Tu1618 Roux-en-Y Drainage of the Pancreatic Stump by Nonstented Duct-to-Mucosa Anastomosis Reduced the Amylase Level in the Drainage Fluid After Distal Pancreatectomy With En-bloc Celiac Axis Resection

Abstract

Background: Pancreatic cancer is one of the leading causes of cancer mortality. Surgery is the only chance of cure, but is inappropriate for patients with metastasis. Aim: To evaluate the frequency of liver metastasis on MRI in patients with resectable pancreatic cancer and normal liver on contrast enhanced MDCT. Methods: Between April 2012-13, all patients with resectable pancreatic cancer based on CT staging underwent MRI liver utilising hepatocyte specific contrast agent and diffusion weight imaging. Results: Forty five consecutive patients were examined. Thirty two were male and 13 were female. Median age was 64 years (range 31-76 years). MRI was performed at a median of 2 weeks from CT. Thirteen (29%) patients with normal liver on CT had findings consistent with liver metastases while 4 (9%) had indeterminate liver lesions on MRI. Three of the 4 patients with indeterminate liver lesions demonstrated progression on follow up imaging consistent with metastases. One of the 28 patients with a normal MRI liver underwent palliative bypass on discovering a 5mm subcapsular lesion at laparotomy. At a median follow up of 12 months, 3 of the remaining 27 patients with normal MRI had evidence of liver metastasis (7, 10 and13 months post MRI) while 4 had extrahepatic disease. Survival was significantly reduced in patients with liver metastasis on MRI (p=0.01). Conclusion: MRI identified liver metastases in 36% of patients with resectable pancreatic cancer on MDCT and should be included in the routine staging of these patients.