Pancreatic Fistula In Patients Research Articles

A radiomics-based formula for the preoperative prediction of postoperative pancreatic fistula in patients with pancreaticoduodenectomy.

ObjectiveThe objective of the study was to develop and validate a radiomics-based formula for the preoperative prediction of postoperative pancreatic fistula (POPF) in patients undergoing pancreaticoduodenectomy (PD).Materials and methodsA total of 117 consecutive patients who underwent PD were enrolled in this retrospective study. Radiomics features were extracted from portal venous phase computed tomography of the above patients. The least absolute shrinkage and selection operator logistic regression was used to construct a formula of Rad-score calculation. Then the performance of the formula was assessed with standard pancreatic Fistula Risk Score.ResultsThe Rad-score could predict POPF with an area under the curve (AUC) of 0.8248 in the training cohort and of 0.7609 in the validation cohort. Patients who had experienced POPF generally had a statistically higher Rad-score than those who had not experienced POPF in both cohorts. The AUC of the Rad-score was statistically higher than the Fistula Risk Score for predicting POPF in both the training and validation cohort.ConclusionA novel radiomics-based formula was developed and validated for predicting POPF in patients who underwent PD, which provides a new method for identifying POPF risks and may help to improve informed decision-making in the prevention of POPF at low cost.

Retrospective analysis of risk factors for occurrence of pancreatic fistula in patients following pancreaticoduodenectomy

Pancreaticoduodenectomy still is a “gold standard” in treatment of hepatopancreaticobiliary tumors. The causes of pancreatic fistula were analyzed in 414 patients aged from 22 to 81 following pancreaticoduodenectomy due to periampullary tumors. The said patients were operated on during the period from 2008 to 2017. The aim of this study is to improve outcomes of pancreatic resection based on a retrospective analysis of the causes of postoperative pancreatic fistulae and the development of a range of measures to prevent the above complication. Influence of risk factors of pancreatic fistula formation was evaluated by Pirson’s method (χ2). The factors contributing to the occurrence of pancreatic fistulas included type of resection (Whipple pancreaticoduodenectomy, pylorus preserving pancreaticoduodenectomy; χ2=8.616,1, p=0.0033, p<0.01), kind of pathology (cancer of the pancreatic head; χ2=7.658,1, p=0.0057, p<0.01), type of pancreaticojejunostomy (invaginative pancreatic duct-jejunostomy; χ2=17.83,1, p=0.0001, p<0.001) and technique for drainage of the major pancreatic duct (pancreaticojejunostomy on external drainage; χ2=16.40,1, p=0.0001, p<0.001). The detailed study of risk factors for the occurrence of pancreatic fistula is essential for improving the prognosis, prophylaxis and treatment of this pathology. The quality of the surgical intervention and the course of the postoperative period in patients with periampullary tumors depend on the choice of resection type, techniques for surgical interventions on the pancreas.

Impact of neoadjuvant therapy on postoperative outcomes after pancreaticoduodenectomy.

Surgical resection provides the only potentially curative treatment of pancreatic cancer. Neoadjuvant chemotherapy and/or radiation (NAT) is used to downstage patients with borderline resectable tumors. The objective of this study was to examine the postoperative morbidity and mortality of NAT after pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDA). Using the American College of Surgeons-National Surgical Quality Improvement Project Targeted Pancreatectomy data, we identified patients who underwent a PD for PDA from 2014 to 2015. Patients were grouped by receipt of NAT 90 days before PD. Bivariable and multivariable analyses was used to compare postoperative outcomes. A total of 3748 patients with PDA underwent PD; 926 (24.7%) received NAT. Those in the NAT group had more major vein resections, and longer operating times (all P < 0.001). On pathologic staging, those in the NAT group had smaller tumors (T1, 10.9% vs 5.1%; P < 0.001) and fewer nodes positive (N0, 49% vs 28%; P < 0.001). There were no differences in 30-day postoperative mortality or overall complications. On multivariable analysis, patients who received NAT had a lower likelihood of pancreatic fistula (OR, 0.67; P < 0.001). NAT does not increase the overall postoperative morbidity or mortality of PD for PDA. There is a decreased likelihood of pancreatic fistulas in patients that receive neoadjuvant therapy.

Influence of preoperative cholangitis after biliary drainage on postoperative pancreatic fistula in patients who undergo pancreaticoduodenectomy

Influence of preoperative cholangitis after biliary drainage on postoperative pancreatic fistula in patients who undergo pancreaticoduodenectomy

Influence of cholangitis after preoperative endoscopic biliary drainage on postoperative pancreatic fistula in patients with middle and lower malignant biliary strictures

Preoperative cholangitis after preoperative drainage has been reported to increase postoperative complications, particularly pancreatic fistula. We therefore examined the effects of cholangitis after preoperative endoscopic biliary drainage (EBD) on postoperative pancreatic fistula in patients with middle and lower malignant biliary strictures. The study group comprised 102 patients who underwent EBD among patients who underwent surgery. Of the 102 patients, 33 (32%) had postoperative pancreatic fistulas, and 56 (55%) had preoperative cholangitis after preoperative drainage. Analysis of risk factors for preoperative cholangitis showed that a total bilirubin level of 2.9 mg/dL or higher (hazard ratio [HR], 2.95; 95% confidence interval [CI], 1.223-7.130; P = 0.016) and a surgical waiting time of 29 days or longer (HR, 4.23; 95% CI, 1.681-10.637; P = 0.02) were independent risk factors for cholangitis. Patients with preoperative cholangitis had a significantly higher incidence of pancreatic fistula than did patients without preoperative cholangitis (78.8 vs 21.2%; P = 0.001). Patients with biliary cancer had a significantly higher incidence of pancreatic fistula than did those with pancreatic cancer (72.7 vs 27.2%; P = 0.005). Multivariate analysis showed that preoperative cholangitis (HR, 4.8; 95% CI, 1.785-12.992; P = 0.001) and biliary cancer (HR, 3.5; 95% CI, 1.335-8.942; P = 0.006) were significant independent risk factors for postoperative pancreatic fistula. Prevention of preoperative cholangitis, a risk factor for postoperative pancreatic fistula, is likely to decrease the incidence of postoperative pancreatic fistula.

Amylase concentration in drainage fluid as a predictive factor for severe postoperative pancreatic fistula in patients with gastric cancer.

Postoperative pancreatic fistula (PPF) sometimes occurs after gastrectomy. We examined the risk factors for severe PPF and evaluated the predictive value of amylase concentration in drainage fluid. We retrospectively reviewed 591 patients who underwent curative gastrectomy for gastric cancer. A multivariate analysis was conducted to identify the risk factors for severe PPF. Receiver operating characteristic curves were used to identify the appropriate amylase cut-off value to predict severe PPF. Severe PPF occurred in 23 (3.9%) cases. The multivariate analysis indicated that splenectomy (P = 0.009) was the only significant risk factor. The area under the curve of amylase in drainage fluid for predicting severe PPF on postoperative day (POD) 3 was much greater than that on POD 1 (0.972 vs. 0.894). When the cut-off values for amylase were determined to be 2900U/L on POD 1 and 2100U/L on POD 3, the risk ratio for severe PPF on POD 3 was higher than that on POD 1 (99.2 vs. 30.2). Splenectomy was an independent risk factor for severe PPF. An amylase level of 2100U/L on POD 3 may be a reliable cut-off value for the early diagnosis of patients at high risk of severe PPF.

Risk factors of postoperative pancreatic fistula in patients after distal pancreatectomy: a systematic review and meta-analysis

Postoperative pancreatic fistula (POPF) is a common complication following distal pancreatectomy (DP). However, the risk factors of this complication in patients after DP still remain controversial. The aim of our study is to estimate the association between potential risk factors and POPF. Relevant articles published up to June 21, 2016 were identified via PubMed, EMBASE, Web of Science, and The Cochrane Library. Studies that examined the risk factors of POPF following DP were enrolled. 20 articles (2070 patients) were finally included in this study. The pooled data suggested that patients with soft pancreas, higher Body Mass Index (BMI), blood transfusion, elevated intraoperative blood loss, and longer operative time had a decreased risk for POPF. However, age, gender, malignant pathology, types of stump closure, octreotide therapy, history of diabetes and chronic pancreatitis, splenectomy, multiorgan resection, main duct ligation, preoperative serum albumin levels, PGA felt wrapping, and extended lymphadenectomy could not be regarded as risk factors for POPF. Our analytic data demonstrated that pancreas texture, BMI, blood transfusion, intraoperative blood loss, and operative time were clinical predictor for POPF. This study may assist surgeons to screen patients with high risk of POPF and select appropriate treatment measures.

Clinical significance of circumportal pancreas, a rare congenital anomaly, in pancreatectomy

BackgroundCircumportal pancreas is a rare congenital pancreatic anomaly. The aim of this study was to clarify the clinical characteristics of patients with circumportal pancreases undergoing pancreatectomy. MethodsThe medical records of 508 patients who underwent pancreatectomy were retrospectively reviewed. The prevalence of circumportal pancreas and related anatomical variations were assessed. Surgical procedures and postoperative outcomes were compared in patients with and without circumportal pancreas. ResultsCircumportal pancreas was observed in 9 of the 508 patients (1.7%). In all nine patients, the portal vein was completely encircled by the pancreatic parenchyma above the level of the splenoportal junction, and the main pancreatic duct ran dorsal to the portal vein. The rate of variant hepatic artery did not differ significantly in patients with and without circumportal pancreas. Pancreatic fistula developed more frequently in patients with than without circumportal pancreas (44% vs. 14%, p = 0.03), but other clinical parameters did not differ significantly in these two groups. ConclusionsDespite being rare, circumportal pancreas may increase the risk of postoperative pancreatic fistula in patients undergoing pancreatectomy. However, a prospective, large-cohort study is necessary to determine the real incidence of relevant anatomical variations and the definitive clinical significance of this rare anomaly.

Preoperative computed tomography scan to predict pancreatic fistula after distal pancreatectomy using gland and tumor characteristics

BackgroundPreoperative risk stratification for postoperative pancreatic fistula in patients undergoing distal pancreatectomy is needed. MethodsRisk factors for postoperative pancreatic fistula in 220 consecutive patients undergoing distal pancreatectomy at 2 major institutions were recorded retrospectively. Gland density was measured on noncontrast computed tomography scans (n = 101), and histologic scoring of fat infiltration and fibrosis was performed by a pathologist (n = 120). ResultsForty-two patients (21%) developed a clinically significant pancreatic fistula within 90 days of surgery. Fat infiltration was significantly associated with gland density (P = .0013), but density did not predict pancreatic fistula (P = .5). Recursive partitioning resulted in a decision tree that predicted fistula in this cohort with a misclassification rate less than 15% using gland fibrosis (histology), density (HU), margin thickness (cm), and pathologic diagnosis. ConclusionsThis multicenter study shows that no single perioperative factor reliably predicts postoperative pancreatic fistula after distal pancreatectomy. A decision tree was constructed for risk stratification.

Application of duct-to-mucosa continuous anastomosis in the pancreaticojejunostomy

Objective: Pancreaticojejunostomy is the most important anastomosis in Whipple operations, it's closely related to the pancreatic fistula. Present a variety of pancreatic enteric anastomosis methods have advantages and disadvantages, this study was to explore a method of pancreaticojejunostomy in pancreaticoduodenectomy. Methods: Clinical data from June 2013 to June 2015 of 165 pancreaticoduodenectomy resection patients were retrospectively analyzed, at the FourthHospital ofHebeiMedicalUniversity,HepatobiliarySurgery.Of the patients, 53 patients with Prolene line continuous duct-to-mucosa, and 112 patients with end-to-side of pancreatic anastomosis were used. Diagnostic criteria referenced the International pancreatic fistula Study Group (ISGPF) defined in 2005. Statistical analysis was performed with the c2 test. A probability value of less than 0.05 was considered statistically significant. Descriptionof operateprocess: Select themainpancreatic ductdiameterover 1.5mm patients. Briefly, upon completion of the PD, the pancreatic remnant was mobilized for 1e2 cm to allow adequate placement of the posterior outer-layer sutures.Find the main pancreatic duct, and suture the bleeding section. The posterior outer-layer anastomosis was performed by using continuous suture technique. Generally, double needle 4-0 prolene sutures were placed starting at the pancreatic remnant andwere continued through the seromuscular layer of the backwall of the jejunum.A 2mmdiameter hole was poked on the jejunum nearing the main pancreatic duct. Double needle 5-0 prolene line continuous suture the whole jejunal wall and the paries posterior of pancreatic duct. Select appropriate diameter internal plastic stent, the end of the stent was positioned within the pancreatic duct. Place the other end of the stent into the jejunum. Then the similar process was performedwith 5-0 prolene line continuous suturing the whole jejunal wall and the antetheca of pancreatic duct. Finally 4-0Prolene continuous suture the seromuscular layer of the jejunum and the anterior wall of pancreas. Results: The incidence of pancreatic fistulas in patients with prolene line continuous suture was 3.8%(2/53), and in those with end-to-side suture it was 15.2% (17/112) (P < 0.05). According to the international clinical grading system, grade A of POPF was found in 2 patients of the prolene line continuous suture group, and were successfully discharged under the conservative treatment. Conclusion: This method of duct-to-mucosa anastomosis with Prolene line continuous suturing is simple and time-saving with obviously reducing incidence of pancreatic fistula. It's continuous anastomosis of main pancreatic duct and the whole jejunum layer, exactly, not easy to occur pancreatic fistula, less affected by the pancreas texture. The Prolene thread and Needle as a whole, lines of smooth, less friction, is suitable for continuous anastomosis. This method of anastomosis is proved to be safe and efficient in preventing pancreatic fistula.

Three continuous suction drainages to avoid severe pancreatic fistula in patients with soft pancreas after pancreaticoduodenectomy

s / Pancreatology 14 (2014) S1eS129 S116 Conclusion: Pancreatoduodenectomywithportal vein resection and left renal grafting is a safe procedure without risk of renal failure. During CT a collateral flow through left ovarian veinwere observed. The left renal vein is an adequate vessel for grafting because of relatively easy access with a good chance to obtain a vessel of suitable length and vessel diameter.

The incidental diagnosis of intraductal papillary mucinous neoplasms (IPMNs) in patients with liver cirrhosis doubles that of controls

s / Pancreatology 15 (2015) S1eS141 S121 Aims:Wewent in order to clarify the effect of three continuous suction drainages to avoid severe pancreatic fistula in patients with soft pancreas after pancreaticoduodenectomy. Patients & methods: This is a retrospective review of 40 patients who underwent PD for periampullary cancer. The remnant pancreas showed a soft texture in all cases. Reconstruction was undertaken with Child procedure. And duct-tomucosa anastomosis (sub-total diversion) was used in pancreaticojejunostomy (PJ). PF was diagnosed according to the International Study Group for Pancreatic Fistula (ISGPF). All patients (n1⁄440) were divided into 2 groups. Group1 (n1⁄414) patients having drainage tubes behind the foramen of Winslow and dorsal space of PJ, Group2 (n1⁄426): patients having an additional tube in caudal space of left lobe of liver. We compared postoperative pancreatic fistula (POPF) severity, additional treatment and mortality between these groups. Results: There were no differences in the background of the two groups. 13 patients developed into PF. Incidence of grade B and C POPF in group1 and 2 was 50% and 11% respectively. Seven of 14 patients in group1 complicated pancreatic fistula and 4 patients required ultrasonic-guided percutaneous drainage. Notably, the all abscess site spread in caudal space of left lobe of liver. Although 8 patients in group2 developed into PF, they required only anti-biotic drug. Conclusion: Three adequate continuous drainages can prevent POPF after PD from developing into fatal complication.

Pancreaticojejunostomy with duct-to-mucosa is superior to total diversion in the incidence of over grade B pancreatic fistula in patients with soft pancreas

Pancreaticojejunostomy with duct-to-mucosa is superior to total diversion in the incidence of over grade B pancreatic fistula in patients with soft pancreas

The influence of transection site on the development of pancreatic fistula in patients undergoing distal pancreatectomy: A review of 294 consecutive cases

Pancreatic fistula (PF) is a significant cause of morbidity in patients undergoing distal pancreatectomy (DP), with an incidence of 15-40%. It remains unclear if the location of pancreatic transection affects the rate of PF occurrence. This study examines the correlation between the transection site of the pancreas during DP and the incidence of PF. All cases of DP from October 2005 to January 2012 were reviewed retrospectively from an institutional review board-approved database at the Thomas Jefferson University Hospital. Patient demographics and perioperative outcomes were analyzed. The pancreatic transection location was determined by review of operative reports, and then dichotomized into 2 groups: neck/body or tail. PF were graded following the International Study Group on Pancreatic Fistula guidelines. During the study period, 294 DP were performed with 244 pancreas transections at the neck/body and 50 at the tail. Of the 294 patients, 52 (17.7%) developed a postoperative PF. The incidence of PF after transection at the tail of the pancreas was higher (28%) when compared with transection at the neck/body (15.6%; P = .04). When stratified by PF grade, grade A PF occurred more commonly when transection of the gland was at the tail (22% tail vs 8.2% neck/body; P = .007); however, no difference was found for grade B/C PF (6% tail vs 7.4% neck/body; P = 1). Our data suggest that PF occurs more often when the tail is transected during DP, although the majority are low grade and of minimal clinical significance. More severe PF occurred equally between the transection sites.

Three continuous suction drainages to avoid severe pancreatic fistula in patients with soft pancreas after pancreaticoduodenectomy

Three continuous suction drainages to avoid severe pancreatic fistula in patients with soft pancreas after pancreaticoduodenectomy

Evidence-based value of prophylactic intraperitoneal drainage following pancreatic resection: A meta-analysis

Background and objectiveProphylactic intraperitoneal drainage is usually indwelled after abdominal operation. This study assessed whether prophylactic intraperitoneal drainage was of value after pancreatic resection. MethodsA systematic literature search was performed to identify relevant articles. Data aggregation and analysis were performed using RevMan 5.0 software package. ResultsA randomized controlled trial and seven observational cohort studies including a total of 2690 patients were eligible. The overall and major complication rates and the occurrence of pancreatic fistula in patients with drainage were higher than those without drainage. Prophylactic intraperitoneal drainage was not associated with a statistically significant reduction in the need for percutaneous drainage, reoperation and readmission, or with an increase in mortality. ConclusionThe present meta-analysis demonstrated that prophylactic intraperitoneal drainage after pancreatic resection appears to be unable to improve the postoperative course, and may be associated with more severe and higher rate of complication and increased pancreatic fistula occurrence. There is a serious bias in the criteria to insert drain or not in these retrospective studies. Therefore these results should be confirmed by randomized controlled trial.

Tumor Recurrence Is Independent of Pancreatic Fistula in Patients after Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma

Recurrence of pancreatic adenocarcinoma after pancreaticoduodenectomy (PD) can be increased in patients with pancreatic fistula (PF). The purpose of our study was to determine if a relationship exists between PF and tumor recurrence (both peritoneal and local) in patients after PD for pancreatic ductal adenocarcinoma. A single-institution, retrospective analysis of 221 patients who underwent PD from January 2001 to December 2009 was conducted. Electronic charts and medical records were queried for tumor characteristics, recurrence, and complications. Presence and grading of PF was determined using the criteria of the International Study Group on Pancreatic Fistula. Data were analyzed using chi-square and Kaplan-Meier survival statistics. There were 114 male and 107 female patients. Mean age was 66 years (range 35 to 91 years). The vast majority (84%) of patients had stage II disease; 143 (65%) had positive lymph nodes (median 2 positive nodes; range 1 to 17 positive nodes). Pancreatic fistula developed in 23 patients (grade A, n = 9; grade B, n = 13; grade C, n = 1; 10.2%). Peritoneal recurrence was noted in 20 patients (9%). Of the 23 patients with PF, peritoneal recurrence developed in 3 (13%). Of the 198 patients without PF, peritoneal recurrence developed in 17 (10%). Local recurrence occurred in 47 patients (21%), 5 (2%) in patients with PF and 42 (21%) in those without PF (p = NS). In Kaplan-Meier survival analysis, there was no significant difference in recurrence-free survival (p = 0.4) and overall survival (p = 0.3) for those with PF vs those without PF. Patients with PF after PD were not found to have a significant increase in local or peritoneal recurrence. Therefore, in this analysis, postoperative PF does not appear to serve as an adverse prognostic marker.

Pancreaticojejunostomy with duct-to-mucosa improves the incidence of over grade B pancreatic fistula in patients with soft pancreas compared with total diversion

Pancreaticojejunostomy with duct-to-mucosa improves the incidence of over grade B pancreatic fistula in patients with soft pancreas compared with total diversion

Laparoscopic enucleation of benign and borderline pancreatic neoplasms

s / Pancreatology 13 (2013) S2–S98 S52 Patients & methods: Radiology data were compared with the findings from 51 standard, 58 extended and 17 total pancreaticoduodenectomies; 9 distal resections with CA excision; and 28 palliations for PC. The survival of 11 patients with controversial CT and EUS data with regard to arterial invasion, after R0/R1 procedures (false-positive CT results, Group A), was compared to survival after eight R2 resections (false-negative CT results, Group B) and after 12 bypass procedures for locally advanced cancer (truepositive CT results, Group C) Results: In all of the cases in group A, operative exploration revealed no arterial invasion, as predicted by CT. The one-year survival in Group A was 88.9%, and the two-year survival was 26.7%, with a median follow-up of 22 months. One-year survival was not attained in groups B and C, with a significant difference in survival (Pa-b 1⁄4 0.0029, Pb-c 1⁄4 0.003). Conclusion: In all of the cases in group A, operative exploration revealed no arterial invasion, as predicted by CT. The one-year survival in Group A was 88.9%, and the two-year survival was 26.7%, with a median follow-up of 22 months. One-year survival was not attained in groups B and C, with a significant difference in survival (Pa-b 1⁄4 0.0029, Pb-c 1⁄4 0.003). PI-117 Abstract id: 299. Laparoscopic enucleation of benign and borderline pancreatic neoplasms Giuseppe Malleo, Giovanni Marchegiani, Despoina Daskalaki, Isacco Damoli, Claudio Bassi, Giovanni Butturini. Department of Surgery, University of Verona, Italy Introduction:Minimally invasive enucleation of pancreatic neoplasms is a very uncommon procedure. Aims: Here we describe the shortand long-term results of laparoscopic enucleations performed at our institution for benign to borderline lesions of the pancreas. Patients m median KPS 90 (range 80-100) received trabectedin. Prior therapy consisted of adjuvant gemcitabine (N1⁄43); adjuvant PEXG (cisplatin, epirubicin, capecitabine, gemcitabine; N1⁄42); PEXG (N1⁄419) or gemcitabine (N1⁄41) for mPA. Median prior PFS was 9 months; maximum response to prior chemotherapy in 20 mPA pts was PR in 14 (70%) and SD in 6 (30%). Only 1 pt completed all the planned 9 cycles; 23 interrupted trabectedin due to PD, and 1 due to toxicity. Only 2 pts (8%) were PFS-6. Median PFS was 1.9 months (range 0.7-7.4). Median OSwas 4.7 months (range 1.1-13.9) and 1-yr OS was 24%. No PR and 6 SD (24%) were observed. Grade 3-4 toxicity consisted of neutropenia (44%); fatigue (16%); anemia, thrombocytopenia and transaminitis (8% each); febrile neutropenia (4%). Conclusion: This study showed that trabectedin has a limited activity compared to other drugs used as salvage therapy in mPA. PI-119 Abstract id: 46. Pancreaticojejunostomy with duct-to-mucosa improves the incidence of over grade B pancreatic fistula in patients with soft pancreas compared with total diversion Satoshi Mizutani , Hideyuki Suzuki , Takayuki Aimoto , Seiji Yamagishi , Akira Muraki , Arichika Hoshino , Masanori Yoshino , Masanori Watanabe , Eiji Uchida . 1 Institute of Gastroenterology, Nippon Medical School, Japan Department of Surgery, Nippon Medical School, Japan Introduction: Pancreatic fistula (PF) is the most critical complication after pancreaticoduodenectomy (PD). Although pancreaticojejunostomy with total diversion (PJ-TD) is technically easy, this reconstruction method often results in high incidence of PF. On the other hand, pancreaticojejunostomy with duct-to-mucosa anastomosis (PJ-DM) has been recently established as the standard procedure despite technical difficulty. Aims: The aim is to compare clinical outcomes after the procedure between cases receiving PJ-DM and PJ-TD, especially focusing on the incidence of PF. Patients & methods: Thirty two patients with periampular cancer underwent PD. Remnant pancreas in all cases showed soft texture. Patients were divided into two groups: receiving PJ-TD (n1⁄415) and PJ-DM (n1⁄417). We compared patient backgrounds, perioperative factors, and postoperative complications between both groups. PF was assessed according to the definition of PF by International Study Group of Pancreatic Fistula. Results: There were no differences in patient backgrounds and perioperative factors. The incidence rate of all grades PF was relatively high, 41% in the PJ-DM group and 67% in the PJ-TD group. However, PF with over grade B were detected in only 1 patient (6%) of the PJ-DM group while 6 patients (40%) of the PJ-TD showed grade B&C PF. There was no surgeryrelated death in both groups. Conclusion: The PJ-DM procedure seems to be superior to the PJ-TD method in terms of decrease in the incidence rate of PF.

A phase II trial of second-line therapy with trabectedin in metastatic pancreatic adenocarcinoma (mPA)

s / Pancreatology 13 (2013) S2–S98 S52 Patients & methods: Radiology data were compared with the findings from 51 standard, 58 extended and 17 total pancreaticoduodenectomies; 9 distal resections with CA excision; and 28 palliations for PC. The survival of 11 patients with controversial CT and EUS data with regard to arterial invasion, after R0/R1 procedures (false-positive CT results, Group A), was compared to survival after eight R2 resections (false-negative CT results, Group B) and after 12 bypass procedures for locally advanced cancer (truepositive CT results, Group C) Results: In all of the cases in group A, operative exploration revealed no arterial invasion, as predicted by CT. The one-year survival in Group A was 88.9%, and the two-year survival was 26.7%, with a median follow-up of 22 months. One-year survival was not attained in groups B and C, with a significant difference in survival (Pa-b 1⁄4 0.0029, Pb-c 1⁄4 0.003). Conclusion: In all of the cases in group A, operative exploration revealed no arterial invasion, as predicted by CT. The one-year survival in Group A was 88.9%, and the two-year survival was 26.7%, with a median follow-up of 22 months. One-year survival was not attained in groups B and C, with a significant difference in survival (Pa-b 1⁄4 0.0029, Pb-c 1⁄4 0.003). PI-117 Abstract id: 299. Laparoscopic enucleation of benign and borderline pancreatic neoplasms Giuseppe Malleo, Giovanni Marchegiani, Despoina Daskalaki, Isacco Damoli, Claudio Bassi, Giovanni Butturini. Department of Surgery, University of Verona, Italy Introduction:Minimally invasive enucleation of pancreatic neoplasms is a very uncommon procedure. Aims: Here we describe the shortand long-term results of laparoscopic enucleations performed at our institution for benign to borderline lesions of the pancreas. Patients m median KPS 90 (range 80-100) received trabectedin. Prior therapy consisted of adjuvant gemcitabine (N1⁄43); adjuvant PEXG (cisplatin, epirubicin, capecitabine, gemcitabine; N1⁄42); PEXG (N1⁄419) or gemcitabine (N1⁄41) for mPA. Median prior PFS was 9 months; maximum response to prior chemotherapy in 20 mPA pts was PR in 14 (70%) and SD in 6 (30%). Only 1 pt completed all the planned 9 cycles; 23 interrupted trabectedin due to PD, and 1 due to toxicity. Only 2 pts (8%) were PFS-6. Median PFS was 1.9 months (range 0.7-7.4). Median OSwas 4.7 months (range 1.1-13.9) and 1-yr OS was 24%. No PR and 6 SD (24%) were observed. Grade 3-4 toxicity consisted of neutropenia (44%); fatigue (16%); anemia, thrombocytopenia and transaminitis (8% each); febrile neutropenia (4%). Conclusion: This study showed that trabectedin has a limited activity compared to other drugs used as salvage therapy in mPA. PI-119 Abstract id: 46. Pancreaticojejunostomy with duct-to-mucosa improves the incidence of over grade B pancreatic fistula in patients with soft pancreas compared with total diversion Satoshi Mizutani , Hideyuki Suzuki , Takayuki Aimoto , Seiji Yamagishi , Akira Muraki , Arichika Hoshino , Masanori Yoshino , Masanori Watanabe , Eiji Uchida . 1 Institute of Gastroenterology, Nippon Medical School, Japan Department of Surgery, Nippon Medical School, Japan Introduction: Pancreatic fistula (PF) is the most critical complication after pancreaticoduodenectomy (PD). Although pancreaticojejunostomy with total diversion (PJ-TD) is technically easy, this reconstruction method often results in high incidence of PF. On the other hand, pancreaticojejunostomy with duct-to-mucosa anastomosis (PJ-DM) has been recently established as the standard procedure despite technical difficulty. Aims: The aim is to compare clinical outcomes after the procedure between cases receiving PJ-DM and PJ-TD, especially focusing on the incidence of PF. Patients & methods: Thirty two patients with periampular cancer underwent PD. Remnant pancreas in all cases showed soft texture. Patients were divided into two groups: receiving PJ-TD (n1⁄415) and PJ-DM (n1⁄417). We compared patient backgrounds, perioperative factors, and postoperative complications between both groups. PF was assessed according to the definition of PF by International Study Group of Pancreatic Fistula. Results: There were no differences in patient backgrounds and perioperative factors. The incidence rate of all grades PF was relatively high, 41% in the PJ-DM group and 67% in the PJ-TD group. However, PF with over grade B were detected in only 1 patient (6%) of the PJ-DM group while 6 patients (40%) of the PJ-TD showed grade B&C PF. There was no surgeryrelated death in both groups. Conclusion: The PJ-DM procedure seems to be superior to the PJ-TD method in terms of decrease in the incidence rate of PF.