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Abstracts of Papers Submitted to the IASGO World Congress, HBP Surg Meeting, November 15-17, 2017, Lyon, France

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Abstracts of Papers Submitted to the IASGO World Congress, HBP Surg Meeting, November 15-17, 2017, Lyon, France ABSTRACTS Abstracts of Papers Submitted to the IASGO World Congress, HBP SurG Meeting, November 15-17, 2017, Lyon, France ORAL PRESENTATIONS (O) O-001 O-004 SURGICAL ANATOMY IN PANCREATIC HEAD RESECTION SURGERY FOR ADVANCED PDAC A. Horiguchi, M. Ito. Y. Asano, S. Arakawa, M. Shimura, T. Ochi, Thilo Hackert C. Hayashi, H. Yasuoka, T. Kawai, Department of Gastroenterological Surgery, Fujita Health O-005 University School of Medicine. Nagoya, 454-8509, Japan In recent years there has an increase in the indications for CONVERSION SURGERY FOR INITIALLY UNRESECTABLE LOCALLY pancreatic resection of benign or low-grade malignant lesions, ADVANCED PANCREATIC CANCER FOLLOWING especially in young patients with long life expectancy. We present MULTIDISCIPLINARY TREATMENT about vascular anatomy of the pancreas when performing Tsutomu Fujii, S. Yamada, H. Takami, I. Yoshioka, K. Shibuya, pancreatic head resection. When DPPHR (duodenum preserving H. Baba, T. Okumura, Y. Kodera pancreatic head resection) applies to patients with benign or low- University of Toyama, Toyama, 930-0194, Japan grade malignancy, it is important to remove completely the pancreatic head to avoid tumor remnant and pancreatic fistula, In the treatment of pancreatic cancer, the most innovative recent because the majority of the patients with these tumors have the change is the introduction of FOLFIRINOX and nab-paclitaxel as an normal pancreatic exocrine gland, and variation of the branch duct of effective protocol. By multidisciplinary treatment using them, there the head of the pancreas. On the other hand, if complete resection of are increasing cases in which resection is possible in pancreatic the head of the pancreas is performed, there is danger of ischemia cancer which was un-resectable at the time of initial diagnosis. In and perforation of the bile duct or duodenum. During resection of the Japan, this is called “Conversion Surgery”, implying strategy-conver- head of the pancreas, therefore, it is absolutely essential to maintain sion. There is no clear evidence on the validity and usefulness of the blood supply to the bile duct and the duodenum in order to this option; however, good prognosis has been reported little by prevent early postoperative complication. DPPHR is technically little. I will review previous reports of conversion surgery for initially difficult and time-consuming due to reconcile these antinomic unresectable locally advanced pancreatic cancer following multi- techniques, namely, complete resection in the pancreatic head and disciplinary treatment and state the experience and results of our preservation of both the bile duct and the pancreaticoduodenal institution. vessels. The posterior superior duodenal artery crosses the distal bile duct anteriorly and descend along the right border of the bile O-006 duct and crosses again posteriorly at the level of the papilla. The posterior superior pancreaticoduodenal vein has to be preserved to EFFECTIVENESS OF MULTIMODALITY TREATMENT FOR PANCRE- avoid the congestion of the duodenum. For patients, it would ATIC CANCER be beneficial for their QOL if PD could be avoided. Oncologic radi- cality and organ preserving operation is important. DPPHR is just M. Sho, M. Nagai, T. Akahori, S. Nishiwada, K. Nakagawa, enough operation. K. Nakamura, N. Ikeda, T. Tanaka, H. Nishiofuku, T. Tamamoto, M. Hasegawa, K. Kichikawa. Nara Medical University, Nara, 634-8522, Japan O-002 Objectives: The aim of this study was to retrospectively evaluate the impact of neoadjuvant chemoradiotherapy (NACRT) on peri- TECHNICAL CHALLENGES IN PANCREATIC SURGERY operative and long-term clinical outcome in pancreatic cancer (PC). Doris Henne-Bruns Methods: One hundred sixty patients who preoperatively received full-dose gemcitabine (1000 mg/m2) with concurrent radiation of 54 Gy between 2006 and 2016 were analyzed. One hundred thirty O-003 patients who underwent upfront surgery were served as control. Results: Among the 160 patients treated with NACRT, 153 patients WHEN TO PERFORM A PANCREATICODUODENECTOMY IN (96%) completed the protocol treatment. The reasons of failure to THE ABSENCE OF A POSITIVE HISTOLOGY FOR PANCREATIC complete NACRT were drug-induced pneumonia, acute mucosal CANCER injury, severe cholangitis and poor performance status (PS). Furthermore 21 (13%) couldn’t undergo pancreatic resection after Helmut Freiss NACRT because of distant metastasis in 9 patients, tumor progres- sion in 7 and poor PS in 5. The rate of pancreatic fistula was lower and hospital stay was shorter in the NACRT group compared to the Surgery, Gastroenterology and Oncology, 22 (3), 2017 139 ABSTRACTS control group (P=0.033, P=0.002). Furthermore, the rate of lymph O-008 node metastasis, R0 resection and pathological stage were favorable in the NACRT group (P <0.0001, P=0.006, P<0.0001). The MANAGEMENT OF POSTOPERATIVE COMPLICATIONS AFTER completion rate of adjuvant chemotherapy was also higher in the PANCREATODUODENECTOMY NACRT group (P=0.015). Importantly, patients treated with NACRT Zerbi Alessandro had a better prognosis than those without (median survival time: 60.2 vs. 28.5M, P=0.008). In addition, according to tumor O-013 resectability status, patients were classified as R (resectable), BR-P (borderline resectable with venous involvement) and BR-A (border- IMPACT OF SLEEVE GASTRECTOMY AND GASTRIC BYPASS ON line resectable with arterial involvement) groups. As a result, OBESITY COMORBIDITIES IN COMPARISON TO CONSERVATIVE patients treated with NACRT had a better prognosis than those THERAPY AFTER 5 YEARS. without in the R and BR-P groups (58.6 vs. 34.2M, P=0.013, 62.4 vs. 18.8M, P=0.015), while NACRT had no significant impact on N.A. Gad El Hak, Stefan Post, M.A. El Refai. prognosis in the BR-A group. Conclusions: Neoadjuvant chemoradiotherapy may have a variety Objectives: Obesity represents nowadays a global. Obesity is not of favorable impact in pancreatic cancer treatment. Furthermore, only a burden per se, but is also tightly connected to large number NACRT may improve the prognosis especially in resectable and of diseases e.g. diabetes mellitus type 2, hypertension, and borderline resectable pancreatic cancer with venous involvement. dyslipidemia. This clinical study was planned to examine the impact of bariatric surgery procedures (LRYGB and LSG) on obesity related comorbidities in comparison to conventional medical O-007 therapy of morbidly obese patients after 5 years. Methods: Patients were recruited from the outpatient clinic for NEOADJUVANT TREATMENT AND AGGRESSIVE SURGICAL obesity care. 30 operated patients were matched and compared to RESECTION FOR BR AND UR PANCREATIC CANCER. IS R0 30 patients in the conventional group who received medical RESECTION THE KEY FOR BETTER PROGNOSIS? therapy of obesity. Measured outcomes were weight loss, changes in retinal Arteriovenous ratio (AVR), diabetes, dyslipidemia, quality H. Yoshitomi, K. Furukawa, T. Takayashiki, S.Kuboki, S. Takano, of life D. Suzuki, N. Sakai, S. Kagawa, H. Nojima, T. Mishima, Results: %EWL and % TWL were 59.7% and 29.4% after bariatric M. Miyazaki, M. Ohtsuka. surgery versus 3.3 % and 0.5% respectively among medical patients Department of General Surgery, Chiba University, Graduate (P<0.001). Bariatric surgery resulted in improvement of patients’ School of Medicine, Chiba, 260-8670, Japan. lipid profile. Total plasma cholesterol dropped by –37.2 mg/dl after Backgrounds: The optimal treatment for borderline resectable surgery versus only -4.2 mg/dl in conventional therapy group pancreatic cancer (BR) is still controversial. (P<0.001).Triglycerides and LDL dropped postoperatively by -48.8 Aim: To estimate the roles of neoadjuvant treatment and surgical mg/dl and -37.9 mg/dl respectively. Baseline fasting blood sugar resection for pancreatic head BR with arterial involvement (BR-A) decreased significantly from 106.1 mg/dl to 92.1 mg/dl after by retrospective analysis of patients who underwent surgical resec- surgery. After mean of 5 years, 66.2% of our operated patients with tion and pursuit the optimal treatment. DM at baseline examination were in remission at follow up versus Methods: Medical records of 105 patients with BR located in 25% in control group. Our results show that bariatric surgery pancreatic head who underwent surgical resection between 2002- resulted in an amelioration of endothelial function. AVR increased 2014 in Chiba University Hospital were analysed retrospectively. significantly in interventional patients (+0.03, P= 0.05).In control BR-PV and -A were defined according to 7th JPS classification. group, AVR deteriorated and decreased with time by (-0.03) Results: Patients characteristics; M/F: 68/37, Median age: 65 y.o. (35- reflecting metabolic aggravation of endothelial dysfunction. 82), BR-A/-PV: 44/61, Operation methods PD/TP: 102/3. Thirty Conclusion: Bariatric surgery is more effective than conventional patients were treated with neoadjuvant therapy (NAT) (GEM+S-1 medical therapy of obesity in terms of sustained weight loss, (n=21), GEM (n=2), GEM or S-1+radiation (n=5), radiation (n=2)). The improved dyslipidemia and remission of diabetes mellitus. median duration between initiation of NAT and surgery was 2.6m .Beneficial metabolic impact of bariatric surgery on obesity related (range: 1.0-36.1m). Patients treated with NAT survived significantly comorbidities can be witnessed on long term follow up after 5 longer in BR-A (MST: NAT+/- (n=22/22): 51.5/15.2m p=0.0002), but not years. in BR-PV (MST: NAT +/- (n=8/53): 20.5/22.9m). There were no statisti- cal differences in OS between patients with R0 and R1 resection in both BR-A and BR-PV. In contrast, R2 resection resulted in poor prog- O-014 nosis in both groups (MST of R0/1/2; BR-A (n=21/14/9): 28.2/22.7/6.7m, BR-PV (n=41/16/4): 26.8/22.9/4.6m). In BR-A patients, SLEEVE GASTRECTOMY FOR MORBID OBESITY IN there was no statistical difference in local recurrence rate between R0 A WESTERN AFRICAN COUNTRY. FIRST STEPS IN SENEGAL and R1 resection.
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