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AHPBA 2019 Annual Meeting | Eposter Abstracts Friday, March 22, 2019 & Saturday, March 23, 2019

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AHPBA 2019 Annual Meeting | Eposter Abstracts Friday, March 22, 2019 & Saturday, March 23, 2019 AHPBA 2019 Annual Meeting | ePoster Abstracts Friday, March 22, 2019 & Saturday, March 23, 2019 | ePoster Display Only, Kiosk #4 P 73. TRAVEL DISTANCE IS ASSOCIATED WITH IMPROVED SURVIVAL IN HEPATOCELLULAR CARCINOMA C Hester, N Rich, M Augustine, J Mansour, M Porembka, S Wang, H Zeh III, A Singal, A Yopp Presenter: Caitlin Hester MD | University of Texas Southwestern Medical Center Background: An association between travel distance and survival measures has been been demonstrated across gastrointestinal malignancies but thus far has not been examined in patients newly diagnosed with hepatocellular carcinoma (HCC). We aimed to determine the association of travel distance with time to treatment (TTT) and overall survival (OS) in patients newly diagnosed with HCC. Methods: Newly diagnosed HCC patients who received treatment were identified in the Texas Cancer Registry from 2004 to 2015. We compared system- and patient-level factors among patients who traveled short (<12.5 miles), intermediate (12.5-49.9 miles), and long (≥50 miles) travel distances for initial treatment. Anova and Chi-square analyses were used to compare clinicopathologic variables, and Kaplan-Meier with log rank and cox regression models were used to compare survival. Results: 4,329 patients were identified: 2,136 (49.3%) short, 1,380 (31.9%) intermediate, and 813 (18.9%) long distance patients. Patients who traveled intermediate and long distances were more likely to be Non- Hispanic White (59% for intermediate and 60% for long vs 33% for short, p<0.001) and a higher proportion of privately insured patients (29% for intermediate and 24% for long vs 16% for short,p<0.001). Short distance patients were more often Hispanic White (43% vs 24% for intermediate and 31% for long) or Non-Hispanic Black (18% vs 8% for intermediate and long,p<0.001). Long distance travelers were more often initially treated at ACS accredited hospitals (95% vs 73% for short and 89% for intermediate, p<0.001), non-safety net hospitals (53% vs 40% for short and 52% for intermediate,p<0.001), academic centers (80% vs 57% for short and 73% for intermediate,p<0.001), and high volume hospitals (85% vs 63% for short and 78% for intermediate,p<0.001). Long distance travelers had smaller tumors, more localized disease, and were more likely to undergo ablation. Patients who traveled short distances were more likely to undergo surgical resection or transplantation. Long distance travelers had the shortest median TTT (4 weeks vs 5 weeks for short and intermediate,p=0.003). Non-Hispanic Black and Hispanic White races were independently associated with decreased odds of intermediate (OR 0.27, 95%CI 0.2-0.4, and OR 0.40, 95%CI 0.3-0.5) and long (0.27, 95%CI 0.2-0.4, and OR 0.58, 95%CI 0.5-0.7) driving distance compared to short distance. Intermediate distance was associated with the highest median OS of 32 months vs 31 (long) and 22 months (short) (p<0.001). Intermediate distance was independently associated with improved OS (HR 0.89, 95%CI 0.81-0.98) compared to short, but long distance was associated with similar survival. Conclusion: Racial/ethnic minority patients have decreased odds of traveling longer distances for HCC care. Intermediate travel distance (12.5-49.9 miles) is associated with decreased TTT and improved OS compared to other travel distances. AHPBA 2019 Annual Meeting | ePoster Abstracts Friday, March 22, 2019 & Saturday, March 23, 2019 | ePoster Display Only, Kiosk #4 AHPBA 2019 Annual Meeting | ePoster Abstracts Friday, March 22, 2019 & Saturday, March 23, 2019 | ePoster Display Only, Kiosk #4 P 74. VALUE OF ROUTINE DOPPLER ULTRASOUND SCREENING FOR HEPATIC ARTERY THROMBOSIS AFTER LIVER TRANSPLANTATION LK Winer, AR Cortez, TC Lee, MC Morris, A Kassam, F Paterno, TS Diwan, MC Cuffy, RC Quillin III, SA Shah Presenter: Leah Winer MD | University of Cincinnati Background: Hepatic artery thrombosis (HAT) is the most common arterial complication after orthotopic liver transplantation (OLT) and can lead to graft failure and death. Protocoled Doppler ultrasound screening (DUS) is an inexpensive and noninvasive method to detect HAT, but definitive guidelines regarding the optimal timing and frequency of DUS are lacking. The objective of this study was to evaluate a high-volume center’s experience with routine postoperative ultrasound in the detection and management of HAT after OLT. Methods: This is a retrospective review of a prospectively maintained database of patients who underwent deceased donor OLT between January 2013 and June 2018 at a single center. Our institutional protocol was to perform DUS on postoperative days (POD) 1 and 5 unless clinical suspicion or provider preference warranted additional evaluations. HAT was defined as the absence of blood flow in the main, right, and/or left hepatic arteries. Patients were stratified into HAT and non-HAT groups, and donor and recipient demographics, perioperative variables, and outcomes were compared with chi-square and Wilcoxon rank-sum tests. Descriptive statistics were reported as medians and interquartile ranges (IQR), and p-values <0.05 were considered statistically significant. Results: During the study period, 485 OLTs were performed on 470 patients with a median follow-up of 26.0 months (11.6-42.9 months). The rate of HAT was 2.7% (n=13). HAT was associated with higher MELD, older donor age, and the use of aortoiliac jump grafts (all p 0.05). All patients received their first DUS on POD 1 according to protocol, but HAT patients had their second DUS significantly earlier than non-HAT patients (POD 2 vs POD 5, p 0.05). Conclusion: HAT is a devastating complication after OLT and necessitates swift diagnosis to prevent graft loss and death. Routine DUS on POD 1 and 5 was associated with reliable and early detection of HAT, which allowed for prompt surgical intervention and attempt at graft salvage usually without the need for retransplantation. AHPBA 2019 Annual Meeting | ePoster Abstracts Friday, March 22, 2019 & Saturday, March 23, 2019 | ePoster Display Only, Kiosk #4 P 75. HEPATECTOMY FOR MALIGNANCY IN THE AGED POPULATION: A COMPARATIVE STUDY F Gryspeerdt, F Vandenbroucke-Menu, R Lapointe, S Turcotte, M Dagenais, M Plasse, R Letourneau, A Roy Presenter: Filip Gryspeerdt MD | Centre Hospitalier de l'Université de Montréal Background: Worldwide, there is an increase in life expectancy. With increasing age, comorbidities rise and physical reserves decline. The population of patients older than 70 year diagnosed with cancer are expected to rise substantially. Advanced age is sometimes considered as a contra-indication for surgery. However, chronological age does not always correlate with physiologic age and a large proportion of this patients will benefit from surgery. By analysing our experience in a comparative study, we want to justify major surgery in the elderly population. Methods: All records from a prospectively collected database were retrospectively analysed. Benign pathology was excluded. Patients aged 70y or older (OP) at the time of liver surgery for malignancy were compared to patients between 18 and 65y (YP). The primary endpoints for this study were defined as postoperative 90D-morbidity and 90D-mortality. Morbidity was reported according to the modified Clavien- Dindo classification of surgical complications and the Comprehensive Complication Index [CCI]. Major complications were reported as Clavien-Dindo III or greater. The most frequently affected organ system and specific complications were analysed in each group. Results: From 2010 until 2016, 385 patients were identified matching our criteria. Of these patients, 155 in the OP group were compared to 230 patients in the YP group. There were significantly more major hepatectomies in the OP group (58,7% VS 45,2%; p=0,009). The 90-day mortality for the OP group was 3.2% (n=5) VS 1.3% (n=3) for the YP group (p=0.195). Major complications (Dindo-Clavien III and IV) were not significantly more frequent in the OP group (16.1% VS 11.5%; p=0.199). In the OP group, there were significantly more patients who suffered from one or more complications (54.2% VS 39.7%; p=0.006) resulting in a mean CCI-score of 16.62 VS 10.16 (p 75y showed a not significant increase in major complications (respectively 17.6% and 18.2%), but CCI scores (17.97 and 17.428 respectively) remained significantly higher in the elderly compared to younger group. Conclusion: Age should not be a contra-indication for liver surgery for malignancy. When well selected, hepatectomy and even major hepatectomy are safe in the aged population. Nevertheless, elderly patients are more prone to having one or more complications and to having more infectious complications compared to the younger population. AHPBA 2019 Annual Meeting | ePoster Abstracts Friday, March 22, 2019 & Saturday, March 23, 2019 | ePoster Display Only, Kiosk #4 AHPBA 2019 Annual Meeting | ePoster Abstracts Friday, March 22, 2019 & Saturday, March 23, 2019 | ePoster Display Only, Kiosk #4 P 76. RE-APPRAISAL OF THE BLUMGART STAGING SYSTEM FOR HILAR CHOLANGIOCARCINOMA A Crown, K Skorohodova, NR Conti, AA Alseidi, TR Biehl, WS Helton, FG Rocha Presenter: Angelena Crown MD | Virginia Mason Medical Center Background: Hilar cholangiocarcinoma is one of the most challenging malignancies to treat given its aggressive nature, propensity for local involvement and distant spread precluding resection for cure. In 1998, the Blumgart staging system was proposed in order to predict resectability, metastases and survival based on preoperative imaging factors. This system has been confirmed in an expanded series. We sought to validate its utility in an external patient cohort. Methods: Consecutive patients referred for the management of hilar cholangiocarcinoma at our institution between 2004-2017 were included in the study. Those with adequate preoperative cross-sectional imaging had their images independently re-reviewed by an independent body radiologist blinded to clinical outcome.
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