P-176 Epidemiology and clinical outcomes of patients with pancreatic tumors discussed in tumor board

Abstract

21 (34.4%) patients were found to be surgically inoperable either due to metastasis or local unresectability after laparotomy. If CECT was considered as a sole diagnostic modality, 27 (40.3%) patients would have been surgically inoperable. Among those patients who were deemed operable by PET-CT, DL detected inoperability in 9 patients (14.7%) (peritoneal 8, omental 6, and liver 3). Laparotomy was performed in the DL-wise operable patients (N¼52) and 12 (23.08%) patients were found to be inoperable due to local invasion. Hence the FNR of CECT, PET-CT, and DL in detecting the inoperability was 40.3%,34.4%, and 23.1%, respectively. Out of the 27 patients who were surgically inoperable, DL detected inoperability and futile laparotomies were avoided in 9 patients. The actual rate would have further increased to 15/ 27(55.5%) if the PET-CT detected metastasis (6 patients) were subjected to DL. On univariate analysis, size of the GB mass in CECT significantly correlated with PET-CT detected inoperability (p value ¼ 0.006; Odds ratio 1.64; CI 1.09 to 2.47). The sensitivity, specificity, PPV and NPV of CECT and PET-CT in detecting the lymph node involvement in operable GBC patients were 14.3%, 82.2%, 11.1%, 86% and 57.1%, 79.1%, 30.8%, 86.1%, respectively. Conclusion:Diagnostic laparoscopy obviated futile laparotomies by more than half (55.5%) of unresectable patients and 22.38% in overall patients. Hence DL should be performed in all the operable GBC patients before surgery. PET-CT can be selectively done in patients with larger GB masses in CECT (>1cm). Though PET-CT is more sensitive compared to CECT, both are not an accurate modality in detecting the lymph node involvement in the case of GBC.