- Email: [email protected]
Technology vs biology: local recurrence following hepatic RFA
S130
ePoster Abstracts
in postoperative complications compared to the open approach (53% vs. 58.9%, P = 0.51) (Figure 1). Conclusion: The minimally invasive approach to pancreatoduodenectomy is associated with lower postoperative morbidity compared to the open approach. However, the significant decrease is seen only in operations that last less than 330 minutes.
Figure 1 Morbidity in open and minimally invasive approaches
to pancreatoduodenectomy by operation length.
Methods: A University of Louisville database was queried for patients undergoing EUS between 2012 and 2016 who carried a diagnosis of CP. Number of EUS criteria for CP was recorded along with number of hospitalizations since diagnosis, average daily narcotic usage, change in body mass index since diagnosis, number of endoscopic interventions since diagnosis, and the requirement for parenchymal resection and/or thoracoscopic splanchnicectomy. Patients were grouped based on EUS criteria met for CP (1e3, 4e5, 6) and groups were compared along these variables. Results: A total of 81 patients met inclusion criteria. 22, 47, and 12 patients met 1-3, 4-5, and 6 EUS diagnostic criteria, respectively. Median follow-up time was 40 months. Along all follow-up parameters, there were no significant differences among the three groups, though patients with 6 Rome criteria on EUS did display a trend toward greater daily narcotic use and requirement for a greater number of pancreatic duct stents over the course of their disease. Conclusion: Despite the role of ultrasonographic criteria in establishing the diagnostic severity of patients with symptomatic chronic pancreatitis, the number of EUS-based criteria does not appear to correlate with symptom severity in this patient population.
Table 1 Correlation of endoscopic ultrasound diagnostic criteria for chronic pancreatitis with surrogate markers of symptom
severity. Endoscopic ultrasound diagnostic criteria for chronic pancreatitis
p-value
1–3 (n [ 22)
4–5 (n [ 47)
‡6 (n [ 12)
Hospitalizations since diagnosis
0 (0–10)
1 (0–15)
3 (0–6)
0.43
Daily narcotic use (mg morphine equivalents)
42 (20–90)
23 (10–360)
105 (30–180)
0.34
Change in BMI
0.04 (−2.90 to 1.76)
-0.03 (−4.60 to 5.49)
0.19 (−3.38 to 2.74)
0.44
Pancreatic resection
1 (4.5%)
2 (4.3%)
0 (0%)
0.28
Thoracoscopic splanchicectomy
0 (0%)
1 (2.1%)
0 (0%)
0.67
# ERCP since diagnosis
0 (0–7)
0 (0–6)
0 (0–4)
0.70
PD stent placement
7 (31.8%)
13 (27.7%)
5 (41.7%)
0.79
PD stent number
0 (0–6)
0 (0–4)
0 (0–3)
0.62
*Continuous variables expressed as median, range. Categorical variables expressed as n, %.
P26 ASSESSING THE VALUE OF ENDOSCOPIC ULTRASOUND IN PREDICTING SYMPTOM SEVERITY IN CHRONIC PANCREATITIS J. Richey, N. Bhutiani, A. Brown, J. Tierney, M. Bahr and G. Vitale University of Louisville, Louisville, KY, USA Objective: Endoscopic ultrasound (EUS)-based criteria have been validated as a sensitive and specific metric for diagnosing chronic pancreatitis (CP), no studies have evaluated the correlation between number of criteria met and symptom severity over the course of the disease. This study aimed to assess the relationship between the number of EUS-based diagnostic criteria for CP and CP severity over time.
P27 TECHNOLOGY VS BIOLOGY: LOCAL RECURRENCE FOLLOWING HEPATIC RFA B. Wagman, R. Chaudhary, E. Karlin, H. El-Bayar and L. Wagman St. Joseph Hospital, Houston, TX, USA Objective: For RFA-treated hepatic tumors: examine recurrence patterns including size, determine curative potential, and contrast technical with biologic failure (local vs systemic). Methods: Retrospective cohort that received laparoscopic or open RFA from 2003-2014 for hepatic tumors of any histologic type. Medical records reviewed for recurrence at RFA site (local), and/or another site in the liver or body (non-local).
HPB 2017, 19 (S1), S120eS192
ePoster Abstracts Results: Data analyzed on 106 lesions from 76 patients, 49 male, 27 female. Average age: 62.7, range: 37 to 84. Average lesion size: 2.3 cm, range: 0.1e7.6 cm. Colorectal adenocarcinoma liver metastasis was the most common tumor type, (48.1% of index lesions, 43.4% of patients), followed by hepatocellular carcinoma (24.5% of index lesions, 27.6% of patients). All others were of various histologies. Average follow up time: 21 months, median local recurrence: 12 months. There were fifty recurrences among the 106 index lesions, 5 (4.7%) local only, 11 (10.4%) local and non-local concurrently, and 34 non-local only (32.1%). No association existed between lesion size >3.0 cm and risk of recurrence (p = 0.743), nor did an association exist between lesion size >3.0 cm and risk of local recurrence (p = 0.210). There was no association between treatment type and risk of recurrence (p = 0.45). Conclusion: There is a high tumor control rate using RFA, with only five independent local recurrences, an overall failure rate of <5%. Given w40% of patients developed new disease outside of the RFA site, the focus of evaluation of this treatment modality should be on local control, achieved in 63/76 patients. Therefore, RFA serves as a tissue-sparing alternative to resection. Outcomes Total With recurrences (%) Local only
Index lesion N (%)
Patient N (%)
106 (100)
76 (100)
50 (47.2)
37 (48.7)
5 (4.7)
5 (6.6)
Local & non-local
11 (10.4)
8 (10.5)
Non-local only
34 (32.1)
24 (31.6)
56 (52.8)
39 (51.3)
<3.0 cm
79 (74.5)
N/A
3.0 cm
27 (25.5)
N/A
Without recurrence (%) Index lesion size
Treatment of index lesion Open RFA
66 (62.3)
47 (61.8)
Laparoscopic RFA
40 (37.7)
29 (38.2)
P28 POSTOPERATIVE OUTCOMES OF LOCAL EXCISION VERSUS RADICAL EXCISION FOR PANCREATIC NEUROENDOCRINE TUMORS A. Gangi, S. Orcutt, A. Kumar, M. Scott, M. Malafa, P. Hodul, J. Pimiento and D. A. Anaya H. Lee Moffitt Cancer Center, Tampa, FL, USA Objective: Local excision (LE) or enucleation is advocated over radical excision (RE) for select patients with pancreatic neuroendocrine tumors (PNET). However the difference in risk-profile between these two techniques is unknown. We sought to compare and examine postoperative outcomes for patients with PNET having LE and RE. Methods: The NCDB was queried to identify patients with non-metastatic, T1-T2 PNET tumors who underwent surgical resection (2004-2013). Baseline clinical and tumor characteristics were compared by resection type. Primary and secondary outcomes were postoperative mortality (30-
HPB 2017, 19 (S1), S120eS192
S131
and 90-day), and 30-day readmission. Overall survival (OS) was also compared. Multivariate logistic regression was performed to examine the association between resection type and outcomes. Results: 3,217 patients were identified, 225 (7%) had LE with no significant differences in baseline clinical variables between the two groups. There were no significant differences between LE and RE patients in 30-day readmission (7.6% vs. 9.2%, P = 0.5), and 30- or 90- day mortality rates (0.7% vs. 1.8%, P = 0.55, and 0.8% vs. 2.6%, P = 0.3). After multivariate logistic regression LE was not associated with different odds in 30-day mortality (OR 0.52 [95% CI 0.07e3.9]), 90-day mortality (0.41 [0.06e3.04]), or 30-day readmission (0.76 [0.42e1.37]). With a median follow-up of 30.4 months (IQR 27.1), median OS was not reached and mean OS was equivalent for both groups (log-rank = 0.22). Conclusion: The risk-profile of LE is equivalent to RE when considering mortality and readmission risks. Decisions regarding procedure type should be made on the basis of technical feasibility and surgeon’s preference (familiarity with technique).
P29 THE IMPACT OF THERAPEUTIC AND EMPIRIC ANTIBIOTICS ON WALLED OFF PANCREATIC NECROSUM REQUIRING OPERATIVE INTERVENTION A. Gupta, M. Driedger, E. Dixon, F. Sutherland, O. Bathe, N. Zyromski and C. Ball University of Calgary, Calgary, Canada Objective: Antimicrobial prophylaxis for acute pancreatitis with walled-off pancreatic necrosum (WOPN) is not beneficial. The impact of varying therapeutic/empiric preoperative antibiotics (ABx) on this patient cohort is unknown however. The primary aim was to evaluate the outcome of patients who underwent surgical management for WOPN after receiving preoperative therapeutic/empiric ABx. Methods: Patients who underwent surgical intervention for WOPN from 2005e2016 were reviewed. Those receiving therapeutic, empiric and no ABx (control) were compared. Outcomes included mortality, morbidity, and culture-positive WOPN. Standard statistical analysis was employed (p < 0.05). Results: Of 66 patients, 27 (41%) received preoperative ABx (14 empiric, 13 therapeutic). Both the ABx and control groups had similar demographics (p > 0.05). ABx and control groups rarely displayed clinical evidence of infected WOPN (15% vs. 10%, p = 0.58), nor mortality (4% vs. 0% respectively, p = 0.26). The ABx cohort displayed significantly more complications compared to the control cohort (26% vs. 5%, p = 0.02). Both empiric and therapeutic ABx resulted in similar complication rates (36% vs. 15%, p = 0.35). More culture-positive WOPN was observed within the ABx cohort compared to control (59% vs. 21%, p < 0.01). Gram-positive organisms dominated in both cohorts (94% vs. 75%, p = 0.19). Similar rates of culture-positive WOPN were identified in the empiric and therapeutic ABx groups (57% vs. 54%, p = 0.86). Conclusion: Preoperative ABx administration does not result in increased mortality amongst patients with WOPN.
ePoster Abstracts
in postoperative complications compared to the open approach (53% vs. 58.9%, P = 0.51) (Figure 1). Conclusion: The minimally invasive approach to pancreatoduodenectomy is associated with lower postoperative morbidity compared to the open approach. However, the significant decrease is seen only in operations that last less than 330 minutes.
Figure 1 Morbidity in open and minimally invasive approaches
to pancreatoduodenectomy by operation length.
Methods: A University of Louisville database was queried for patients undergoing EUS between 2012 and 2016 who carried a diagnosis of CP. Number of EUS criteria for CP was recorded along with number of hospitalizations since diagnosis, average daily narcotic usage, change in body mass index since diagnosis, number of endoscopic interventions since diagnosis, and the requirement for parenchymal resection and/or thoracoscopic splanchnicectomy. Patients were grouped based on EUS criteria met for CP (1e3, 4e5, 6) and groups were compared along these variables. Results: A total of 81 patients met inclusion criteria. 22, 47, and 12 patients met 1-3, 4-5, and 6 EUS diagnostic criteria, respectively. Median follow-up time was 40 months. Along all follow-up parameters, there were no significant differences among the three groups, though patients with 6 Rome criteria on EUS did display a trend toward greater daily narcotic use and requirement for a greater number of pancreatic duct stents over the course of their disease. Conclusion: Despite the role of ultrasonographic criteria in establishing the diagnostic severity of patients with symptomatic chronic pancreatitis, the number of EUS-based criteria does not appear to correlate with symptom severity in this patient population.
Table 1 Correlation of endoscopic ultrasound diagnostic criteria for chronic pancreatitis with surrogate markers of symptom
severity. Endoscopic ultrasound diagnostic criteria for chronic pancreatitis
p-value
1–3 (n [ 22)
4–5 (n [ 47)
‡6 (n [ 12)
Hospitalizations since diagnosis
0 (0–10)
1 (0–15)
3 (0–6)
0.43
Daily narcotic use (mg morphine equivalents)
42 (20–90)
23 (10–360)
105 (30–180)
0.34
Change in BMI
0.04 (−2.90 to 1.76)
-0.03 (−4.60 to 5.49)
0.19 (−3.38 to 2.74)
0.44
Pancreatic resection
1 (4.5%)
2 (4.3%)
0 (0%)
0.28
Thoracoscopic splanchicectomy
0 (0%)
1 (2.1%)
0 (0%)
0.67
# ERCP since diagnosis
0 (0–7)
0 (0–6)
0 (0–4)
0.70
PD stent placement
7 (31.8%)
13 (27.7%)
5 (41.7%)
0.79
PD stent number
0 (0–6)
0 (0–4)
0 (0–3)
0.62
*Continuous variables expressed as median, range. Categorical variables expressed as n, %.
P26 ASSESSING THE VALUE OF ENDOSCOPIC ULTRASOUND IN PREDICTING SYMPTOM SEVERITY IN CHRONIC PANCREATITIS J. Richey, N. Bhutiani, A. Brown, J. Tierney, M. Bahr and G. Vitale University of Louisville, Louisville, KY, USA Objective: Endoscopic ultrasound (EUS)-based criteria have been validated as a sensitive and specific metric for diagnosing chronic pancreatitis (CP), no studies have evaluated the correlation between number of criteria met and symptom severity over the course of the disease. This study aimed to assess the relationship between the number of EUS-based diagnostic criteria for CP and CP severity over time.
P27 TECHNOLOGY VS BIOLOGY: LOCAL RECURRENCE FOLLOWING HEPATIC RFA B. Wagman, R. Chaudhary, E. Karlin, H. El-Bayar and L. Wagman St. Joseph Hospital, Houston, TX, USA Objective: For RFA-treated hepatic tumors: examine recurrence patterns including size, determine curative potential, and contrast technical with biologic failure (local vs systemic). Methods: Retrospective cohort that received laparoscopic or open RFA from 2003-2014 for hepatic tumors of any histologic type. Medical records reviewed for recurrence at RFA site (local), and/or another site in the liver or body (non-local).
HPB 2017, 19 (S1), S120eS192
ePoster Abstracts Results: Data analyzed on 106 lesions from 76 patients, 49 male, 27 female. Average age: 62.7, range: 37 to 84. Average lesion size: 2.3 cm, range: 0.1e7.6 cm. Colorectal adenocarcinoma liver metastasis was the most common tumor type, (48.1% of index lesions, 43.4% of patients), followed by hepatocellular carcinoma (24.5% of index lesions, 27.6% of patients). All others were of various histologies. Average follow up time: 21 months, median local recurrence: 12 months. There were fifty recurrences among the 106 index lesions, 5 (4.7%) local only, 11 (10.4%) local and non-local concurrently, and 34 non-local only (32.1%). No association existed between lesion size >3.0 cm and risk of recurrence (p = 0.743), nor did an association exist between lesion size >3.0 cm and risk of local recurrence (p = 0.210). There was no association between treatment type and risk of recurrence (p = 0.45). Conclusion: There is a high tumor control rate using RFA, with only five independent local recurrences, an overall failure rate of <5%. Given w40% of patients developed new disease outside of the RFA site, the focus of evaluation of this treatment modality should be on local control, achieved in 63/76 patients. Therefore, RFA serves as a tissue-sparing alternative to resection. Outcomes Total With recurrences (%) Local only
Index lesion N (%)
Patient N (%)
106 (100)
76 (100)
50 (47.2)
37 (48.7)
5 (4.7)
5 (6.6)
Local & non-local
11 (10.4)
8 (10.5)
Non-local only
34 (32.1)
24 (31.6)
56 (52.8)
39 (51.3)
<3.0 cm
79 (74.5)
N/A
3.0 cm
27 (25.5)
N/A
Without recurrence (%) Index lesion size
Treatment of index lesion Open RFA
66 (62.3)
47 (61.8)
Laparoscopic RFA
40 (37.7)
29 (38.2)
P28 POSTOPERATIVE OUTCOMES OF LOCAL EXCISION VERSUS RADICAL EXCISION FOR PANCREATIC NEUROENDOCRINE TUMORS A. Gangi, S. Orcutt, A. Kumar, M. Scott, M. Malafa, P. Hodul, J. Pimiento and D. A. Anaya H. Lee Moffitt Cancer Center, Tampa, FL, USA Objective: Local excision (LE) or enucleation is advocated over radical excision (RE) for select patients with pancreatic neuroendocrine tumors (PNET). However the difference in risk-profile between these two techniques is unknown. We sought to compare and examine postoperative outcomes for patients with PNET having LE and RE. Methods: The NCDB was queried to identify patients with non-metastatic, T1-T2 PNET tumors who underwent surgical resection (2004-2013). Baseline clinical and tumor characteristics were compared by resection type. Primary and secondary outcomes were postoperative mortality (30-
HPB 2017, 19 (S1), S120eS192
S131
and 90-day), and 30-day readmission. Overall survival (OS) was also compared. Multivariate logistic regression was performed to examine the association between resection type and outcomes. Results: 3,217 patients were identified, 225 (7%) had LE with no significant differences in baseline clinical variables between the two groups. There were no significant differences between LE and RE patients in 30-day readmission (7.6% vs. 9.2%, P = 0.5), and 30- or 90- day mortality rates (0.7% vs. 1.8%, P = 0.55, and 0.8% vs. 2.6%, P = 0.3). After multivariate logistic regression LE was not associated with different odds in 30-day mortality (OR 0.52 [95% CI 0.07e3.9]), 90-day mortality (0.41 [0.06e3.04]), or 30-day readmission (0.76 [0.42e1.37]). With a median follow-up of 30.4 months (IQR 27.1), median OS was not reached and mean OS was equivalent for both groups (log-rank = 0.22). Conclusion: The risk-profile of LE is equivalent to RE when considering mortality and readmission risks. Decisions regarding procedure type should be made on the basis of technical feasibility and surgeon’s preference (familiarity with technique).
P29 THE IMPACT OF THERAPEUTIC AND EMPIRIC ANTIBIOTICS ON WALLED OFF PANCREATIC NECROSUM REQUIRING OPERATIVE INTERVENTION A. Gupta, M. Driedger, E. Dixon, F. Sutherland, O. Bathe, N. Zyromski and C. Ball University of Calgary, Calgary, Canada Objective: Antimicrobial prophylaxis for acute pancreatitis with walled-off pancreatic necrosum (WOPN) is not beneficial. The impact of varying therapeutic/empiric preoperative antibiotics (ABx) on this patient cohort is unknown however. The primary aim was to evaluate the outcome of patients who underwent surgical management for WOPN after receiving preoperative therapeutic/empiric ABx. Methods: Patients who underwent surgical intervention for WOPN from 2005e2016 were reviewed. Those receiving therapeutic, empiric and no ABx (control) were compared. Outcomes included mortality, morbidity, and culture-positive WOPN. Standard statistical analysis was employed (p < 0.05). Results: Of 66 patients, 27 (41%) received preoperative ABx (14 empiric, 13 therapeutic). Both the ABx and control groups had similar demographics (p > 0.05). ABx and control groups rarely displayed clinical evidence of infected WOPN (15% vs. 10%, p = 0.58), nor mortality (4% vs. 0% respectively, p = 0.26). The ABx cohort displayed significantly more complications compared to the control cohort (26% vs. 5%, p = 0.02). Both empiric and therapeutic ABx resulted in similar complication rates (36% vs. 15%, p = 0.35). More culture-positive WOPN was observed within the ABx cohort compared to control (59% vs. 21%, p < 0.01). Gram-positive organisms dominated in both cohorts (94% vs. 75%, p = 0.19). Similar rates of culture-positive WOPN were identified in the empiric and therapeutic ABx groups (57% vs. 54%, p = 0.86). Conclusion: Preoperative ABx administration does not result in increased mortality amongst patients with WOPN.