1, K. Okamoto1, S. Sakuramoto1, S. Yamaguchi1, I. Koyama1. 1Gastrointestinal Surgery, Saitama International Medical Center, Saitama Medical University, Hidaka-shi, Saitama, Japan Rationale: Data on enhanced recovery programs after thoracic esophageal cancer surgery for high risk patients are sparse. The aim of this study was to evaluate the impact of an enhanced recovery after surgery (ERAS) program in patients with high risk who underwent a transthoracic esophagectomy. Methods: 33 patients who underwent a transthoracic esophagectomy were put enrolled into ERAS program for high risk patients (Group H). This group was then compared with a group of 99 patients who had a standard risk (Group S). The outcome measures comprised the morbidity rate, the average postoperative days when the patients started walking and enteral nutrition, postoperative pneumonia, anastomotic leak, and length of postoperative hospital stay and readmission rates within 30 days. This was a retrospective study. Results: The morbidity, anastomotic leak, postoperative pneumonia and readmission rates were 52%, 21%, 9% and 0%, and 39%, 13%, 6% and 1%, in Groups H and S, respectively ( p < 0.01, n.s, n.s, and n.s). The average postoperative days when the patients started walking and enteral nutrition in Groups H and S were 1.0, 1.4 and 1.2, 1.0 days, respectively ( p < 0.01, and n.s). The length of postoperative hospital stay was reduced in Group S in comparison to that in Group H (average 21.7 versus 32.3 days; p < 0.01). Conclusion: Groups H was inferior in starting walking, hospital stay and mortality rate, compared with group S. However, there were no statistical differences in morbidity rates including postoperative pneumonia. Even in high risk patients, an ERAS protocol is managed safely and is effective for the prevention of postoperative complications. Disclosure of Interest: None declared.
SUN-P270 IMPACT OF SARCOPENIA ON PREOPERATIVE PULMONARY FUNCTION IN HEPATO-BILLIARY PANCREATIC CANCER H. Shirai1 *, T. Kaido1, S. Okumura1, S. Yao1, A. Kobayashi1, Y. Hamaguchi1, S. Yagi1, N. Kamo1, H. Okajima1, S. Uemoto1. 1 Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Kyoto University, Kyoto, Japan Rationale: The impact of sarcopenia on preoperative pulmonary function in hepato-billiary pancreatic (HBP) cancer patients remains unclear. Methods: This study comprised 461 patients with hepatocellular carcinoma (HCC), 180 patients with bile duct cancer (BDC) and 297 patients with pancreatic cancer who underwent resection between 2003 and 2015. Using preoperative CT imaging at the L3 level, the quantity and quality of skeletal muscle were evaluated by psoas muscle mass index (PMI) and intramuscular adipose tissue content (IMAC), respectively. (1) The correlation between preoperative pulmonary function and sarcopenic factors. (2) Preoperative pulmonary function according to preoperative sarcopenia status based on the sexcut-off values for PMI and IMAC. Results: (1) In males, PMI was significantly correlated with preoperative VC and FEV1.0 in HCC patients, VC and FEV1.0 in BDC patients, and %VC, VC, and FEV1.0 in pancreatic cancer patients. IMAC was significantly correlated with preoperative VC and FEV1.0 in HCC patients, %VC, VC and FEV1.0 in BDC patients, and FEV1.0% and FEV1.0 in pancreatic cancer patients. In females, IMAC was significantly correlated with preoperative VC and FEV1.0 in HCC patients and VC and FEV1.0 in pancreatic cancer patients. (2) In males, preoperative %VC, VC, FEV1.0 in HCC patients, VC and FEV1.0 in BDC patients and %VC, VC in pancreatic cancer patients were significantly lower in the preoperative sarcopenia group than in the normal group. In females, preoperative pulmonary function had no significant difference between the two groups. Conclusion: Preoperative sarcopenia has a strong negative impact on pulmonary function in HBP cancer patients. Disclosure of Interest: None declared.
SUN-P271 PERCUTANEOUS ENDOSCOPIC DERIVATION STOMA (PEDS) VS VACUUM THERAPY IN ENTERO-ATMOSPHERIC FISTULA PATIENTS J. Sobocki1 *. 1Department of General Surgery and Clinical Nutrition, Medical Universty of Warsaw, Warsaw, Poland Rationale: Patients with entero-atmospheric fistula (EAF) are characterized with high nutritional loses from fistula, long hospital stay and high mortality. The aim of the study was to evaluate effects of percutaneous endoscopic derivation stoma (PEDS) vs vacuum therapy with regard to nutritional improvement and time to hospital discharge. Methods: Twenty patients with EAF were included into the study and divided into two groups: A- PEDS and B – vacuum. All patients were fed totally parenteraly. The following parameters were evaluated: time to patient mobilization, vigour improvement in one week time (self estimation scale −3 to +3),