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The efficacy of preoperative nutritional assessment for palliative biliary and gastrointestinal bypass of unresectable pancreatic cancer
Abstracts / Pancreatology 16 (2016) S1eS192
have not been studied well. In this study, we report surgical outcome in patients who underwent emergency PD in our hospital. Patients and methods: We retrospectively analyzed the data of 6 patients who underwent emergency PD between 2014 and 2015. Results: The patients consisted of 3 male and 3 female with a median age of 66.5. Indications of emergency PD are perforation of the duodenum and/or penetration to the retroperitoneum following ERCP and/or interventional endoscopy in 4 patients, gastrointestinal bleeding in 1, and pancreatic trauma in 1. Time from the onset to the operation are <24hours in 5 patients, and <48 hours in 1. Median time of the surgery and intraoperative blood loss are 248 minutes, and 535ml, respectively. No patient developed postoperative pancreatic fistula defined by the ISGPF of grade B or C. Overall morbidity rate was 42%. One patient died from lung edema postoperatively. A median length of postoperative hospital stay was 17.5 days. Conclusion: Although we lost one patient postoperatively, the morbidity of emergency PD was acceptable comparing to those of elective PD. Emergency PD should be performed without time delay if indicated.
P-016. Risk factors of peritoneal recurrence after pancreatectomy suggested the possibility of intraoperative dissemination of cancer cells Kyohei Ariake 1, Hideo Ohtsuka 1, Fuyuhiko Motoi 1, Koji Fukase 1, Kunihiro Masuda 1, Masamichi Mizuma 1, Hiroki Hayashi 1, Kei Nakagawa 1, Takanori Morikawa 1, Shimpei Maeda 1, Tatsuyuki Takadate 1, Takeshi Naitoh 1, Shinichi Egawa 2, Michiaki Unno 1 1 Department of Surgery, Tohoku University Graduate School of Medicine, Japan 2 Division of International Cooperation for Disaster Medicine, Tohoku University, Japan
Background: Peritoneal recurrence (PR) after curative surgical resection is one of the most frequent recurrences in pancreatic cancer. The aim of this study was to find the risk factors of PR, and ways to prevent it. Methods: Medical records of 200 patients diagnosed with postpancreatectomy recurrence were reviewed retrospectively. Patients were divided into two groups according to the first site of recurrence: PR and non-PR. Clinicopathological characteristics were compared between the groups. To find the independent risk factors for PR, the Cox proportional hazards regression model was used. Results: The incidence of portal vein resection, blood transfusion, portal vein invasion, and pancreatic nerve plexus invasion, and the operation time and blood loss were significantly higher in the PR group. Multivariate analysis indicated that excessive blood loss, portal vein invasion, and pancreatic nerve plexus invasion were independent risk factors for PR. Conclusions: Local invasive cancers are likely to microscopically spread in the retroperitoneal direction, and these sites are widely exposed during pancreatectomy. Thus all three independent risk factors for PR identified in this study suggest the possibility that PR is caused by intraoperative dissemination of cancer cells or stimulating factors into the abdominal cavity. A careful strategy for avoiding intraoperative dissemination of cancer cells and blood loss might be effective for preventing post-pancreatectomy PR.
P-017. Impact of the clinical outcomes on different recurrence patterns in patients with resected pancreatic ductal adenocarcinoma Kabuto Takano, Kazuyasu Takizawa, Takashi Kobayashi, Toshifumi Wakai Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Japan
S99
Introduction: The majority of patients with curative resection of pancreatic ductal adenocarcinoma (PDAC) recur within 5 years after surgery. However, the prognosis associated with different patterns of recurrence have not been fully studied. The aim of this study is to elucidate the association between the clinical outcomes and the patterns of recurrence after curative intent resection of PDAC. Methods: We performed a retrospective analysis of 106 consecutive patients who underwent curative intent resection of PDAC without preoperative treatment from 2001 to 2015. The number of patients with R0, R1, R2 resection was 80 (75.5%), 22 (20.8%), 4 (3.7%) respectively. The median duration of follow-up was 17 (range 1-129) months. Of the 106 patients, 95 patients (89.6%) had adjuvant chemotherapy. The location of first recurrences, and the association between the patterns of recurrence and clinical outcomes including relapse-free survival (RFS) and the survival time after recurrence was studied. Survival analysis was performed using the Kaplan-Meier method with log-rank test for univariate analyses. Results: Of the 106 patients, 63 patients developed recurrent disease. Of these 63, 10 (15.9%) had recurrent disease limited to pulmonary metastases, 20 (31.7%) had liver metastasis alone, 14 (22.2%) local recurrence only, and 12 (19.1%) peritoneal recurrence alone, 7 (11.1%) had recurrence in multiple sites including the liver. The patients with recurrence limited to lung had 11.3 months (Mo) median RFS, which was significantly longer than those with other metastatic patterns, in the liver (6.6Mo), in the peritoneal (9.3Mo) or locally (8.6Mo) (p¼0.026). The patients with recurrence limited to lung had a 16.8Mo median survival from recurrence to death, which was significantly better than the survival associated with recurrence in the liver (12.2Mo), in the peritoneum (4.7Mo) or locally (6.5Mo) (p¼0.04). Conclusion: The patients with lung recurrence of PDAC have a significantly better prognosis than those with recurrence in other sites.
P-018. The efficacy of preoperative nutritional assessment for palliative biliary and gastrointestinal bypass of unresectable pancreatic cancer Masaru Tsuchiya, Naohiro Washizawa, Tetsuya Maeda, Jun Ishii, Toshio Katagiri, Yoshihisa Kubota, Takamaru Koda, Yasuo Nagashima, Yu Matsumoto, Shigeki Imamura, Yuichiro Otsuka, Hironori Kaneko Division of General and Gastroenterological Surgery, Department of Surgery (Omori), Toho University, Japan Background: A substantial number of patients with unresectable pancreatic cancer eventually develop biliary or gastric outlet obstruction. Therefore, the patients of advanced pancreatic cancer are often coexistent with malnutrition. This study aimed to evaluate of the efficacy of preoperative nutrition of palliative biliary and gastric bypass surgery in patients with unresectable pancreas cancer as predictors of postoperative outcomes. Methods: We retrospectively reviewed the 44 consecutive patients who underwent palliative biliary and gastric bypass surgery for unresectable pancreatic cancer between January 2005 and December 2014. Controlling nutritional status (CONUT) and prognostic nutritional Index (PNI) were counted as preoperative nutritional assessment. Results: There were twenty eight men and sixteen women. Their median age was 68 years (range, 48-86). Low CONUT score and PNT>40 were 23 cases (52%) and 22 cases (50%). 19 cases (43.2%) had diagnosed unresectable during operation and converted from radical operation to palliative bypass. Median blood loss was 269 ml (range 10-1068), and operative duration was 260 minutes (range 104-466). Postoperative morbidity and mortality rates were 26.3% and 4.5%, respectively. Mean hospital stay was 26 days. Median survival was 5.5 months (range 0.9-35.6). On univariate analysis, preoperative treatment (p¼0.001), low CONUT (p¼0.002), PNI>40 (p¼0.01), convert group (p¼0.003), postoperative oral intake (p<0.001), complication (p¼0.009), postoperative treatment (p<0.001) were significantly associated with prognosis. On multivariate analysis, only postoperative treatment (p<0.001, HR¼10.1: 95%CI¼2.85-35.6) was independently associated with worse prognosis.
S100
Abstracts / Pancreatology 16 (2016) S1eS192
Conclusion: Preoperative nutritional assessment for palliative biliary and gastrointestinal bypass of unresectable pancreatic cancer is convenient and useful prediction for postoperative outcomes. However, this study suggested postoperative treatment is an important factor for postoperative long-term survival.
P-019. The role of local treatment for the recurrence of pancreatic cancer after pancreatectomy Daisuke Ban 1, Yasuhito Iwao 1, Yoshiya Ishikawa 1, Shuichi Watanabe 1, Yuki Mizuno 1, Norimichi Chiyonobu 1, Hiroki Ueda 1, Yoshiteru Ohata 1, Taku Sato 1, Yusuke Mitsunori 1, Satoshi Matsumura 1, Arihiro Aihara 1, Takanori Ochiai 1, Atsushi Kudo 1, Shinji Tanaka 2, Minoru Tanabe 1 1
Department of Hepatobiliary and Pancreatic Surgery, Tokyo Medical and Dental University, Japan 2 Department of Molecular Oncology, Tokyo Medical and Dental University, Japan
Methods: Eleven cases were enrolled, and the time from initial pancreatectomy to recurrence, location of recurrence, and outcome after surgical treatment for recurrence were evaluated. Results: The median time to recurrence was 364 days (55-2162 days). The time to recurrence was more than a year in 5 cases, and the locations of recurrence in these cases were the remnant pancreas and lung in 3 and 2 cases respectively. Among these 5 cases, a second recurrence was observed in only 1 case, and survival after surgical treatment for the first recurrent site was more than 3years in 3 cases. On the contrary, as for the remaining 6 cases, the time to recurrence was less than 1 year and the recurrences were located in the abdomen but not in the remnant pancreas. A second recurrence was observed in all of these 6 cases, and the survival was less than 2 years in 4 out of 6 cases. Conclusion: Based on the results of this study, recurrence in the remnant pancreas and lung after curative resection for pancreatic ductal cancer could be a potential indication for surgical treatment.
P-021. Background: Pancreatic ductal carcinoma (PDAC) is one of the most malignant cancer, although the curative resection could be achieved. The mainstay of the treatment for the recurrence after pancreatectomy is chemotherapy, whereas the role of the local treatment is seemed to be little. However, we have often experienced patients who obtained long survive after resection or radiation therapy for recurrence lesion. The aim of this study is to reveal the role of surgical treatment for recurrence after the curative resection for PDAC. Method: Between January 2005 and October 2015, 158 patients who underwent curative resection for PDAC were retrospectively analyzed. In particular, the pattern of recurrence and the treatments for them were investigated. Result: Of 158 patients, recurrence occurred in 92 patients. Of whom, solitary and multiple recurrence occurred in 21 and 72 patients, respectively. Solitary recurrence developed in various site followed as; liver 5, local site around the pancreas 12, remnant pancreas 4. Of them, surgical treatments (n¼8, 38.1%) was performed for solitary site recurrence (liver 1, remnant pancreas 4, local site 3). Radiation with chemotherapy (n¼5) and only chemotherapy (n¼5) was performed. Median survival time (MST) of patients with surgical treatment was 79 months, which is significantly better than other treatments with MST of 29 months (p¼0.008). MST of local treatments including surgery and radiation with chemotherapy was 53.2 months, which was also significantly better than other treatments with MST of 15.7 months (p¼0.017). Conclusion: The local treatments for solitary recurrence after pancreatectomy for PDAC is effective in selected patients. The indication to them should be considered in terms of personalized aspects.
P-020.
Outcomes of remnant pancreatectomy for pancreatic tumor Tatsuo Ito, Toshihiko Masui, Kenzo Nakano, Asahi Sato, Seiichiro Tada, Kei Yamane, Takayuki Anazawa, Kyoichi Takaori, Shinji Uemoto Department of Surgery, Kyoto University, Japan Introduction: Pancreatic tumor often develops in some of the remnant pancreas after distal pancreatectomy or pancreaticoduodenectomy. Here, we investigated the outcomes after remnant pancreatectomy for pancreatic tumor at our hospital. Patients and methods: We had 9 patients who underwent remnant pancreatectomy for pancreatic cancer after pancreatectomy at our hospital from 2006 to 2015 and the outcome was analyzed retrospectively with the medical records. Results: The patients included in this study were 4 women and 5 men. The mean age was 70.8±9.5 years. 4 patients had IPMN (include associated carcinoma) 2 patients had pancreatic ductal adenocarcinoma (PDAC), 2 patients had recurrence of PDAC and one patient was neuroendocrine tumor on pathological findings. Median period from first operation to remnant pancreatectomy is 42 months. Although the recurrence has not seen in all of the IPMN patients after remnant pancreatectomy, the patients with PDAC were all died because of the recurrence of carcinoma. All patients needed extrinsic insulin injection. The average dose of insulin was 22.8±19 IU/day, and HbA1c level was 7.9±1.9% on the half year after operation. Discussion: Because the total pancreatectomy may cause the sever diabetes mellitus and restriction of quality of life, the indication of remnant pancreatectomy should be considered carefully. The prognosis of IPMN after remnant pancreatectomy is favorable and IPMN seems a good indication for remnant pancreatectomy.
Impact of surgical treatment for recurrent pancreatic cancer after curative pancreatectomy Atsushi Miyamoto, Naoki Hama, Sakae Maeda, Mamoru Uemura, Kazuyoshi Yamamoto, Masakazu Miyake, Kazuhiro Nishikawa, Michihiko Miyazaki, Masataka Ikeda, Motohiro Hirao, Mitsugu Sekimoto, Shoji Nakamori Department of Surgery, National Hospital Organization Osaka National Hospital, Japan Background and aim: Pancreatic cancer is one of the major causes of cancer-related death in Japan. Although complete resection of the primary lesion is the only curative treatment, the 5-year survival rate after curative resection is approximately 20% because of high rate of recurrence. Chemotherapy is regarded as the standard treatment for recurrence of pancreatic cancer, and the outcome of surgical treatment for recurrent pancreatic cancer has not been well evaluated. The aim of this study was to clarify the significance of surgical treatment for recurrence after curative pancreatectomy for pancreatic ductal cancer.
P-022. Systematic review on the treatment of isolated local recurrence of pancreatic cancer after curative surgery: Re-resection, chemoradiotherapy and SBRT Vincent P. Groot 1, Hjalmar C. van Santvoort 2, 3, Steffi J.E. Rombouts 1, Jeroen Hagendoorn 1, Inne H. Borel Rinkes 1, Marc G. Besselink 3, M. van Vulpen 4, Joseph M. Herman 5, Christopher L. Wolfgang 6, I. Quintus Molenaar 1 1
Department of Surgical Specialities, UMC Utrecht Cancer Center, Netherlands 2 Department of Surgery, St. Antonius Hospital Nieuwegein, Netherlands 3 Department of Surgery, Academic Medical Center Amsterdam, Netherlands
have not been studied well. In this study, we report surgical outcome in patients who underwent emergency PD in our hospital. Patients and methods: We retrospectively analyzed the data of 6 patients who underwent emergency PD between 2014 and 2015. Results: The patients consisted of 3 male and 3 female with a median age of 66.5. Indications of emergency PD are perforation of the duodenum and/or penetration to the retroperitoneum following ERCP and/or interventional endoscopy in 4 patients, gastrointestinal bleeding in 1, and pancreatic trauma in 1. Time from the onset to the operation are <24hours in 5 patients, and <48 hours in 1. Median time of the surgery and intraoperative blood loss are 248 minutes, and 535ml, respectively. No patient developed postoperative pancreatic fistula defined by the ISGPF of grade B or C. Overall morbidity rate was 42%. One patient died from lung edema postoperatively. A median length of postoperative hospital stay was 17.5 days. Conclusion: Although we lost one patient postoperatively, the morbidity of emergency PD was acceptable comparing to those of elective PD. Emergency PD should be performed without time delay if indicated.
P-016. Risk factors of peritoneal recurrence after pancreatectomy suggested the possibility of intraoperative dissemination of cancer cells Kyohei Ariake 1, Hideo Ohtsuka 1, Fuyuhiko Motoi 1, Koji Fukase 1, Kunihiro Masuda 1, Masamichi Mizuma 1, Hiroki Hayashi 1, Kei Nakagawa 1, Takanori Morikawa 1, Shimpei Maeda 1, Tatsuyuki Takadate 1, Takeshi Naitoh 1, Shinichi Egawa 2, Michiaki Unno 1 1 Department of Surgery, Tohoku University Graduate School of Medicine, Japan 2 Division of International Cooperation for Disaster Medicine, Tohoku University, Japan
Background: Peritoneal recurrence (PR) after curative surgical resection is one of the most frequent recurrences in pancreatic cancer. The aim of this study was to find the risk factors of PR, and ways to prevent it. Methods: Medical records of 200 patients diagnosed with postpancreatectomy recurrence were reviewed retrospectively. Patients were divided into two groups according to the first site of recurrence: PR and non-PR. Clinicopathological characteristics were compared between the groups. To find the independent risk factors for PR, the Cox proportional hazards regression model was used. Results: The incidence of portal vein resection, blood transfusion, portal vein invasion, and pancreatic nerve plexus invasion, and the operation time and blood loss were significantly higher in the PR group. Multivariate analysis indicated that excessive blood loss, portal vein invasion, and pancreatic nerve plexus invasion were independent risk factors for PR. Conclusions: Local invasive cancers are likely to microscopically spread in the retroperitoneal direction, and these sites are widely exposed during pancreatectomy. Thus all three independent risk factors for PR identified in this study suggest the possibility that PR is caused by intraoperative dissemination of cancer cells or stimulating factors into the abdominal cavity. A careful strategy for avoiding intraoperative dissemination of cancer cells and blood loss might be effective for preventing post-pancreatectomy PR.
P-017. Impact of the clinical outcomes on different recurrence patterns in patients with resected pancreatic ductal adenocarcinoma Kabuto Takano, Kazuyasu Takizawa, Takashi Kobayashi, Toshifumi Wakai Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Japan
S99
Introduction: The majority of patients with curative resection of pancreatic ductal adenocarcinoma (PDAC) recur within 5 years after surgery. However, the prognosis associated with different patterns of recurrence have not been fully studied. The aim of this study is to elucidate the association between the clinical outcomes and the patterns of recurrence after curative intent resection of PDAC. Methods: We performed a retrospective analysis of 106 consecutive patients who underwent curative intent resection of PDAC without preoperative treatment from 2001 to 2015. The number of patients with R0, R1, R2 resection was 80 (75.5%), 22 (20.8%), 4 (3.7%) respectively. The median duration of follow-up was 17 (range 1-129) months. Of the 106 patients, 95 patients (89.6%) had adjuvant chemotherapy. The location of first recurrences, and the association between the patterns of recurrence and clinical outcomes including relapse-free survival (RFS) and the survival time after recurrence was studied. Survival analysis was performed using the Kaplan-Meier method with log-rank test for univariate analyses. Results: Of the 106 patients, 63 patients developed recurrent disease. Of these 63, 10 (15.9%) had recurrent disease limited to pulmonary metastases, 20 (31.7%) had liver metastasis alone, 14 (22.2%) local recurrence only, and 12 (19.1%) peritoneal recurrence alone, 7 (11.1%) had recurrence in multiple sites including the liver. The patients with recurrence limited to lung had 11.3 months (Mo) median RFS, which was significantly longer than those with other metastatic patterns, in the liver (6.6Mo), in the peritoneal (9.3Mo) or locally (8.6Mo) (p¼0.026). The patients with recurrence limited to lung had a 16.8Mo median survival from recurrence to death, which was significantly better than the survival associated with recurrence in the liver (12.2Mo), in the peritoneum (4.7Mo) or locally (6.5Mo) (p¼0.04). Conclusion: The patients with lung recurrence of PDAC have a significantly better prognosis than those with recurrence in other sites.
P-018. The efficacy of preoperative nutritional assessment for palliative biliary and gastrointestinal bypass of unresectable pancreatic cancer Masaru Tsuchiya, Naohiro Washizawa, Tetsuya Maeda, Jun Ishii, Toshio Katagiri, Yoshihisa Kubota, Takamaru Koda, Yasuo Nagashima, Yu Matsumoto, Shigeki Imamura, Yuichiro Otsuka, Hironori Kaneko Division of General and Gastroenterological Surgery, Department of Surgery (Omori), Toho University, Japan Background: A substantial number of patients with unresectable pancreatic cancer eventually develop biliary or gastric outlet obstruction. Therefore, the patients of advanced pancreatic cancer are often coexistent with malnutrition. This study aimed to evaluate of the efficacy of preoperative nutrition of palliative biliary and gastric bypass surgery in patients with unresectable pancreas cancer as predictors of postoperative outcomes. Methods: We retrospectively reviewed the 44 consecutive patients who underwent palliative biliary and gastric bypass surgery for unresectable pancreatic cancer between January 2005 and December 2014. Controlling nutritional status (CONUT) and prognostic nutritional Index (PNI) were counted as preoperative nutritional assessment. Results: There were twenty eight men and sixteen women. Their median age was 68 years (range, 48-86). Low CONUT score and PNT>40 were 23 cases (52%) and 22 cases (50%). 19 cases (43.2%) had diagnosed unresectable during operation and converted from radical operation to palliative bypass. Median blood loss was 269 ml (range 10-1068), and operative duration was 260 minutes (range 104-466). Postoperative morbidity and mortality rates were 26.3% and 4.5%, respectively. Mean hospital stay was 26 days. Median survival was 5.5 months (range 0.9-35.6). On univariate analysis, preoperative treatment (p¼0.001), low CONUT (p¼0.002), PNI>40 (p¼0.01), convert group (p¼0.003), postoperative oral intake (p<0.001), complication (p¼0.009), postoperative treatment (p<0.001) were significantly associated with prognosis. On multivariate analysis, only postoperative treatment (p<0.001, HR¼10.1: 95%CI¼2.85-35.6) was independently associated with worse prognosis.
S100
Abstracts / Pancreatology 16 (2016) S1eS192
Conclusion: Preoperative nutritional assessment for palliative biliary and gastrointestinal bypass of unresectable pancreatic cancer is convenient and useful prediction for postoperative outcomes. However, this study suggested postoperative treatment is an important factor for postoperative long-term survival.
P-019. The role of local treatment for the recurrence of pancreatic cancer after pancreatectomy Daisuke Ban 1, Yasuhito Iwao 1, Yoshiya Ishikawa 1, Shuichi Watanabe 1, Yuki Mizuno 1, Norimichi Chiyonobu 1, Hiroki Ueda 1, Yoshiteru Ohata 1, Taku Sato 1, Yusuke Mitsunori 1, Satoshi Matsumura 1, Arihiro Aihara 1, Takanori Ochiai 1, Atsushi Kudo 1, Shinji Tanaka 2, Minoru Tanabe 1 1
Department of Hepatobiliary and Pancreatic Surgery, Tokyo Medical and Dental University, Japan 2 Department of Molecular Oncology, Tokyo Medical and Dental University, Japan
Methods: Eleven cases were enrolled, and the time from initial pancreatectomy to recurrence, location of recurrence, and outcome after surgical treatment for recurrence were evaluated. Results: The median time to recurrence was 364 days (55-2162 days). The time to recurrence was more than a year in 5 cases, and the locations of recurrence in these cases were the remnant pancreas and lung in 3 and 2 cases respectively. Among these 5 cases, a second recurrence was observed in only 1 case, and survival after surgical treatment for the first recurrent site was more than 3years in 3 cases. On the contrary, as for the remaining 6 cases, the time to recurrence was less than 1 year and the recurrences were located in the abdomen but not in the remnant pancreas. A second recurrence was observed in all of these 6 cases, and the survival was less than 2 years in 4 out of 6 cases. Conclusion: Based on the results of this study, recurrence in the remnant pancreas and lung after curative resection for pancreatic ductal cancer could be a potential indication for surgical treatment.
P-021. Background: Pancreatic ductal carcinoma (PDAC) is one of the most malignant cancer, although the curative resection could be achieved. The mainstay of the treatment for the recurrence after pancreatectomy is chemotherapy, whereas the role of the local treatment is seemed to be little. However, we have often experienced patients who obtained long survive after resection or radiation therapy for recurrence lesion. The aim of this study is to reveal the role of surgical treatment for recurrence after the curative resection for PDAC. Method: Between January 2005 and October 2015, 158 patients who underwent curative resection for PDAC were retrospectively analyzed. In particular, the pattern of recurrence and the treatments for them were investigated. Result: Of 158 patients, recurrence occurred in 92 patients. Of whom, solitary and multiple recurrence occurred in 21 and 72 patients, respectively. Solitary recurrence developed in various site followed as; liver 5, local site around the pancreas 12, remnant pancreas 4. Of them, surgical treatments (n¼8, 38.1%) was performed for solitary site recurrence (liver 1, remnant pancreas 4, local site 3). Radiation with chemotherapy (n¼5) and only chemotherapy (n¼5) was performed. Median survival time (MST) of patients with surgical treatment was 79 months, which is significantly better than other treatments with MST of 29 months (p¼0.008). MST of local treatments including surgery and radiation with chemotherapy was 53.2 months, which was also significantly better than other treatments with MST of 15.7 months (p¼0.017). Conclusion: The local treatments for solitary recurrence after pancreatectomy for PDAC is effective in selected patients. The indication to them should be considered in terms of personalized aspects.
P-020.
Outcomes of remnant pancreatectomy for pancreatic tumor Tatsuo Ito, Toshihiko Masui, Kenzo Nakano, Asahi Sato, Seiichiro Tada, Kei Yamane, Takayuki Anazawa, Kyoichi Takaori, Shinji Uemoto Department of Surgery, Kyoto University, Japan Introduction: Pancreatic tumor often develops in some of the remnant pancreas after distal pancreatectomy or pancreaticoduodenectomy. Here, we investigated the outcomes after remnant pancreatectomy for pancreatic tumor at our hospital. Patients and methods: We had 9 patients who underwent remnant pancreatectomy for pancreatic cancer after pancreatectomy at our hospital from 2006 to 2015 and the outcome was analyzed retrospectively with the medical records. Results: The patients included in this study were 4 women and 5 men. The mean age was 70.8±9.5 years. 4 patients had IPMN (include associated carcinoma) 2 patients had pancreatic ductal adenocarcinoma (PDAC), 2 patients had recurrence of PDAC and one patient was neuroendocrine tumor on pathological findings. Median period from first operation to remnant pancreatectomy is 42 months. Although the recurrence has not seen in all of the IPMN patients after remnant pancreatectomy, the patients with PDAC were all died because of the recurrence of carcinoma. All patients needed extrinsic insulin injection. The average dose of insulin was 22.8±19 IU/day, and HbA1c level was 7.9±1.9% on the half year after operation. Discussion: Because the total pancreatectomy may cause the sever diabetes mellitus and restriction of quality of life, the indication of remnant pancreatectomy should be considered carefully. The prognosis of IPMN after remnant pancreatectomy is favorable and IPMN seems a good indication for remnant pancreatectomy.
Impact of surgical treatment for recurrent pancreatic cancer after curative pancreatectomy Atsushi Miyamoto, Naoki Hama, Sakae Maeda, Mamoru Uemura, Kazuyoshi Yamamoto, Masakazu Miyake, Kazuhiro Nishikawa, Michihiko Miyazaki, Masataka Ikeda, Motohiro Hirao, Mitsugu Sekimoto, Shoji Nakamori Department of Surgery, National Hospital Organization Osaka National Hospital, Japan Background and aim: Pancreatic cancer is one of the major causes of cancer-related death in Japan. Although complete resection of the primary lesion is the only curative treatment, the 5-year survival rate after curative resection is approximately 20% because of high rate of recurrence. Chemotherapy is regarded as the standard treatment for recurrence of pancreatic cancer, and the outcome of surgical treatment for recurrent pancreatic cancer has not been well evaluated. The aim of this study was to clarify the significance of surgical treatment for recurrence after curative pancreatectomy for pancreatic ductal cancer.
P-022. Systematic review on the treatment of isolated local recurrence of pancreatic cancer after curative surgery: Re-resection, chemoradiotherapy and SBRT Vincent P. Groot 1, Hjalmar C. van Santvoort 2, 3, Steffi J.E. Rombouts 1, Jeroen Hagendoorn 1, Inne H. Borel Rinkes 1, Marc G. Besselink 3, M. van Vulpen 4, Joseph M. Herman 5, Christopher L. Wolfgang 6, I. Quintus Molenaar 1 1
Department of Surgical Specialities, UMC Utrecht Cancer Center, Netherlands 2 Department of Surgery, St. Antonius Hospital Nieuwegein, Netherlands 3 Department of Surgery, Academic Medical Center Amsterdam, Netherlands