Tu1576 Surgical Apgar Score Does Not Predict Morbidity and Mortality for Patients Undergoing Pancreaticoduodenectomy for Pancreatic Adenocarcinoma

Abstract

S A T A b st ra ct s 51.9%, electrocautery 34.6%, ultrasonic scalpel 8.4%, saline coupled radio frequency ablation (RFA) 3.17% and scalpel 1.8%. The visible pancreatic duct and/or parenchymawere oversewn in 73%. In 21.6%, pancreatic stump was treated with the RFA device. Clinically significant leak was seen in 3.4% of patients whose pancreas was transected with a stapler and oversewn versus 15.3% of patients in whose pancreas was stapled. Patients whose pancreas was transected using the scalpel or an energy device and treated with RFA had a 13.3% CSL rate. Pancreas transected using a stapler and the stump treated with RFA had a 19.2% CSL rate, whereas oversewing a pancreatic margin that had been treated with the RFA device had a 28.6% clinically significant leak rate. A patient with transected margin treated with oversewn relative to a patient whose pancreas transected with stapler and oversewn was at highest risk for CSL [p = ,0.001, OR 11.5 (CI 3.1 42.4)]. In univariate models, the use of the RFA device and oversewing of the pancreatic duct were predictors of a CSL (p ,0.05). On evaluating various modes of transection, there was interaction of RFA with oversewing and stapling with oversewing of the pancreatic stump (p ,0.001)]. Conclusion: Among various methods available for pancreatic transection during DP, many of them recent technologies, none have a clinical superiority. Using the stapler to transect the pancreas has a higher rate of clinically significant leak as compared to treating the transected stump with RFA. Using the RFA device in addition to a stapler or oversewing the transected margin has a higher rate of clinically significant leak and should not be attempted. Randomized trials of newer technologies to help solve this age old dilemma are necessary.