Outcomes of pancreatic resection: Analysis of the french national database on 6436 patients

Abstract

s / Pancreatology 13 (2013) S2–S98 S77 were: sex, age, co-morbidities, body mass index, American Society of Anesthesiologists score, characteristics of the pancreatic remnant and preoperative diagnosis. Results: Two hundred and eight patients were recorded. The pancreatic fistula rate was 29.3% and it was significantly related to the type of resection, the soft texture of the pancreatic remnant (P1⁄40.037), a Wirsung duct diameter 24 kg/m2 (P1⁄40.011); a Wirsung duct size 3 (P 24 kg/m2, Wirsung duct size <3 mm and preoperative diagnosis may be considered as preoperative factors related to a soft pancreas and they resulted useful in predicting the incidence of pancreatic fistulas. PII-82 Abstract id: 41. Outcomes of pancreatic resection: Analysis of the french national database on 6436 patients Valeria de Franco , Melanie Dufresne , Romain Guille , Nicolas Regenet . 1 Facult e de M edecine, Universit e de Nantes, France 2 Institut National de la Sant e et de la Recherche M edicale, INSERM U531, Hospital Rangueil, Toulouse, France Introduction: National reports on outcome after pancreatic resection are missing in Europe. Aims: To analyze outcomes after pancreatectomy using a large national database. Patients & methods: French health care database was screened to identify all patients undergoing left pancreatectomy (LP) and pancreaticoduodenectomy (PD) between 2009 and 2010. Parameters including age, medical history, indication and support structure were retrieved. Retrospective analysis were performed to measure morbidity and mortality rates. Results: On LP (n1⁄42352), 461 centers performed at least one LP per year (44 over 10 LP). Laparoscopywas used in 13% of cases. Indicationwas a malignant tumor in 50% of cases. The average age was 59 ( 15). The average length of stay was 20 days ( 16). The overall morbidity rate was 55%. Postoperative mortality rate was 5% and 9% at one-year. Two risk factors for complications emerged: age (p 1⁄4 0.01) and surgical approach (p<0.0001 for laparotomy). On PD (n1⁄44084), 455 centers performed at least one PD per year (89 over 10 PD). Indicationwas a malignant tumor in 80% of cases. The average agewas 64 ( 12). The average length of staywas 26 days ( 18). The overall morbidity rate was 67,5%. Postoperative mortality rate was 6% and 12% at one-year. Two risk factors for complications emerged: age (p 1⁄4 0.006) and a threshold of 10 PD per year (p1⁄40.03). Conclusion: This study confirms the still high rate of complications after pancreatic surgery. It confirms the advantage of laparoscopy in regards of LP. The effect-center seems less important than the suggested in the literature. PII-83 Abstract id: 278. Enhanced recovery after surgery pathway in patients undergoing pancreaticoduodenectomy: Results of a case-match analysis Nicolo Pecorelli , Gianpaolo Balzano , Riccardo Ariotti , Giovanni Capretti , Beretta Luigi , Braga Marco . 1 Pancreas Unit, Dept of Surgery, S. Raffaele Scientific Institute, Milan, Italy Dept of Anesthesiology, S. Raffaele Scientific Institute, Milan, Italy Introduction: Enhanced recovery after surgery (ERAS) pathway reduced morbidity and length of hospital stay (LOS) in orthopedics, bariatric, and colorectal surgery. A comprehensive ERAS protocol has not yet been tested in patients undergoing pancreaticoduodenectomy (PD) and incomplete data about ERAS items compliance have been reported. Aims: To assess compliance to an ERAS protocol and its impact on short-term outcome in patients undergoing PD. Patients & methods: A specific ERAS protocol has been applied in 115 consecutive patients undergoing PD in our institution between 2010 and 2012. Each ERAS patient was matched with one patient who received standard perioperative care. Match criteria were age, gender, malignant / benigndisease, andPD-specific prognostic score (Braga et al. AnnSurg 2011). Results: Compliance was high for preoperative and intraoperative ERAS items. The most relevant deviation from ERAS protocol occurred for intraoperative i.v. fluids restriction; in fact 87% of patients required more fluids than planned. A substantial delay of postoperative oral feeding recovery, mobilization, and i.v. fluid withdrawal was observed in patients with complications. Morbidity rate was 60.0 % in ERAS and 66.1% in control group (p1⁄4 0.412). ERAS pathway significantly reduced LOS only in uneventful patients. Conclusion: ERAS pathway was feasible and safe, however relevant deviations from the protocol occurred for intra-, postoperative i.v. fluids, recovery of oral feeding and mobilization. ERAS pathway had no effect on morbidity rate and shortened LOS only in uneventful patients. PII-84 Abstract id: 286. Interventional radiologic therapy for postpancreatectomy hemorrhage as the first line treatment Youichi Kawano, Takayuki Aimoto, Nobuhiko Taniai, Hiroshi Yoshida, Yoshiharu Nakamura, Masato Yoshioka, Akira Matsushita, Yoshiaki Mizuguchi, Tetsuya Shimizu, Junji Takada, Hideyuki Takada, Hiroki Sumiyoshi, Eiji Uchida. Department of Surgery, Nippon Medical School, Tokyo, Japan Introduction: Postpancreatectomy hemorrhage (PPH) is a life-threatening complication after pancreatic surgery. Although the International Study Group of Pancreatic Surgery (ISGPS) established the definition and grading of PPH, there is no consensus of PPH therapeutic strategy because of a wide variety of clinical situation. Aims: The aim of this study is to determine which treatment should be appropriate as the first line treatment for PPH. Patients & methods: Three hundred thirty patients after pancreatic surgery at our institute were reviewed in this study. We examined patient backgrounds, characteristics and treatment of PPH, clinical outcomes. Results: Eighteen cases (4.2%) had PPH and 11cases of them (61.1 %) were associated with postoperative pancreatic fistula. The distribution of ISGPS grades was: grade B1⁄4 5 cases, grade C1⁄4 13 cases. On first-line, interventional radiology (IVR) was performed in 13 of 18 cases. Since the past decade, interventional procedures have been undergone successfully in all cases. There was no mortality in patients receiving IVR treatment. Conclusion: IVR treatment is considered to be the primary treatment for PPH because IVR is less invasive and more effective than surgery. PII-85 Abstract id: 300. Outbreak of antibiotic-resistant klebsiella pneumoniae in a high-volume pancreatic surgery unit Giuseppe Malleo, Giovanni Marchegiani, Eleonora Morelli, Harmony Impellizzert, Laura Maggino, Valentina Todaro, Roberto Salvia, Giovanni Butturini, Claudio Bassi. Department of Surgery, University of Verona, Italy Introduction: The threat of infections due to multidrug-resistant organisms is increasing. No effective drugs are available for the therapy of