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Usage of fibrin-based sealants in distal pancreatectomy
Abstracts / Pancreatology 15 (2015) S1eS141
Aims: We present a new method for pancreatic sentinel node (SN) detection with gamma probe. Patients & methods: Seven patients with cT2N0M0 pancreatic head cancer were enrolled between 2009 to 2012 to this exploratory study. One day prior to surgery, preoperative endoscopic intratumoral administration of Tc99m labeled nanocolloid followed by scintigraphy study 2 hours later was conducted. Peroperative gamma probe detection of SN was also performed. Results: Radiotracer administration was feasible in all patients. Scintigraphy study showed interaortocaval dissemination in 2 patients, hepatic contamination in 2 patients, colonic contamination in 4 patients and no activity in 1 patient. Intraoperative SN detection was accomplished in 2 patients, both with negative results. Only 4 pancreatic cancers could be resected and only 1 SN could be confirmed as true negative by final histopathologic analysis. Conclusion: This new method of pancreatic SN detection is technically feasible but challenging. Results do not allow clinical validation.
1030. Usage of fibrin-based sealants in distal pancreatectomy ski, Andrzej Hellmann, Dariusz Łaski, Justyna Kostro, Michał Szyman ski Stanisław Hac, Zbigniew Sledzin sk, Poland Medical University of Gdan Introduction: Pancreatic fistula (PF) after distal pancreatectomy (DP) is still one of the major complication after this procedure. Different techniques for closing pancreas stump are used. There is no clear evidence which one is better hand-sewn or stapler technique. For both techniques, a fistula rate of approximately 30% has been reported. Aims: We want to present our experience with usage of fibrin-based sealant (Baxter Tissucol Duo S) during the open DP. Fibrin glue is used to strengthen the hand-sewn closer of pancreatic remnant. Patients & methods: 8 patients underwent DP in 2014. Indications for operations included cystic tumors (n ¼ 3), neuroendocrine tumors (n ¼ 3), adenocarcinoma (n ¼ 2). Open approach DP was performed. Elective ligation of main pancreatic duct, hand-sawn suturing of remnant and usage of fibrin-based sealant to cover the remnant were performed. Results: There were 3 PF observed. Only class A fistulas were observed. No severe complication was noticed. Average hospitalization time was 8,6 days. Conclusion: Fibrin glue is safe, and well tolerable by patients. Application do not prolongate the operating procedure. Although the series was short, lack of PF class B and C indicates that application of fibrin-based sealant can be use as a routine procedure during DP.
1031. Impact of surgical strategies on initiation and outcome of palliative chemotherapy in patients with unresectable pancreatic carcinoma at exploration Maryam Haghighi 1, Srinivas Sanjeevi 1, Tommy Ivanics 2, John Blomberg 3, Lke Andr en-Sandberg 1, Lars Lundell 3, Marco Del Chiaro 3, Christoph Ansorge 3 1 Department of Upper GI Surgery, Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden 2 Department of Surgery, Mayo Clinic Rochester, MN, United States 3 Division of Surgery, Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
Introduction: Despite modern staging, up to 30% of patients with pancreatic cancer (PC) planned for curative-intent resection (CIR), are found to be unresectable at laparotomy (EXL). Standard practice for these patients is the construction of a prophylactic bilioenteric/gastroenteric bypass (PDB).
S81
Aims: To compare PDB with EXL alone regarding the outcome of palliative chemotherapy (PCT) and observation/supportive care (OSC) in PC patients unresectable at laparotomy. Patients & methods: Of histologically proven PC planned for CIR between 2008 and 2013, unresectable patients were identified. Demographics, operative/postoperative data and PCT/OSC outcomes were recorded. Disease-specific survival (DSS) was determined using the Kaplan-Meier method and compared using the log-rank test, prognostic interactions were investigated using Cox’s regression model. Results: Seventy-one out of 341 patients were found to be unresectable at EXL (19 locally advanced, 31 liver metastasis, 21 carcinomatosis, resectability-rate 80%). Forty-eight patients underwent PDB (23 EXLþ/GE). EXL/PDB groups showed no differences regarding length of stay, 30/ 90-days mortality, PCT initiation or median DSS (EXL 6.7, PDB 8 months, p¼0.174). Compared to OSC, PCT was associated with significantly longer median DSS for locally advanced (16 vs 6 months, p¼0.046) and metastasized PC (10 vs 2 months, p<0.001). PCT with prior EXL had a significantly longer median DSS than PCT with prior PDB (18.5 vs 11.6 months, p¼0.023). Conclusion: In patients with pancreatic cancer found to be unresectable at laparotomy, prophylactic double bypass procedures may exert negative effects on the efficacy of palliative chemotherapy. In the light of less invasive alternatives, this vulnerable patient group deserves additional prospective studies to define optimum palliation strategies.
1032. Pancreatic localization of a low-grade myofibroblastic sarcoma. A case report Valbona Lico 1, Anna Caterina Milanetto 2, Rita Alaggio 3, Umberto Basso 4, Claudio Pasquali 2 1
Pancreatic and Digestive Endocrine Unit, Univeristy of Padua, Italy Pancreatic and Digestive Endocrine Unit, University of Padua, Italy 3 Pathology, University of Padua, Italy 4 Oncology, University of Padua, Italy 2
Introduction: Low-grade myofibroblastic sarcoma (LGMS) is a rare malignant tumor, defined as a distinct entity in 2002. LGMS occurs in the soft tissue of the head and neck, extremities, trunk, retroperitoneum, bone and breast. They are prone to local recurrence. Surgery is the main therapeutic option. Aims: We report the clinical and pathological features of a patient with a LGMS of the right leg with pancreatic metastasis. Patients & methods: A 65-year-old female with a history of a resected LGMS of the right leg in 2007, two reoperations for local recurrence (2009 and 2012) followed by chemotherapy and radiotherapy, was referred to our center for a 27 mm, solid, hypervascular, pancreatic head lesion at a CT scan performed 84 months after the first occurrence of LGMS. Tumor markers were negative. FNA-Echoendoscopy was inconclusive. Ga68Dotatoc PET-TC showed a moderate uptake in the uncinate process. The patient developed obstructive jaundice and diarrhea and underwent a percutaneous biliary drainage. Despite the biliary drainage, the bilirubin levels increased with features of liver insufficiency. Results: In August 2014, the patient underwent a pancreaticoduodenectomy which was complicated by a biliary fistula, treated conservatively. Histology and immunohistochemistry showed a low-grade myofibroblastic sarcoma involving the duodenum, main bile duct and the posterior margin of the pancreatic resection (R1). She received no postoperative adjuvant therapy. The patient is well without recurrence seven months after surgery. Conclusion: This is the first report of a LGMS with pancreatic metastasis. CT features and Ga68-Dotatoc PET-CT in this patient may mimick a neuroendocrine pancreatic tumor.
Aims: We present a new method for pancreatic sentinel node (SN) detection with gamma probe. Patients & methods: Seven patients with cT2N0M0 pancreatic head cancer were enrolled between 2009 to 2012 to this exploratory study. One day prior to surgery, preoperative endoscopic intratumoral administration of Tc99m labeled nanocolloid followed by scintigraphy study 2 hours later was conducted. Peroperative gamma probe detection of SN was also performed. Results: Radiotracer administration was feasible in all patients. Scintigraphy study showed interaortocaval dissemination in 2 patients, hepatic contamination in 2 patients, colonic contamination in 4 patients and no activity in 1 patient. Intraoperative SN detection was accomplished in 2 patients, both with negative results. Only 4 pancreatic cancers could be resected and only 1 SN could be confirmed as true negative by final histopathologic analysis. Conclusion: This new method of pancreatic SN detection is technically feasible but challenging. Results do not allow clinical validation.
1030. Usage of fibrin-based sealants in distal pancreatectomy ski, Andrzej Hellmann, Dariusz Łaski, Justyna Kostro, Michał Szyman ski Stanisław Hac, Zbigniew Sledzin sk, Poland Medical University of Gdan Introduction: Pancreatic fistula (PF) after distal pancreatectomy (DP) is still one of the major complication after this procedure. Different techniques for closing pancreas stump are used. There is no clear evidence which one is better hand-sewn or stapler technique. For both techniques, a fistula rate of approximately 30% has been reported. Aims: We want to present our experience with usage of fibrin-based sealant (Baxter Tissucol Duo S) during the open DP. Fibrin glue is used to strengthen the hand-sewn closer of pancreatic remnant. Patients & methods: 8 patients underwent DP in 2014. Indications for operations included cystic tumors (n ¼ 3), neuroendocrine tumors (n ¼ 3), adenocarcinoma (n ¼ 2). Open approach DP was performed. Elective ligation of main pancreatic duct, hand-sawn suturing of remnant and usage of fibrin-based sealant to cover the remnant were performed. Results: There were 3 PF observed. Only class A fistulas were observed. No severe complication was noticed. Average hospitalization time was 8,6 days. Conclusion: Fibrin glue is safe, and well tolerable by patients. Application do not prolongate the operating procedure. Although the series was short, lack of PF class B and C indicates that application of fibrin-based sealant can be use as a routine procedure during DP.
1031. Impact of surgical strategies on initiation and outcome of palliative chemotherapy in patients with unresectable pancreatic carcinoma at exploration Maryam Haghighi 1, Srinivas Sanjeevi 1, Tommy Ivanics 2, John Blomberg 3, Lke Andr en-Sandberg 1, Lars Lundell 3, Marco Del Chiaro 3, Christoph Ansorge 3 1 Department of Upper GI Surgery, Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden 2 Department of Surgery, Mayo Clinic Rochester, MN, United States 3 Division of Surgery, Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
Introduction: Despite modern staging, up to 30% of patients with pancreatic cancer (PC) planned for curative-intent resection (CIR), are found to be unresectable at laparotomy (EXL). Standard practice for these patients is the construction of a prophylactic bilioenteric/gastroenteric bypass (PDB).
S81
Aims: To compare PDB with EXL alone regarding the outcome of palliative chemotherapy (PCT) and observation/supportive care (OSC) in PC patients unresectable at laparotomy. Patients & methods: Of histologically proven PC planned for CIR between 2008 and 2013, unresectable patients were identified. Demographics, operative/postoperative data and PCT/OSC outcomes were recorded. Disease-specific survival (DSS) was determined using the Kaplan-Meier method and compared using the log-rank test, prognostic interactions were investigated using Cox’s regression model. Results: Seventy-one out of 341 patients were found to be unresectable at EXL (19 locally advanced, 31 liver metastasis, 21 carcinomatosis, resectability-rate 80%). Forty-eight patients underwent PDB (23 EXLþ/GE). EXL/PDB groups showed no differences regarding length of stay, 30/ 90-days mortality, PCT initiation or median DSS (EXL 6.7, PDB 8 months, p¼0.174). Compared to OSC, PCT was associated with significantly longer median DSS for locally advanced (16 vs 6 months, p¼0.046) and metastasized PC (10 vs 2 months, p<0.001). PCT with prior EXL had a significantly longer median DSS than PCT with prior PDB (18.5 vs 11.6 months, p¼0.023). Conclusion: In patients with pancreatic cancer found to be unresectable at laparotomy, prophylactic double bypass procedures may exert negative effects on the efficacy of palliative chemotherapy. In the light of less invasive alternatives, this vulnerable patient group deserves additional prospective studies to define optimum palliation strategies.
1032. Pancreatic localization of a low-grade myofibroblastic sarcoma. A case report Valbona Lico 1, Anna Caterina Milanetto 2, Rita Alaggio 3, Umberto Basso 4, Claudio Pasquali 2 1
Pancreatic and Digestive Endocrine Unit, Univeristy of Padua, Italy Pancreatic and Digestive Endocrine Unit, University of Padua, Italy 3 Pathology, University of Padua, Italy 4 Oncology, University of Padua, Italy 2
Introduction: Low-grade myofibroblastic sarcoma (LGMS) is a rare malignant tumor, defined as a distinct entity in 2002. LGMS occurs in the soft tissue of the head and neck, extremities, trunk, retroperitoneum, bone and breast. They are prone to local recurrence. Surgery is the main therapeutic option. Aims: We report the clinical and pathological features of a patient with a LGMS of the right leg with pancreatic metastasis. Patients & methods: A 65-year-old female with a history of a resected LGMS of the right leg in 2007, two reoperations for local recurrence (2009 and 2012) followed by chemotherapy and radiotherapy, was referred to our center for a 27 mm, solid, hypervascular, pancreatic head lesion at a CT scan performed 84 months after the first occurrence of LGMS. Tumor markers were negative. FNA-Echoendoscopy was inconclusive. Ga68Dotatoc PET-TC showed a moderate uptake in the uncinate process. The patient developed obstructive jaundice and diarrhea and underwent a percutaneous biliary drainage. Despite the biliary drainage, the bilirubin levels increased with features of liver insufficiency. Results: In August 2014, the patient underwent a pancreaticoduodenectomy which was complicated by a biliary fistula, treated conservatively. Histology and immunohistochemistry showed a low-grade myofibroblastic sarcoma involving the duodenum, main bile duct and the posterior margin of the pancreatic resection (R1). She received no postoperative adjuvant therapy. The patient is well without recurrence seven months after surgery. Conclusion: This is the first report of a LGMS with pancreatic metastasis. CT features and Ga68-Dotatoc PET-CT in this patient may mimick a neuroendocrine pancreatic tumor.