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Surgical therapy for cancer of the pancreas
S100
Abstracts / Pancreatology 16 (2016) S1eS130
Introduction: The documented incidence of pediatric pancreatitis (PP) is very low, less than 1/100,000 in almost all European countries, whereas it is around 3.6-13.2/100,000 in the USA and Australia. Aims: Our aim is to understand the diagnostic practice in the USA and Europe. Patients & methods: PINEAPPLE-R is a registered (ISRCTN35618458), observational, multinational clinical trial. Prestudy protocol already published (http://www.ncbi.nlm.nih.gov/pubmed/26641250). Patients under 18 years presenting with abdominal pain at emergency and surgical units were included. Information on patients concerning their clinical symptoms, results of imaging examinations and pancreatic enzyme measurements (PEM) were collected retrospectively. One American and seven Hungarian centres were involved. The details of the study are available at http://pancreas.hu/en/studies/pineapple. Until now 23644 patient records of eight pediatric health care centres were collected. Results: We analysed and compared 11733 American and 11911 Hungarian patients data. All together, 8.3% (1970/23644) of the patients appearing at ER unit had abdominal pain. The incidence of abdominal pain was 6.2% in the USA whereas 10.4% in Hungary. The rate of the transabdominal ultrasonography was similar in the USA and in Hungary (28.2 % vs. 31.2%). However, concerning PEM, 8-times more measurement were performed in the USA than in Hungary (21.6% (157/728) vs 2,8 % (35/ 1242)). Not surprisingly the incidence of pancreatitis was 5.5 times higher in the USA (4/728) than in Hungary (1/1242). Conclusion: The PINEAPPLE-R clearly shows that the number of PEM performed at ER units are unacceptably low in children which could be the reason of low incidences of PP. The diagnoses of PP correlates with PEM.
Abstract ID: 1645. Surgical therapy for cancer of the pancreas Uros Milosevic 1, ÐorCe Milosevic 2, Tijana Kokovic 3, Jasenka Dokmanovic 4, Pavle Milosevic 1 1 Clinical Center of Vojvodina Novi Sad, Clinic for Abdominal, Endocrine and Transplant Surgery, Serbia 2 Clinical Center of Vojvodina Novi Sad, Clinic for Vascular and Transplant Surgery, Serbia 3 Clinical Center of Vojvodine Novi Sad, Institute for Radiology, Serbia 4 Clinical Center of Vojvodina Novi Sad, Clinic for Anesthesiology and Intensive Care, Serbia
Introduction: The estimated 5-year prevalence of people in the world living with pancreatic cancer is 4.1 per 100,000 (below 5%), but in patients who underwent pancreatic resection the fiveyear rate may be up to 20%. It is one of the leading causes of cancer-related death. It has almost equal incidence in men (16.2) and women (15.1). Perioperative mortality rate has been significantly reduced in high volume institutions and has become less than 5%. Surgical resection is still the only therapeutic option that offers prolonged (five year) survival. Aims: To present results of surgical resection indicated for pancreatic cancer. Patients & methods: A retrospective study included the patients operated at the Department for Abdominal, Endocrine and Transplant surgery, Clinical Center of Vojvodina. Results: In the period from January 1st 2007 to January 1st 2015 a total of 197 patients with pancreatic adenocarcinoma underwent resection. There were 128 (64.9%) male and 69 (35.02%) female patients. The most common locations of cancer were the head, then the body and the tail of the pancreas and they were found in 155 (78.7%) cases, 33 (16.7%) cases and 9 (4.6%) cases, respectively. The postoperative mortality appeared in 6 (3.04%) cases and postoperative morbidity in 61 (30.9%) cases. Conclusion: For patients with pancreatic cancer, surgical resection still remains the only chance for prolonged (five year) survival .These procedures are performed with acceptable postoperative mortality and morbidity rate. The average survival was 21.64±3.23 months, the median being 9.2±2.26 months. The five-year survival rate was 13.5%.
Abstract ID: 1646. Ileus is a predictor of local infection in patients with acute necrotizing pancreatitis Robert Moran 1, Niloofar Jalaly 1, Ayesha Kamal 1, Sandesh Rao 2, Theodore James 2, Swetha Kambhampati 2, Robert Klapheke 2, Martin Makary 3, Kenzo Hirose 3, Vivek Kumbhari 1, Ellen Stein 1, Mouen Khashab 1, Anne Marie Lennon 1, Anthony Kalloo 1, Atif Zaheer 4, Ruben Hernaez 1, Vikesh Singh 1 1
Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, United States 2 Department of Medicine, Johns Hopkins University School of Medicine, United States 3 Division of Surgical Oncology, Department of Surgery, Johns Hopkins University School of Medicine, United States 4 Division of Abdominal Imaging, Department of Radiology, Johns Hopkins University School of Medicine, United States Introduction: Infected pancreatic necrosis (IPN) is associated with increased morbidity and mortality. Gut barrier dysfunction has been shown to increase the risk of bacterial translocation from the gut into the pancreatic bed. Aims: The primary aim of the study is to evaluate if ileus, a clinical marker of gut barrier dysfunction, can predict the development of IPN. Patients & methods: A retrospective cohort study of patients with necrotizing pancreatitis (NP) was conducted from 2000-2014. Ileus was defined as 2 of the following modified surgical criteria: nausea/vomiting; inability to tolerate a diet, absence of flatus, abdominal distension and features of ileus on imaging. Multivariable cox proportional hazard analysis was used to evaluate predictors of IPN. Results: 142 patients were identified with NP, 61 with IPN and 81 with sterile necrosis. In comparison to a chart diagnosis of ileus, the ileus criteria had a sensitivity, specificity and positive and negative predictive value of 100%, 93%, 78% and 100%, respectively. On multivariate cox proportional hazard analysis, antecedent ileus [HR:2.6, 95%CI:1.4e4.9] and extensive necrosis [HR:2.8, 95%CI:1.3-5.8], but not Bacteremia [HR:1.09, 95%CI:0.6-2.1] were associated with the development of IPN. Conclusion: Ileus is independently associated with the future development of IPN. Further studies will be needed to determine if ileus can serve as a clinical marker to direct therapeutic interventions aimed at reducing the incidence of IPN.
Abstract ID: 1649. Circulating histones accurately predict persistent organ failure and mortality in patients with acute pancreatitis within 24 h of admission Tingting Liu 1, Wei Huang 2, Peter Szatmary 2, Simon Abrams 1, Yasir Alhamdi 1, Ziqi Lin 3, Ilias Gomatos 2, Steve Lane 4, David Criddle 5, William Greenhalf 2, Guozheng Wang 1, Robert Sutton 2, Cheng-Hock Toh 6 1
Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom 2 NIHR Liverpool Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom 3 Department of Integrated Traditional and Western Medicine, West China Hospital, Sichuan University, Chengdu, China 4 Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom 5 Department of Cellular and Molecular Physiology, University of Liverpool, Liverpool, United Kingdom 6 Roald Dahl Haemostasis and Thrombosis Centre, Royal Liverpool University Hospital, Liverpool, United Kingdom Introduction: Early prediction for acute pancreatitis (AP) severity remains a challenge. Circulating histones are elevated early in mouse models and correlate with disease severity.
Abstracts / Pancreatology 16 (2016) S1eS130
Introduction: The documented incidence of pediatric pancreatitis (PP) is very low, less than 1/100,000 in almost all European countries, whereas it is around 3.6-13.2/100,000 in the USA and Australia. Aims: Our aim is to understand the diagnostic practice in the USA and Europe. Patients & methods: PINEAPPLE-R is a registered (ISRCTN35618458), observational, multinational clinical trial. Prestudy protocol already published (http://www.ncbi.nlm.nih.gov/pubmed/26641250). Patients under 18 years presenting with abdominal pain at emergency and surgical units were included. Information on patients concerning their clinical symptoms, results of imaging examinations and pancreatic enzyme measurements (PEM) were collected retrospectively. One American and seven Hungarian centres were involved. The details of the study are available at http://pancreas.hu/en/studies/pineapple. Until now 23644 patient records of eight pediatric health care centres were collected. Results: We analysed and compared 11733 American and 11911 Hungarian patients data. All together, 8.3% (1970/23644) of the patients appearing at ER unit had abdominal pain. The incidence of abdominal pain was 6.2% in the USA whereas 10.4% in Hungary. The rate of the transabdominal ultrasonography was similar in the USA and in Hungary (28.2 % vs. 31.2%). However, concerning PEM, 8-times more measurement were performed in the USA than in Hungary (21.6% (157/728) vs 2,8 % (35/ 1242)). Not surprisingly the incidence of pancreatitis was 5.5 times higher in the USA (4/728) than in Hungary (1/1242). Conclusion: The PINEAPPLE-R clearly shows that the number of PEM performed at ER units are unacceptably low in children which could be the reason of low incidences of PP. The diagnoses of PP correlates with PEM.
Abstract ID: 1645. Surgical therapy for cancer of the pancreas Uros Milosevic 1, ÐorCe Milosevic 2, Tijana Kokovic 3, Jasenka Dokmanovic 4, Pavle Milosevic 1 1 Clinical Center of Vojvodina Novi Sad, Clinic for Abdominal, Endocrine and Transplant Surgery, Serbia 2 Clinical Center of Vojvodina Novi Sad, Clinic for Vascular and Transplant Surgery, Serbia 3 Clinical Center of Vojvodine Novi Sad, Institute for Radiology, Serbia 4 Clinical Center of Vojvodina Novi Sad, Clinic for Anesthesiology and Intensive Care, Serbia
Introduction: The estimated 5-year prevalence of people in the world living with pancreatic cancer is 4.1 per 100,000 (below 5%), but in patients who underwent pancreatic resection the fiveyear rate may be up to 20%. It is one of the leading causes of cancer-related death. It has almost equal incidence in men (16.2) and women (15.1). Perioperative mortality rate has been significantly reduced in high volume institutions and has become less than 5%. Surgical resection is still the only therapeutic option that offers prolonged (five year) survival. Aims: To present results of surgical resection indicated for pancreatic cancer. Patients & methods: A retrospective study included the patients operated at the Department for Abdominal, Endocrine and Transplant surgery, Clinical Center of Vojvodina. Results: In the period from January 1st 2007 to January 1st 2015 a total of 197 patients with pancreatic adenocarcinoma underwent resection. There were 128 (64.9%) male and 69 (35.02%) female patients. The most common locations of cancer were the head, then the body and the tail of the pancreas and they were found in 155 (78.7%) cases, 33 (16.7%) cases and 9 (4.6%) cases, respectively. The postoperative mortality appeared in 6 (3.04%) cases and postoperative morbidity in 61 (30.9%) cases. Conclusion: For patients with pancreatic cancer, surgical resection still remains the only chance for prolonged (five year) survival .These procedures are performed with acceptable postoperative mortality and morbidity rate. The average survival was 21.64±3.23 months, the median being 9.2±2.26 months. The five-year survival rate was 13.5%.
Abstract ID: 1646. Ileus is a predictor of local infection in patients with acute necrotizing pancreatitis Robert Moran 1, Niloofar Jalaly 1, Ayesha Kamal 1, Sandesh Rao 2, Theodore James 2, Swetha Kambhampati 2, Robert Klapheke 2, Martin Makary 3, Kenzo Hirose 3, Vivek Kumbhari 1, Ellen Stein 1, Mouen Khashab 1, Anne Marie Lennon 1, Anthony Kalloo 1, Atif Zaheer 4, Ruben Hernaez 1, Vikesh Singh 1 1
Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, United States 2 Department of Medicine, Johns Hopkins University School of Medicine, United States 3 Division of Surgical Oncology, Department of Surgery, Johns Hopkins University School of Medicine, United States 4 Division of Abdominal Imaging, Department of Radiology, Johns Hopkins University School of Medicine, United States Introduction: Infected pancreatic necrosis (IPN) is associated with increased morbidity and mortality. Gut barrier dysfunction has been shown to increase the risk of bacterial translocation from the gut into the pancreatic bed. Aims: The primary aim of the study is to evaluate if ileus, a clinical marker of gut barrier dysfunction, can predict the development of IPN. Patients & methods: A retrospective cohort study of patients with necrotizing pancreatitis (NP) was conducted from 2000-2014. Ileus was defined as 2 of the following modified surgical criteria: nausea/vomiting; inability to tolerate a diet, absence of flatus, abdominal distension and features of ileus on imaging. Multivariable cox proportional hazard analysis was used to evaluate predictors of IPN. Results: 142 patients were identified with NP, 61 with IPN and 81 with sterile necrosis. In comparison to a chart diagnosis of ileus, the ileus criteria had a sensitivity, specificity and positive and negative predictive value of 100%, 93%, 78% and 100%, respectively. On multivariate cox proportional hazard analysis, antecedent ileus [HR:2.6, 95%CI:1.4e4.9] and extensive necrosis [HR:2.8, 95%CI:1.3-5.8], but not Bacteremia [HR:1.09, 95%CI:0.6-2.1] were associated with the development of IPN. Conclusion: Ileus is independently associated with the future development of IPN. Further studies will be needed to determine if ileus can serve as a clinical marker to direct therapeutic interventions aimed at reducing the incidence of IPN.
Abstract ID: 1649. Circulating histones accurately predict persistent organ failure and mortality in patients with acute pancreatitis within 24 h of admission Tingting Liu 1, Wei Huang 2, Peter Szatmary 2, Simon Abrams 1, Yasir Alhamdi 1, Ziqi Lin 3, Ilias Gomatos 2, Steve Lane 4, David Criddle 5, William Greenhalf 2, Guozheng Wang 1, Robert Sutton 2, Cheng-Hock Toh 6 1
Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom 2 NIHR Liverpool Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom 3 Department of Integrated Traditional and Western Medicine, West China Hospital, Sichuan University, Chengdu, China 4 Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom 5 Department of Cellular and Molecular Physiology, University of Liverpool, Liverpool, United Kingdom 6 Roald Dahl Haemostasis and Thrombosis Centre, Royal Liverpool University Hospital, Liverpool, United Kingdom Introduction: Early prediction for acute pancreatitis (AP) severity remains a challenge. Circulating histones are elevated early in mouse models and correlate with disease severity.