340 Background: Locally advanced disease requiring pancreaticoduodenectomy (PD) with venous reconstruction is a controversial topic that is often determined by careful patient selection. There are numerous published single institution, but sparse multicenter studies, demonstrating the safety and efficacy of PD with venous reconstruction. The goal of this study is to evaluate survival outcomes in patients who underwent a PD with our without venous reconstruction utilizing a large statewide database. Methods: The California Cancer Registry (CCR) was used to obtain data on all PD performed from 2000-2011. This data was merged with Office of Statewide Planning and Development data to obtain inpatient hospitalization data. ICD-09 codes were used to identify all PD with or without venous reconstruction. Data was obtained on demographics, disease process, surgery, hospitalization statistics, and survival. Venous reconstruction was divided into venous segmental resection with reconstruction (VSR) and primary repair of the vein with a patch (PR). Survival was analyzed using Kaplan-Meier Survival analysis (KM). Results: Data were obtained on 5,228 patients who underwent PD, 3.7% (161) underwent venous reconstruction (148; 2.8% VSR and 43; 0.8% PR). A significant overall survival difference between PD and all vascular reconstruction was observed (23 months vs 17 months respectively, p < 0.001). Further analysis revealed no significant difference in survival between standard PD and PD with PR (median 21 months; p = 0.2). However, there was a significant survival advantage of PD compared to PD with VSR (21 vs 16 months respectively, p < 0.001). Evaluation of length of stay and complications revealed no statistical difference (p = 0.07 and p = 0.8). Conclusions: Venous reconstruction in PD is associated with worse survival compared to PD alone. Interestingly, patients who had a PR had a better survival than VSR alone. Overall survival for all comers of vascular reconstruction remains inferior which reinforces the biology of disease as an important predictor of outcomes as well as shorter segment portal vein involvement conferring improved survival.
418 Background: Frailty has been associated with adverse postoperative outcomes. However, little is known about its correlation with survival in resected pancreatic cancer. This study examined the correlation of frailty with postoperative outcomes and survival after pancreatectomy for cancer. Methods: Data from National Surgical Quality Improvement Program (NSQIP) patients (n = 7400) who underwent pancreatectomy between 2011 to 2013. A modified frailty index (mFI) validated for use in NSQIP was used to examine correlations between frailty and postoperative outcomes. California Cancer Registry (CCR) data for patients (n = 4959) who underwent pancreatectomy for cancer between 2000 to 2012 was used to assess the association between the Charlson Comorbidity Index (CCI), as a surrogate for frailty, and overall survival. Results: The distribution of NSQIP patients according to the mFI was 0, 1, 2, 3, 4 in 2797 (37.8%), 3422 (46.2), 1074 (14.5), 104 (1.4) and 3 (0.04) respectively. The patients were divided to non frail (mFI = 0), mildly frail (mFI = 1-2), or severely frail (mFI3 ≥ 3). Overall, 8.7% of patients experienced a grade 4 Clavien complication and 3.1% experienced postoperative mortality. Worsening frailty correlated with an increase in grade 4 Clavien complications (non-frail: 6.3% vs. mildly frail: 9.7% vs. severely frail: 26.2%; p < 0.001) and mortality (1.9% vs. 3.8% vs. 4.7% respectively; p < 0.001). The majority of CCR patients had similarly few comorbidities: CCI: 0, 1, ≥ 2 in 3869 (77.8%), 861 (17.31%) and 243 (4.89%) respectively. Median survival decreased as CCI increased (for CCI 0, 1 and ≥ 2 was 23 vs. 19 vs. 15 months respectively; p < 0.001). Conclusions: Frailty is a powerful correlate of postoperative outcome and survival for resected pancreatic cancer patients and is an important consideration in planning for surgical intervention.
Objective: Management of post-pancreatitis peripancreatic fluid collections depends on the size, location, and contents of the collection as well as any associated symptoms. The amount of time elapsed after acute pancreatitis is also considered in international consensus guidelines. With increased surgeon experience in minimally invasive approaches, many techniques for laparoscopic treatment of these collections have been described. Advances in endoscopic modalities also allows many perigastric and periduodenal collections to be treated endoscopically. Rates of recurrence, repeat intervention, and procedural morbidity are considered in reviews comparing open, laparoscopic, and endoscopic approaches. We present a case of walledoff pancreatic necrosis (WOPN) treated with robotic cystgastrostomy and pancreatic debridement. Methods: A robotic cystgastrostomy was performed in a patient who developed WOPN after acute biliary pancreatisis. Key features differentiating this procedure from laparoscopic transgastric approaches include the size of the anterior gastrotomy, the use of hand-sewn technique to mature the cystgastrostomy, and no routine use of stapling devices. Results: The patient was discharged on postoperative day 4. Her follow-up imaging demonstrated resolution of the WOPN. Conclusion: Use of the surgical robot confers many benefits of minimally invasive surgery to the treatment of postacute pancreatic fluid collections while utilizing technical features of the procedure described in the open approach. Longitudinal analysis is needed to determine if the robotic approach affects surgical outcomes, rate of fluid collection resolution, or occurrence of complications. V12LAPAROSCOPIC CENTRAL PANCREATECTOMY WITH ROUX-EN-Y PANCREATOJEJUNOSTOMY Objective: Central pancreatectomy is an alternative technique for benign or low-grade malignant tumors of the neck of the pancreas. The objective is to present a video of a laparoscopic central pancreatectomy Methods: A 48-year-old woman with a 2.5 cm incidental cystic tumor in the neck of the pancreas is referred. Pancreas is transected with an endoscopic linear stapler on the right side of the tumor followed by transection of the distal pancreas. After completion of pancreatic resection, Roux-en-Y jejunal loop is prepared. An end-to-side pancreatojejunostomy is then performed in a double layer technique duct-to-mucosa. Results: Operative time was 4 hours with minimum blood loss. Patients was discharged on the 4th postoperative day.Patient developed a type A pancreatic fistula that was treated by late removal of the drain. Pathology confirmed a mucinous cystadenoma with no malignant transformation. Patient did not develop exocrine or endocrine pancreatic insufficiency on late follow-up. Conclusion: Totally laparoscopic central pancreatectomy is feasible and it is a useful technique for removal of tumors located in the neck of the pancreas. Objective: Radical antegrade modular pancreatosplenectomy, originally proposed by Strasberg, has been accepted as a standard operation fo...
Objective: Experience with hepatic arterial infusion pump (HAIP) for colorectal cancer liver metastases (CRCLM) comes from few specialized centers. Little is known about its use in a large, population based cancer registry level. Methods: We contacted a case-only analysis of California Cancer Registry (CCR) data (2000e2012) to detect patients who underwent HAI pump (HAIP) for CRCLM.
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