The GAME score is a preoperative prognostic tool that can be used to inform treatment selection.

Imaging-based TBS was superior to traditional tumor size and number and was comparable to pathology-based TBS. Imaging-based TBS may have the potential to facilitate improved preoperative risk stratification of patients with CRLM.

The present case series suggests that the incidence of concomitant KRAS/BRAF mutations in surgical cohorts may be higher than previously hypothesized, and associated with more variable survival outcomes than expected.

Patients with involved or sub-mm margins demonstrated a similar inferior OS vs. patients with a margin width > 1 mm. Consequently, a uniform definition of R1 as a margin width < 1 mm should perhaps be employed by future studies.

Background Pancreatic ductal adenocarcinoma (PDAC) often presents with nonspecific symptoms and the workup is not standardized. To study the impact of delays in diagnosis and in the initiation of treatment, we investigated the relationship between length of diagnostic intervals and surgical resectability. Methods We performed a retrospective chart review of patients evaluated for PDAC at Johns Hopkins in 2014. Data were collected on the patient (date of first symptoms—first medical appointment), diagnostic (first medical appointment—diagnosis of PDAC), and treatment (diagnosis of PDAC—1st day of treatment) time intervals, and the upfront treatment received. Asymptomatic patients diagnosed incidentally, or for whom records were incomplete, were excluded from analysis. Results Of 453 charts reviewed, 116 patients met inclusion criteria. The median patient interval was 14 days [interquartile range (IQR): 6–30 days], the median diagnostic interval was 22 days (IQR: 8–46 days), and the median treatment interval was 26 days (IQR: 15–35 days). Thirty-eight patients (33%) received upfront surgery and 78 (67%) received nonsurgical treatment. After adjusting for multiple factors, the odds of receiving surgery significantly increased for individuals with a patient interval of 30 days or less [adjusted odds ratio (aOR): 3.41; 95% confidence interval (CI): 1.08–13.20; P=0.050] and with a diagnostic interval of 60 days or less (aOR: 15.68; 95% CI: 2.95–291.00, P=0.009). Conclusions A patient interval less than 1 month and a diagnostic interval less than 2 months for symptomatic PDAC are associated with increased odds of upfront surgical resection. These data provide initial evidence that reducing diagnostic delays may lead to improved outcomes in PDAC.

with the open approach. This study aims to assess the rate and predictors of conversion and its effect on perioperative outcomes. METHODS: We used the pancreas-targeted NSQIP dataset between 2014 and 2015 to identify patients who underwent MIDP (robotic/laparoscopic) and converted cases. We compared patients' characteristics, perioperative parameters and outcomes in the MIDP and conversion groups. Multivariate analysis (MVA) was used to determine the predictors of conversion and its association with postoperative outcomes. RESULTS: We identified 1,512 MIDP of which 92 (18.0%) were converted. On MVA, the predictors of conversion were BMI (odds ratio [OR]¼1.03; 95% CI: 1.01, 1.06), T3/T4 malignant disease (OR¼2.46; 95% CI: 1.55, 3.89), pancreatitis (OR¼2.83; 95% CI: 1.52, 5.27) compared to benign disease, albumin level (OR¼0.60; 95% CI: 0.43, 0.86). Robotic cases were associated with lower risk of conversion compared to laparoscopic (OR¼0.32; 95% CI: 0.19, 0.52). Unadjusted outcomes showed that converted cases had higher 30-day mortality compared to MIDP (2.2% vs 0.3%, p¼0.001), higher rates of major complications (48.5% vs 29.0%, p<0.001), organ space SSI (14.3% vs 6.7%, p<0.001), bleeding requiring transfusion (20.3% vs 3.0%, p<0.001), sepsis/septic shock (8.2% vs 4.8%, p¼0.035) and delayed gastric emptying (7.6% vs 2.2%, p<0.001). There was no difference in the rate of pancreatic fistula. On MVA, conversion was associated with major complications (OR¼2.03; 95% CI: 1.46, 2.83) and delayed gastric emptying (OR¼2.59; 95% CI: 1.22, 5.52). CONCLUSIONS: Conversion is associated with higher morbidity and mortality than completed MIPD. Understanding the risks and predictors of conversion may improve patient counseling, selection and outcomes.

e15738 Background: PDAC often presents with nonspecific symptoms and the workup for suspected PDAC is not standardized. While surgery remains the only curative therapy, only 20% of PDAC is resectable due to local extension or metastasis. We examined the relationship between diagnostic interval of PDAC and surgical resectability. Methods: We performed a retrospective chart review of patients evaluated for PDAC at the Center for Pancreas Cancer at Johns Hopkins in 2014. Data were collected on the patient, diagnostic, and treatment time intervals (defined as days between first symptoms to medical presentation, presentation to diagnosis, and diagnosis to treatment), diagnostic tests performed, and the type of initial treatment. Asymptomatic patients diagnosed incidentally, or those for whom initial medical presentation was unclear, were excluded from our analysis. Results: Of 453 charts reviewed, 116 patients met our inclusion criteria. The median patient interval was 14 days (IQR 6-30), the median diagnostic interval was 22 days (IQR 8-46), and the median treatment interval was 26 days (IQR 15-35). The median number of diagnostic tests performed was 8 (IQR 6-11). At the time of diagnosis, 7 patients (6%) had stage 1, 53 (46%) had stage 2, 24 (21%) had stage 3, and 32 (28%) had stage 4 disease. A total of 38 patients (33%) received upfront surgery for treatment of PDAC and 78 (67%) received nonsurgical treatment. Non-white individuals had lower odds of receiving surgery (Adjusted Odds Ratio [aOR]: 0.09, 95% Confidence Interval [CI]: 0.01, 0.74, p = 0.024). After adjusting for age, sex, race and diagnostic clinic, the odds of receiving surgery significantly increased for individuals with a patient interval of 1 month or less (aOR: 3.47, 95% CI: 1.003, 12.0, p = 0.010) and with a diagnostic interval of 2 months or less (aOR: 15.3, 95% CI: 1.90, 122, p = 0.019). Conclusions: A patient interval of less than 1 month and a diagnostic interval less than 2 months for symptomatic PDAC were associated with an increased probability of upfront surgical treatment. These data indicate that extended intervals prior to PDAC diagnosis may reduce the odds of obtaining a potentially curative treatment.

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