The results of laparoscopic staging for periampullary carcinoma at a tertiary pancreaticobiliary centre

Abstract

s / International Journal of Surgery 23 (2015) S15eS134 S64 Aim: NHS hospitals currently have limited capacity for emergency laparoscopic cholecystectomy (LC) in emergency theatre. A new pathway allowing emergency LC on elective lists was evaluated to assess cost effectiveness and impact on patient care. Methods: We identified acute admissions for biliary complaints between April September 2014 prospectively, and collected data on readmissions, length of stay (LOS) and conversions. Data, including referral mode, admissions whilst awaiting surgery and conversions, was collected retrospectively on elective LC performed during this period. Results: Out of 207 acute admission, 115(56%) were eligible for emergency surgery. 33(28.7%) had emergency surgery; 20 in emergency theatre and 13 on the pathway. Of the 13, one was converted and LOS averaged 8 days. 11(13.4%) of the remaining 82 were readmitted whilst awaiting surgery. 131 patients had elective LC. Of these, 38(29%) had prior acute admission. LOS for these 38 patients averaged 8 days. None required conversion. Five (13.1%) of the 38 had readmissions whilst awaiting surgery; mean LOS was 6 days. Conclusion: It is feasible to do emergency LC on elective lists. It may prevent readmission in patients undergoing delayed surgery, although impact on LOS and conversions remains to be assessed. 0355: THE RESULTS OF LAPAROSCOPIC STAGING FOR PERIAMPULLARY CARCINOMA AT A TERTIARY PANCREATICOBILIARY CENTRE M. Horner , A. Whalley , K. Silver , N. Mowbray , B. Al-Sarireh , T. Brown . Abertawe Bro Morgannwg University Health Board, UK; 2 Swansea University, UK Aim: Despite pre-operative radiological staging a significant proportion of patients with periampullary cancers have occult metastases or local vessel involvement at attempted resection and undergo a palliative bypass. Recent guidelines have suggested that Staging Laparoscopy (SL) should be undertaken in selected cases prior to resection. We studied the effectiveness of SL in detecting metastatic disease and avoiding non-therapeutic laparotomy. Methods: This retrospective study reviewed patients who underwent SL between January 2009 and September 2014. These patients had raised carbohydrate antigen 19-9 (CA 19-9) levels and/or suspicious clinicoradiological features. Results: 105 patients (53 Female, Mean age1⁄4 69 years) underwent SL of which 23 (21.9%) had metastases. 66 patients underwent attempted resection, however 13 were found to have metastases or locally advanced disease. This resulted in 12 palliative bypasses and 1 open and close laparotomy being performed. Overall 10 (9.8%) patients had a false negative SL. Conclusion: SL is useful in the staging of periampullary neoplasms enabling a significant number of patients to avoid the attendant morbidity of a non-therapeutic laparotomy. There is room for improvement with the use of this technique to reduce the near 10% false negative rate. 0454: MANAGEMENT OF PANCREATIC CYSTS WITHIN A UK TERTIARY CENTRE J. Pilkington, R. Patel, A. Razack, S. Khulusi, K. Wedgwood, D. Dasgupta, P. Lykoudis. Hull and East Yorkshire Hospitals NHS Trust, UK Aim: Our aims were to review the investigation and management of pancreatic cysts at a tertiary referral centre. Methods: Retrospective data was collected on patients coded with a diagnosis of ‘simple cyst of pancreas' over a 32-month period (January 2012-August 2014). Results: 97 patients were identified and 65 of these had been subsequently discussed at the hepatopancreatobiliary multidisciplinary (MDT) team meeting. Patients were excluded from this study with a history of pancreatitis (n 1⁄4 8). Fourteen patients (24%) presented with abdominal/ back pain that may have been attributable to the identified cyst. Thirtynine patients (67%) were investigated with cross sectional imaging and endoscopic ultrasound (EUS). The MDT decision was: to remove sixteen patients (28%) from the cancer pathway due to predicted indolent behavior or comorbidity and unsuitability for further investigation and management; to perform active surveillance of twenty-three patients (40%); and perform surgery in the remaining sixteen patients (28%). Of those that underwent surgery, histopathology and cytology found that fourteen were benign lesions and in two cases found evidence of malignancy. Conclusion: Appropriate imaging and further management found that the majority of lesions are benign. As growth and malignancy were observed, we advocate the role of long-term surveillance. 0568: DUODENUM PRESERVING PANCREATIC HEAD RESECTION VERSUS PANCREATICODUODENECTOMY FOR CHRONIC PANCREATITIS: SYSTEMATIC REVIEW AND META-ANALYSIS C. Halkias , S. Kaptanis , M. Chatzikonstantinou . Queen's Hospital Romford, UK; Homerton University Hospital, UK; Medway Maritime