Systematic review of the literature on the use of sealants in pancreatic surgery

Abstract

s / Pancreatology 13 (2013) S2–S98 S84 Patients & methods: A series of 141 patients undergoing surgery for CNP at Karolinska University Hospital was retrospectively analyzed. There were 60 males and 81 females; the mean age was 60.3 yrs. CT was performed in 138 patients (97.8%), MR in 85 (60.3%), and EUS in 31 (21.9%). Results: Histology confirmed the pre-operative diagnosis in 60.9% of patients. The concordance rate between pre-operative diagnosis and histology was similar for asymptomatic and symptomatic lesions (60.5% vs 61.4%; p1⁄4NS). The rate of correct diagnosis increased over time (20042006: 54.5%, 2007-2012: 61.7%, 2010-2012: 63.5%). Lymphoepitelial cysts (2/2) were misdiagnosed most frequently, followed by serous cystic neoplasia (24/33, 72.2%), solid pseudopapillary neoplasia (5/8, 62.5%), mucinous cystic neoplasia (7/25, 28%), and IPMN (17/56, 23.3%). Reevaluating the surgical indication in view of the histological diagnosis, surgical resection was not required in 13 patients (9.2%). There was no mortality in this patient group, and morbidity amounted to 53.8%. Conclusion: The results confirm that preoperative diagnostic errors are quite common in CNP, however, the percentage of patients who unnecessarily undergo surgery is low (9.2%). The error rate is similar for symptomatic and asymptomatic patients. PII-106 Abstract id: 288. Systematic review of the literature on the use of sealants in pancreatic surgery Jasmijn Smits , Hjalmar van Santvoort , Marc Besselink , Quintus Molenaar . University Medical Center Utrecht, Netherlands Academic Medical Center, Netherlands Introduction: A pancreatic fistula is a potentially life threatening complication of pancreatic surgery. Aims: The aim of this systematic review is to evaluate the role of sealants in pancreatic surgery in terms of preventing pancreatic fistula. Patients & methods: We performed a systematic search of the literature from January 2005 to December 2012. Inclusion criteria were studies on the use of local sealants in pancreatic surgery that reported mortality and the rate of pancreatic fistula (primary outcome). Animal studies, studies in non-English language, studies that use liquid or not topical sealants and studies not using the ISGPF classification for postoperative pancreatic fistula (POPF) were excluded. Results: Seven studies were included: one randomized controlled trial, two prospective and four retrospective observational cohort studies. Distal pancreatectomy was performed in 436 patients (sealants n1⁄4258, controls n1⁄4178) and 121 patients underwent pancreatoduodenectomy (sealants n1⁄494, controls n1⁄427). Following distal pancreatectomy, 108 patients(42%) treated with sealants developed POPF versus 93 patients(53%) in the control group(p1⁄40.03). Of these 22(9%) versus 22(12%) were clinically relevant(grade B and C fistula, p1⁄40.19). Following pancreatoduodenectomy, 9 patients(10%) treated with sealants versus 3 patients(11%) in the control group developed POPF(p1⁄40.81), of which 3(3%) versus 1(3%)were clinically relevant(p1⁄40.89). Therewerenomajor differences in time todrain removal, hospital stay, morbidity and mortality. Conclusion: The current data do not support the routine use of sealants in pancreatic surgery, because there was no effect on clinically relevant fistula. Larger well-designed studies are needed to determine the efficacy of local sealants in preventing pancreatic fistula after pancreatic resection. PII-107 Abstract id: 31. Frequency and characterization of benign lesions in patients undergoing surgery for the suspicion of solid pancreatic neoplasm Francesco Vitali , Torsten Hansen , Ralf Kiesslich , Stefan Heinrich , Peter Mildenberger , Anisha Kumar , Antonio Amodio , Luigi Benini , Italo Vantini , Luca Frulloni . University of Verona, Italy University of Mainz, Germany Introduction: A diagnosis of benign lesions is reported in 5-21% of patients undergoing pancreatoduodenectomy for pancreatic neoplasm, whereas no data have yet been published for body-tail resections. Aims: Aim of the study was to investigate the frequency and to characterize the benign lesions mimicking cancer in the head and in the bodytail of the pancreas. Patientsm Campus L€ ubeck, Germany Universit€ atsklinik Freiburg, Germany Introduction: Despite improved diagnostic methods, correct diagnosis and treatment of cystic lesions of the pancreas (CLP) still constitutes a clinical challenge. Aims: This study aimed at retrospective evaluation of diagnostic accuracy and surgical treatment of CLP. Patients & methods: Patients with CLP referred to our institution for evaluation and treatment between 2001 and 2012 were retrospectively analyzed. Statistical calculationswere performedwith IBM SPSS Version 20. Results: A total of n1⁄4234 patients of median age 63 (range 22-90) years were included in the study, of whom n1⁄4160 (68%) were operated, n1⁄417 treated minimally invasive or interventionally and n1⁄457 were observed only. Most frequent definite histologically confirmed lesions in the 160 operated patients were benign pancreatic pseudocysts (BPP, 30%) and intraductal papillary mucinous neoplasms (IPMN, 24%), followed by various rare entities like serous and mucinous cystic neoplasms, cystadenocarcinoma, neuroendocrine tumor and others. Of resected IPMN, 46% were invasive and multivariate analysis disclosed younger age, absence of symptoms or former malignancy and presence of diabetes as independent risk factors for invasive transformation. Clinical or preoperative classification as benign or malignant showed fair accuracy, as only 4% of lesions regarded as benign turned out to be malignant after resection and no patient without resection developed malignancy at a median follow-up of 8 months. In the subgroup of patients operated for suspected benign IPMN, malignancy rate was 13%. Conclusion: Diagnostic accuracy regarding the biology of CLP is relatively high. We suggest that parenchyma-sparing techniques can be performed if benign CLP are suspected. PII-109 Abstract id: 69. Are the new IPMN’s guideline effective to predict the presence of invasive IPMCarcinoma? A single center experience Giovanni Taffurelli , Claudio Ricci , Salvatore Buscemi , Marielda D’Ambra , Carlo Alberto Pacilio , Raffaele Pezzilli , Donatella Santini , Riccardo Casadei , Francesco Minni .