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The impact of diabetes mellitus on survival following resection and adjuvant chemotherapy for pancreatic ductal adenocarcinoma
Abstracts / Pancreatology 16 (2016) S1eS130
destruction are thrombosis of the portal venous system and erosion of gastrointestinal vessels leading to ischemic complications or hemorrhages. Vessel destruction varies from mild, clinically unimportant, to severe, leading to complications that require immediate surgical intervention. There are no known factors that would predict severe vascular infiltration. Despite the development of intensive care in pancreatitis, there are only a few recent studies on vascular complications. Aims: To verify the influence of vascular infiltration on survival of patients with pancreatitis. Patients & methods: A retrospective analysis of 272 patients, admitted to the Clinical Department of Gastroenterological Surgery and Transplantation at the Central Clinical Hospital of the Ministry of the Interior in Warsaw was performed. The criteria for diagnosis of vessel infiltration were: erosion of gastrointestinal vessels with acute bleeding, tumor infiltration of local veins, vessel destruction leading to acute ischemic complications. Results: Vascular infiltration is an important mortality risk factor among patients with pancreatitis (p<0,005, OR¼1,46). It was observed in 6.3% of the group. 35% of the patients with vascular complications died. The long-term survival of patients with vascular infiltration was significantly shorter in comparison with the others (5-year survival 48% vs 65%). The development of vascular complications did not depend on sex, age, type of pancreatitis (acute or chronic), or surgery. Conclusion: The infiltration of vessels is an important complication of pancreas inflammation that leads to severe complications. Vascular infiltration significantly worsens the prognosis of patients with pancreatitis.
Abstract ID: 1442, Oral-34. The impact of diabetes mellitus on survival following resection and adjuvant chemotherapy for pancreatic ductal adenocarcinoma Jorg Kleeff 1, Eithne Costello 1, Richard Jackson 1, Chris Halloran 1, William Greenhalf 1, Paula Ghaneh 1, Richard F. Lamb 1, Markus Lerch 2, Julia Mayerle 2, Daniel Palmer 1, Trevor Cox 1, Charlotte L. Rawcliffe 1, Oliver Strobel 3, Markus W. Büchler 3, John P. Neoptolemos 1 1
University of Liverpool, United Kingdom Ernst-Moritz-Arndt-University Greifswald, Germany 3 University of Heidelberg, Germany 2
Introduction: Diabetes mellitus is frequently observed in pancreatic cancer patients and is both a risk factor and an early manifestation of the disease. Aims: The prognostic relevance of diabetes in pancreatic cancer is not known with conflicting results regarding a potential adverse effect of diabetes on overall survival (0S). Patients & methods: We analyzed the prognostic impact of diabetes on the outcome of pancreatic cancer following resection and adjuvant chemotherapy using individual patient data from there European Study Group for Pancreatic Cancer (ESPAC) randomized controlled trials of adjuvant therapy: ESPAC-1Plus, ESPAC-1 and ESPAC-3. Analyses were carried out to assess the association between clinical characteristics and the presence of pre-operative diabetes as well as the effect of diabetic status on OS. Results: 1106 patients were analysed, 258 (23%) had confirmed diabetes and 848 (77%) did not. Median (95% confidence interval) unadjusted OS was 22.3 (20.8e24.1) and 18.8 (17.0e22.2) months in non-diabetic patients and diabetic patients respectivly(p¼0.28). Diabetic patients were older, had increased weight and more co-morbidities than non-diabetic patients. Multivariable analysis demonstrated that diabetic patients had an increased risk of death (HR: 1.30 (95%CI 1.04, 1.63), P¼0.023). Maximum tumor size (MTS) of diabetic patients was larger at randomization, (33.6mm Vs 29.7mm, p¼0.005). In diabetic patients MTS had a significant impact on OS for non-insulin dependent patients (HR: 1.68 (95%CI 1.11, 2.54), but not for insulin dependent patients (HR: 0.94 (95%CI 0.78, 1.14). Conclusion: Diabetes mellitus was associated with increased tumor size and reduced survival following pancreatic cancer resection and adjuvant chemotherapy.
S67
Abstract ID: 1443. Mucinous cystic neoplasms of the pancreas: Correlation between management recomendations (International, European and AGA consensus) and pathological findings in a series of 44 operated IPMN and MCN oz 4, Judith Millastre 1, Emma Martínez 2, Silvia Espina 3, Guillermo Mun Carlos Horndler 5, Luis Sarria 6, Maria Teresa Soria 3, Eduardo Bajador 3 1 Lozano Blesa University Hospital, Department of Gastroenterology, Spain 2 Cruces University Hospital, Department of Gastroenterology, Spain 3 Miguel Servet University Hospital, Department of Gastroenterology, Spain 4 Lozano Blesa University Hospital, Department of Pathology, Spain 5 Miguel Servet University Hospital, Department of Pathology, Spain 6 Miguel Servet University Hospital, Department of Radiology, Spain
Introduction: IPMN-MD/IPMN-BD and MCN have malignant potential. IAP-2012, European-2013 and AGA-2015 guidelines differ in criteria for surgical resection. Aims: To analyze the suitability of a more conservative management regarding the predictive value of risk criteria described in different consensus for high-grade-displasia(HGD)/adenocarcinoma(AC). Materials & methods: 44 operated IPMN/MCN were included. Demographic, imaging, operative/pathological data, and outcomes were recorded. Results: IPMN-MD: n¼18 (89%male, median-age¼64y). 16/18 (89%) showed HGD/AC, and 13/16 (81.25%) were symptomatic (PPV¼92.9%) ) with 43.7% jaundiced (only 1 symptomatic without malignancy). Malignant median-size¼36.7mm (range:15-80) vs benign median-size¼27.5mm (range:20-35) (p ¼ 0.45). All HGD/AC presented at least one of the following criteria: size30mm (75%,PPV¼92.3%), Wirsung5mm (68.75%,PPV¼84.6), Mural Nodules/Thickened Wall (68.75%,PPV¼100). IPMN-BD: n¼10, (55.6% female, median-age¼68y). 100% were symptomatic (probable selection bias) and 5/10(50%) showed HGD/AC. Malignant median-size¼43.8 mm (range:22-70) vs bening median-size¼32.2 mm (range:15-52)(p¼0.39). 80% HGD/AC presented at least one of the following criteria: Wirsung5mm, Mural Nodules/Thickened Wall (Sensitivity¼80%, Specificity¼100%). MCN: n¼16, (87.5%female, median-age¼50y). 8/16(50%) were symptomatic and only 3/16(18.75%) showed HGD/AC. All malignant were symptomatic, with median-size¼103.7 mm(range:35-200). Benign madian-size¼43.7 mm (range 15-80)(P¼0.028). Size was an excellent predictor of benignity (<40mm:NPV¼85.7%; <30mm:NPV¼100%). No dilated Wirsung was observed. 30.7% of benign MCN presented Mural Nodules/Peripheral calcifications(PPV¼33.3). Conclusion: Our series support the malignant rate described for IPMNMD/IPMN-BD (88.9% vs 50%). Symptoms and morphological risk-criteria showed high specificity, but the size wasnt discriminant, supporting universal resection. MCN malignant rate was similar to that described in consensus (18.7%). Size was an effective discriminant factor (no malignancy in <30 mm) supporting a more conservative management.
Abstract ID: 1444. Diagnosis, treatment and malignant potential of pancreatic cystic neoplasms: analysis of 10-year experience from a single centre George Bagias 1, Evangelos Misiakos 1, Paul Patapis 1, Nikolaos Machairas 2, Nick Zavras 1, Anastasios Machairas 1 1 University of Athens School of Medicine, 3rd Surgical Department, Attikon University Hospital, Greece 2 University of Athens School of Medicine, 2nd Propedeutic Surgical Department, Laikon Hospital, Greece
Introduction: Pancreatic cystic neoplasms (PCN) are rare clinical entities; however can resolve to pancreatic adenocarcinoma (HR: 1.40). Therefore, early diagnosis and aggressive therapy are of high significance. Aims: To evaluate the diagnostic procedure for pancreatic cystic lesions, and to examine their malignant potential.
destruction are thrombosis of the portal venous system and erosion of gastrointestinal vessels leading to ischemic complications or hemorrhages. Vessel destruction varies from mild, clinically unimportant, to severe, leading to complications that require immediate surgical intervention. There are no known factors that would predict severe vascular infiltration. Despite the development of intensive care in pancreatitis, there are only a few recent studies on vascular complications. Aims: To verify the influence of vascular infiltration on survival of patients with pancreatitis. Patients & methods: A retrospective analysis of 272 patients, admitted to the Clinical Department of Gastroenterological Surgery and Transplantation at the Central Clinical Hospital of the Ministry of the Interior in Warsaw was performed. The criteria for diagnosis of vessel infiltration were: erosion of gastrointestinal vessels with acute bleeding, tumor infiltration of local veins, vessel destruction leading to acute ischemic complications. Results: Vascular infiltration is an important mortality risk factor among patients with pancreatitis (p<0,005, OR¼1,46). It was observed in 6.3% of the group. 35% of the patients with vascular complications died. The long-term survival of patients with vascular infiltration was significantly shorter in comparison with the others (5-year survival 48% vs 65%). The development of vascular complications did not depend on sex, age, type of pancreatitis (acute or chronic), or surgery. Conclusion: The infiltration of vessels is an important complication of pancreas inflammation that leads to severe complications. Vascular infiltration significantly worsens the prognosis of patients with pancreatitis.
Abstract ID: 1442, Oral-34. The impact of diabetes mellitus on survival following resection and adjuvant chemotherapy for pancreatic ductal adenocarcinoma Jorg Kleeff 1, Eithne Costello 1, Richard Jackson 1, Chris Halloran 1, William Greenhalf 1, Paula Ghaneh 1, Richard F. Lamb 1, Markus Lerch 2, Julia Mayerle 2, Daniel Palmer 1, Trevor Cox 1, Charlotte L. Rawcliffe 1, Oliver Strobel 3, Markus W. Büchler 3, John P. Neoptolemos 1 1
University of Liverpool, United Kingdom Ernst-Moritz-Arndt-University Greifswald, Germany 3 University of Heidelberg, Germany 2
Introduction: Diabetes mellitus is frequently observed in pancreatic cancer patients and is both a risk factor and an early manifestation of the disease. Aims: The prognostic relevance of diabetes in pancreatic cancer is not known with conflicting results regarding a potential adverse effect of diabetes on overall survival (0S). Patients & methods: We analyzed the prognostic impact of diabetes on the outcome of pancreatic cancer following resection and adjuvant chemotherapy using individual patient data from there European Study Group for Pancreatic Cancer (ESPAC) randomized controlled trials of adjuvant therapy: ESPAC-1Plus, ESPAC-1 and ESPAC-3. Analyses were carried out to assess the association between clinical characteristics and the presence of pre-operative diabetes as well as the effect of diabetic status on OS. Results: 1106 patients were analysed, 258 (23%) had confirmed diabetes and 848 (77%) did not. Median (95% confidence interval) unadjusted OS was 22.3 (20.8e24.1) and 18.8 (17.0e22.2) months in non-diabetic patients and diabetic patients respectivly(p¼0.28). Diabetic patients were older, had increased weight and more co-morbidities than non-diabetic patients. Multivariable analysis demonstrated that diabetic patients had an increased risk of death (HR: 1.30 (95%CI 1.04, 1.63), P¼0.023). Maximum tumor size (MTS) of diabetic patients was larger at randomization, (33.6mm Vs 29.7mm, p¼0.005). In diabetic patients MTS had a significant impact on OS for non-insulin dependent patients (HR: 1.68 (95%CI 1.11, 2.54), but not for insulin dependent patients (HR: 0.94 (95%CI 0.78, 1.14). Conclusion: Diabetes mellitus was associated with increased tumor size and reduced survival following pancreatic cancer resection and adjuvant chemotherapy.
S67
Abstract ID: 1443. Mucinous cystic neoplasms of the pancreas: Correlation between management recomendations (International, European and AGA consensus) and pathological findings in a series of 44 operated IPMN and MCN oz 4, Judith Millastre 1, Emma Martínez 2, Silvia Espina 3, Guillermo Mun Carlos Horndler 5, Luis Sarria 6, Maria Teresa Soria 3, Eduardo Bajador 3 1 Lozano Blesa University Hospital, Department of Gastroenterology, Spain 2 Cruces University Hospital, Department of Gastroenterology, Spain 3 Miguel Servet University Hospital, Department of Gastroenterology, Spain 4 Lozano Blesa University Hospital, Department of Pathology, Spain 5 Miguel Servet University Hospital, Department of Pathology, Spain 6 Miguel Servet University Hospital, Department of Radiology, Spain
Introduction: IPMN-MD/IPMN-BD and MCN have malignant potential. IAP-2012, European-2013 and AGA-2015 guidelines differ in criteria for surgical resection. Aims: To analyze the suitability of a more conservative management regarding the predictive value of risk criteria described in different consensus for high-grade-displasia(HGD)/adenocarcinoma(AC). Materials & methods: 44 operated IPMN/MCN were included. Demographic, imaging, operative/pathological data, and outcomes were recorded. Results: IPMN-MD: n¼18 (89%male, median-age¼64y). 16/18 (89%) showed HGD/AC, and 13/16 (81.25%) were symptomatic (PPV¼92.9%) ) with 43.7% jaundiced (only 1 symptomatic without malignancy). Malignant median-size¼36.7mm (range:15-80) vs benign median-size¼27.5mm (range:20-35) (p ¼ 0.45). All HGD/AC presented at least one of the following criteria: size30mm (75%,PPV¼92.3%), Wirsung5mm (68.75%,PPV¼84.6), Mural Nodules/Thickened Wall (68.75%,PPV¼100). IPMN-BD: n¼10, (55.6% female, median-age¼68y). 100% were symptomatic (probable selection bias) and 5/10(50%) showed HGD/AC. Malignant median-size¼43.8 mm (range:22-70) vs bening median-size¼32.2 mm (range:15-52)(p¼0.39). 80% HGD/AC presented at least one of the following criteria: Wirsung5mm, Mural Nodules/Thickened Wall (Sensitivity¼80%, Specificity¼100%). MCN: n¼16, (87.5%female, median-age¼50y). 8/16(50%) were symptomatic and only 3/16(18.75%) showed HGD/AC. All malignant were symptomatic, with median-size¼103.7 mm(range:35-200). Benign madian-size¼43.7 mm (range 15-80)(P¼0.028). Size was an excellent predictor of benignity (<40mm:NPV¼85.7%; <30mm:NPV¼100%). No dilated Wirsung was observed. 30.7% of benign MCN presented Mural Nodules/Peripheral calcifications(PPV¼33.3). Conclusion: Our series support the malignant rate described for IPMNMD/IPMN-BD (88.9% vs 50%). Symptoms and morphological risk-criteria showed high specificity, but the size wasnt discriminant, supporting universal resection. MCN malignant rate was similar to that described in consensus (18.7%). Size was an effective discriminant factor (no malignancy in <30 mm) supporting a more conservative management.
Abstract ID: 1444. Diagnosis, treatment and malignant potential of pancreatic cystic neoplasms: analysis of 10-year experience from a single centre George Bagias 1, Evangelos Misiakos 1, Paul Patapis 1, Nikolaos Machairas 2, Nick Zavras 1, Anastasios Machairas 1 1 University of Athens School of Medicine, 3rd Surgical Department, Attikon University Hospital, Greece 2 University of Athens School of Medicine, 2nd Propedeutic Surgical Department, Laikon Hospital, Greece
Introduction: Pancreatic cystic neoplasms (PCN) are rare clinical entities; however can resolve to pancreatic adenocarcinoma (HR: 1.40). Therefore, early diagnosis and aggressive therapy are of high significance. Aims: To evaluate the diagnostic procedure for pancreatic cystic lesions, and to examine their malignant potential.