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Value of Preoperative biliary drainage on postoperative outcome after pancreaticoduodenectomy: a case-control study
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Electronic Poster Abstracts
EP02D-116 IMPACT OF OBESITY ON THE OUTCOME OF PANCREATODUODENECTOMY W. Askar and A. El Nakeeb Mansoura University, Gastroenterology Surgical Center, Egypt Background: Obesity has been implicated as a risk factor for perioperative and postoperative complications. The impact of obesity on the outcome of pancreatoduodenectomy (PD) is still controversial. The aim of this study was to determine the impact of obesity on morbidity and mortality in patients undergoing pancreaticoduodenectomy (PD). Patients and method: Between January 2000 and July 2015. Patients were categorized into two groups; Group A (patients with BMI <25) and Group B (patients with BMI >25).Complications were graded according to previously published scales. Other data included length of postoperative hospital stay, blood loss, and operative duration. Results: Only 112/471 patients (25.9%) had BMI >25. The median intraoperative blood loss was more in overweight patients (P = 0.06). The median surgical time in group B was significantly longer than that in group A (P = 0.003). The overall incidence of complications was higher in the overweight group (P = 0.001). The severity of complications was also higher in the overweight group (P = 0.0001). Postoperative pancreatic fistula (POPF) (P = 0.0001) and hospital mortality (P = 0.001) were significantly higher in overweight patients. Oral intake was significantly delayed in overweight patients in comparison to normal weight group (P = 0.02). Postoperative stay was significantly longer in overweight patients (P = 0.0001). Conclusion: PD is associated with an increased risk of postoperative morbidity in overweight patient. Overweight patients must not be precluded from undergoing PD. However, operative techniques and pharmacological prophylaxis to decrease POPF should be considered in overweight patients.
EP02D-117 VALUE OF PREOPERATIVE BILIARY DRAINAGE ON POSTOPERATIVE OUTCOME AFTER PANCREATICODUODENECTOMY: A CASE-CONTROL STUDY A. Abdelrafee and A. El Nakeeb Mansoura University, Gastroenterology Surgical Center, Egypt Introduction: The potential benefit of the preoperative biliary drainage (PBD) on postoperative outcomes remains controversial. The aim of this study was to elucidate surgical outcomes of pancreatoduodenectomy (PD) in patients with PBD and to show the impact of preoperative bilirubin level. Method: We retrospectively studied all patients who underwent PD in our center between January 2000 and June 2014. Group A (patients with PBD) and Group B (patients with non-PBD). The primary outcome was the rate of postoperative complications and their severity. Results: A total number of 588 cases underwent PD. Group A included 314 (53.4%) patients while group B included 274 (46.6%) patients. The overall incidence of complications and its severity were higher in PBD group (P = 0.03 and 0.02).
There was significant difference in the incidence of postoperative pancreatic fistula (P = 0.002), delayed gastric emptying (P = 0.005), biliary leakage (P = 0.04), abdominal collection (P = 0.04) and wound infection (P = 0.04) in PBD group. The mean length of hospital stay was significantly longer in PBD group than in non PBD group (12.86 7.65 days vs 11.05 7.98 days, P = 0.01). No significant impact of preoperative bilirubin level on surgical outcome. Conclusions: PBD before PD was associated with major postoperative complications and stent related complications.
EP02D-118 THE INFLUENCE OF CHANGES IN BODY COMPOSITION FOLLOWING NEOADJUVANT TREATMENT ON OUTCOME AFTER PANCREATICODUODENECTOMY FOR PANCREATIC CANCER M. Takahashi, Y. Kyoden, H. Kanemotoh, N. Oba, M. Watanabe, K. Ohata and M. Takagi Surgery, Shizuoka General Hospital, Japan Introduction: Recently, several reported the usefulness of neoadjuvant treatment for pancreatic cancer. However, preoperative intensive therapy may lead to exacerbation of general condition. The aim of this study was to evaluate the changes in body composition following neoadjuvant treatment after pancreaticoduodenectomy (PD) for pancreatic cancer, and their association with the surgical and survival outcome. Methods: Between 2005 and 2013, consecutive 35 patients (21 men) who underwent neoadjuvant chemotherapy with radiation (NAC-R), followed by PD for pancreatic cancer were enrolled. Median age was 67 years (range, 45e84). Gemcitabin based chemotherapy was performed in 25 patients at 300 mg/m2/week 4. S-1 based in 10 patients at 60 mg/ m2 28 days. Radiation was performed 30 Gy in each patient. Before and after NAC-R, subcutaneous fat area (SFA), visceral fat area (VFA), and Skeletal muscle area (SMA) were measured by the computed tomography and calculated the amount of change. Median values of the amount of change were used to dichotomize each body composition. Results: The 5-year overall survival (OS) and recurrence free survival (RFS) were 20.5% and 14.8%, respectively. Changes (%) in SFA, VFA, and SMA were 20.6 ( 54.9e 171.1), -10.0 ( 51.1e90.8) and 2.7 ( 26.7e13.5), respectively. The SFA change greater than median showed a poor OS (5-year; 12.5% vs 28.1%: P = 0.0492) and RFS (5-year; 5.5% vs 24.2%: P = 0.0097), whereas both VFA and SMA changes were not. Conclusions: The reduction of SFA following NAC-R may indicate the poor prognosis after PD for pancreatic cancer.
EP02D-120 TAILORED PANCREATIC RECONSTRUCTION AFTER PANCREATICODUODENECTOMY: A SINGLE CENTER EXPERIENCE OF 853 CASES A. El Nakeeb Mansoura University, Gastroenterology Surgical Center, Egypt HPB 2016, 18 (S1), e385ee601
Electronic Poster Abstracts
EP02D-116 IMPACT OF OBESITY ON THE OUTCOME OF PANCREATODUODENECTOMY W. Askar and A. El Nakeeb Mansoura University, Gastroenterology Surgical Center, Egypt Background: Obesity has been implicated as a risk factor for perioperative and postoperative complications. The impact of obesity on the outcome of pancreatoduodenectomy (PD) is still controversial. The aim of this study was to determine the impact of obesity on morbidity and mortality in patients undergoing pancreaticoduodenectomy (PD). Patients and method: Between January 2000 and July 2015. Patients were categorized into two groups; Group A (patients with BMI <25) and Group B (patients with BMI >25).Complications were graded according to previously published scales. Other data included length of postoperative hospital stay, blood loss, and operative duration. Results: Only 112/471 patients (25.9%) had BMI >25. The median intraoperative blood loss was more in overweight patients (P = 0.06). The median surgical time in group B was significantly longer than that in group A (P = 0.003). The overall incidence of complications was higher in the overweight group (P = 0.001). The severity of complications was also higher in the overweight group (P = 0.0001). Postoperative pancreatic fistula (POPF) (P = 0.0001) and hospital mortality (P = 0.001) were significantly higher in overweight patients. Oral intake was significantly delayed in overweight patients in comparison to normal weight group (P = 0.02). Postoperative stay was significantly longer in overweight patients (P = 0.0001). Conclusion: PD is associated with an increased risk of postoperative morbidity in overweight patient. Overweight patients must not be precluded from undergoing PD. However, operative techniques and pharmacological prophylaxis to decrease POPF should be considered in overweight patients.
EP02D-117 VALUE OF PREOPERATIVE BILIARY DRAINAGE ON POSTOPERATIVE OUTCOME AFTER PANCREATICODUODENECTOMY: A CASE-CONTROL STUDY A. Abdelrafee and A. El Nakeeb Mansoura University, Gastroenterology Surgical Center, Egypt Introduction: The potential benefit of the preoperative biliary drainage (PBD) on postoperative outcomes remains controversial. The aim of this study was to elucidate surgical outcomes of pancreatoduodenectomy (PD) in patients with PBD and to show the impact of preoperative bilirubin level. Method: We retrospectively studied all patients who underwent PD in our center between January 2000 and June 2014. Group A (patients with PBD) and Group B (patients with non-PBD). The primary outcome was the rate of postoperative complications and their severity. Results: A total number of 588 cases underwent PD. Group A included 314 (53.4%) patients while group B included 274 (46.6%) patients. The overall incidence of complications and its severity were higher in PBD group (P = 0.03 and 0.02).
There was significant difference in the incidence of postoperative pancreatic fistula (P = 0.002), delayed gastric emptying (P = 0.005), biliary leakage (P = 0.04), abdominal collection (P = 0.04) and wound infection (P = 0.04) in PBD group. The mean length of hospital stay was significantly longer in PBD group than in non PBD group (12.86 7.65 days vs 11.05 7.98 days, P = 0.01). No significant impact of preoperative bilirubin level on surgical outcome. Conclusions: PBD before PD was associated with major postoperative complications and stent related complications.
EP02D-118 THE INFLUENCE OF CHANGES IN BODY COMPOSITION FOLLOWING NEOADJUVANT TREATMENT ON OUTCOME AFTER PANCREATICODUODENECTOMY FOR PANCREATIC CANCER M. Takahashi, Y. Kyoden, H. Kanemotoh, N. Oba, M. Watanabe, K. Ohata and M. Takagi Surgery, Shizuoka General Hospital, Japan Introduction: Recently, several reported the usefulness of neoadjuvant treatment for pancreatic cancer. However, preoperative intensive therapy may lead to exacerbation of general condition. The aim of this study was to evaluate the changes in body composition following neoadjuvant treatment after pancreaticoduodenectomy (PD) for pancreatic cancer, and their association with the surgical and survival outcome. Methods: Between 2005 and 2013, consecutive 35 patients (21 men) who underwent neoadjuvant chemotherapy with radiation (NAC-R), followed by PD for pancreatic cancer were enrolled. Median age was 67 years (range, 45e84). Gemcitabin based chemotherapy was performed in 25 patients at 300 mg/m2/week 4. S-1 based in 10 patients at 60 mg/ m2 28 days. Radiation was performed 30 Gy in each patient. Before and after NAC-R, subcutaneous fat area (SFA), visceral fat area (VFA), and Skeletal muscle area (SMA) were measured by the computed tomography and calculated the amount of change. Median values of the amount of change were used to dichotomize each body composition. Results: The 5-year overall survival (OS) and recurrence free survival (RFS) were 20.5% and 14.8%, respectively. Changes (%) in SFA, VFA, and SMA were 20.6 ( 54.9e 171.1), -10.0 ( 51.1e90.8) and 2.7 ( 26.7e13.5), respectively. The SFA change greater than median showed a poor OS (5-year; 12.5% vs 28.1%: P = 0.0492) and RFS (5-year; 5.5% vs 24.2%: P = 0.0097), whereas both VFA and SMA changes were not. Conclusions: The reduction of SFA following NAC-R may indicate the poor prognosis after PD for pancreatic cancer.
EP02D-120 TAILORED PANCREATIC RECONSTRUCTION AFTER PANCREATICODUODENECTOMY: A SINGLE CENTER EXPERIENCE OF 853 CASES A. El Nakeeb Mansoura University, Gastroenterology Surgical Center, Egypt HPB 2016, 18 (S1), e385ee601