- Email: [email protected]
The prognostic impact of retrieved lymph nodes number on perihilar cholangiocarcinoma
E-HPBA: Free Prize Papers major biliary complications. Long-term follow up of these patients is necessary as late strictures may occur.
BILIARY 0573 PRE-OPERATIVE FDG PET-CT PREDICTS OUTCOME FOLLOWING CURATIVE-INTENT RESECTION FOR PERI-HILAR CHOLANGIOCARCINOMA; IS ROUTINE FDG PET-CT INDICATED FOR ALL PATIENTS? I. Wijetunga, S. C. Chin, A. L. Young, A. F. Scarsbrook and K. R. Prasad St James’s University Hospital, UK Aims: We aimed to investigate if pre-operative Fluorine-18 fluorodeoxyglucose (FDG) PET-CT is a useful predictor of outcome in patients undergoing curative-intent resection for peri-hilar (PH-CCA) and intra-hepatic (IH-CCA) cholangiocarcinoma. Methods: All patients who underwent curative-intent resection for PH-CCA and IH-CCA at a single centre over a 5-year period from February 2009-February 2014 were identified from a prospective database. Results of FDG PET-CT including maximum standardized uptake value (SUVmax in g/ml) of primary tumour were collected retrospectively. The SUVmax cut off values 5g/ml for PHCCA and 10g/ml for IH-CCA were used to stratify primary tumours into 2 groups of low and high FDG-avidity using median SUVmax as a guide. 90-day mortalities were excluded from Kaplan-Meier survival analyses. Results: 27 and 35 patients underwent curative-intent resection for PH-CCA and IH-CCA respectively, during the study period. 76% of these patients underwent selective FDG PET-CT pre-operatively. Complete radiological and follow up data were available in 13 and 25 patients, respectively. Median follow up was 18 months. Disease recurrence (p = 0.014) and overall survival (p = 0.027) in the PH-CCA SUVmax >5g/ml group was significantly greater. The two groups were comparable with regards to T and N stage as well as margin status. Differences in IHCCA recurrence and mortality in the two groups were not statistically significant. Conclusions: We have demonstrated that primary tumour SUVmax measurement on pre-operative FDG PET-CT can predict disease recurrence and overall survival following surgical resection of PH-CCA. In addition to the usefulness of FDG PET-CT in disease staging, its assessment of primary tumour metabolic activity shows promise as a way to substratify patients to guide management decisions with the aim of improving survival outcomes in PH-CCA.
BILIARY 0580 THE PROGNOSTIC IMPACT OF RETRIEVED LYMPH NODES NUMBER ON PERIHILAR CHOLANGIOCARCINOMA P. Kambakamba, M. Linecker, K. Slankamenac and M. L. De Oliveira University Hospital Zurich, Zurich, Switzerland
HPB 2016, 18 (S2), e670ee684
e679
Aims: The purpose of this systematic review was to evaluate the number of retrieved lymph nodes for staging of patients undergoing surgery for perihilar cholangiocarcinoma (PHC). Nodal status is an important prognostic factor for survival in PHC. A certain benchmark of lymph node retrieval (LNR) is necessary in order to guarantee a significant lymph node staging and to avoid under staging. However the required minimum number of retrieved lymph nodes remains unclear for PHC. The 7th AJCC TNM edition increased the requirement for the histologic examination of lymph nodes in PHC patients from 3 to 15. The relevance of such recommendation appears to be arbitrary and questionable. Methods: The MEDLINE, EMBASE, and The Cochrane Library databases were systematically screened up to December 2014. Results: 725 abstracts were screened and twenty studies were included for analysis, comprising 3986 patients. The cumulative median LNR was 7 (2- 24). A median LNR > = 15 was reported in 9% of PHC patients and could only be achieved in extended lymphadenectomy. Subgroup analysis revealed a median LNR of 7 (range 7e9) detected the most lymph node positive (N+) patients and showed the lowest risk for under staging patients. In contrast LNR > = 15 did not increase detection rate of N+ patients. Conclusions: The systematic analysis revealed LNR > = 7 is adequate for prognostic staging, while LNR> = 15 does not improve detection of patients with tumor positive lymph nodes.
BILIARY 0591 EUROPEAN SURVEY ON THE MANAGEMENT OF COMMON BILE DUCT STONES M. Vannijvel1, M. Lesurtel2, G. Vangertruyden1 and G. Sergeant1 1 Jessa Ziekenhuis, Belgium; 2University Hospital Zurich, Zurich, Switzerland Aims: Common bile duct (CBD) stones can be managed by either endoscopic retrograde cholangiopancreaticography (ERCP) or laparoscopic common bile duct exploration (LCBDE) with transcystic or transductal stone extraction. There is no significant difference in the mortality, morbidity, retained stones, and failure rates between the two procedures. The aim of this survey was to gather information on the management of CBD stones throughout Europe. Methods: All 331 members of the European-African HPB Association were invited to participate to an online survey by personal email. The study was endorsed by the EAHPBA. Results: Ninety-one (28%) surgeons replied within 14 days. Responding surgeons were mainly attending surgeons (84%), working as HPB surgeons (75%) in academic hospitals (72%). In case of clinically suspected CBD stones, MRCP was the preferred diagnostic test by 61% of respondents. In case of confirmed CBD stones, LCBDE was the preferred therapeutic strategy by 11 respondents only. Previous gastric surgery was considered an absolute contraindication for ERCP by 45% of respondents. In
BILIARY 0573 PRE-OPERATIVE FDG PET-CT PREDICTS OUTCOME FOLLOWING CURATIVE-INTENT RESECTION FOR PERI-HILAR CHOLANGIOCARCINOMA; IS ROUTINE FDG PET-CT INDICATED FOR ALL PATIENTS? I. Wijetunga, S. C. Chin, A. L. Young, A. F. Scarsbrook and K. R. Prasad St James’s University Hospital, UK Aims: We aimed to investigate if pre-operative Fluorine-18 fluorodeoxyglucose (FDG) PET-CT is a useful predictor of outcome in patients undergoing curative-intent resection for peri-hilar (PH-CCA) and intra-hepatic (IH-CCA) cholangiocarcinoma. Methods: All patients who underwent curative-intent resection for PH-CCA and IH-CCA at a single centre over a 5-year period from February 2009-February 2014 were identified from a prospective database. Results of FDG PET-CT including maximum standardized uptake value (SUVmax in g/ml) of primary tumour were collected retrospectively. The SUVmax cut off values 5g/ml for PHCCA and 10g/ml for IH-CCA were used to stratify primary tumours into 2 groups of low and high FDG-avidity using median SUVmax as a guide. 90-day mortalities were excluded from Kaplan-Meier survival analyses. Results: 27 and 35 patients underwent curative-intent resection for PH-CCA and IH-CCA respectively, during the study period. 76% of these patients underwent selective FDG PET-CT pre-operatively. Complete radiological and follow up data were available in 13 and 25 patients, respectively. Median follow up was 18 months. Disease recurrence (p = 0.014) and overall survival (p = 0.027) in the PH-CCA SUVmax >5g/ml group was significantly greater. The two groups were comparable with regards to T and N stage as well as margin status. Differences in IHCCA recurrence and mortality in the two groups were not statistically significant. Conclusions: We have demonstrated that primary tumour SUVmax measurement on pre-operative FDG PET-CT can predict disease recurrence and overall survival following surgical resection of PH-CCA. In addition to the usefulness of FDG PET-CT in disease staging, its assessment of primary tumour metabolic activity shows promise as a way to substratify patients to guide management decisions with the aim of improving survival outcomes in PH-CCA.
BILIARY 0580 THE PROGNOSTIC IMPACT OF RETRIEVED LYMPH NODES NUMBER ON PERIHILAR CHOLANGIOCARCINOMA P. Kambakamba, M. Linecker, K. Slankamenac and M. L. De Oliveira University Hospital Zurich, Zurich, Switzerland
HPB 2016, 18 (S2), e670ee684
e679
Aims: The purpose of this systematic review was to evaluate the number of retrieved lymph nodes for staging of patients undergoing surgery for perihilar cholangiocarcinoma (PHC). Nodal status is an important prognostic factor for survival in PHC. A certain benchmark of lymph node retrieval (LNR) is necessary in order to guarantee a significant lymph node staging and to avoid under staging. However the required minimum number of retrieved lymph nodes remains unclear for PHC. The 7th AJCC TNM edition increased the requirement for the histologic examination of lymph nodes in PHC patients from 3 to 15. The relevance of such recommendation appears to be arbitrary and questionable. Methods: The MEDLINE, EMBASE, and The Cochrane Library databases were systematically screened up to December 2014. Results: 725 abstracts were screened and twenty studies were included for analysis, comprising 3986 patients. The cumulative median LNR was 7 (2- 24). A median LNR > = 15 was reported in 9% of PHC patients and could only be achieved in extended lymphadenectomy. Subgroup analysis revealed a median LNR of 7 (range 7e9) detected the most lymph node positive (N+) patients and showed the lowest risk for under staging patients. In contrast LNR > = 15 did not increase detection rate of N+ patients. Conclusions: The systematic analysis revealed LNR > = 7 is adequate for prognostic staging, while LNR> = 15 does not improve detection of patients with tumor positive lymph nodes.
BILIARY 0591 EUROPEAN SURVEY ON THE MANAGEMENT OF COMMON BILE DUCT STONES M. Vannijvel1, M. Lesurtel2, G. Vangertruyden1 and G. Sergeant1 1 Jessa Ziekenhuis, Belgium; 2University Hospital Zurich, Zurich, Switzerland Aims: Common bile duct (CBD) stones can be managed by either endoscopic retrograde cholangiopancreaticography (ERCP) or laparoscopic common bile duct exploration (LCBDE) with transcystic or transductal stone extraction. There is no significant difference in the mortality, morbidity, retained stones, and failure rates between the two procedures. The aim of this survey was to gather information on the management of CBD stones throughout Europe. Methods: All 331 members of the European-African HPB Association were invited to participate to an online survey by personal email. The study was endorsed by the EAHPBA. Results: Ninety-one (28%) surgeons replied within 14 days. Responding surgeons were mainly attending surgeons (84%), working as HPB surgeons (75%) in academic hospitals (72%). In case of clinically suspected CBD stones, MRCP was the preferred diagnostic test by 61% of respondents. In case of confirmed CBD stones, LCBDE was the preferred therapeutic strategy by 11 respondents only. Previous gastric surgery was considered an absolute contraindication for ERCP by 45% of respondents. In