S30 Abstracts / Pancreatology 19 (2019) S1eS180
Results: Preoperative diagnosis was correct in 79 cases (98,2%). Pa-
tients were presented with abdominal pain (100%), weight loss(76%),
vomiting(30%) and jaundice(18%). CT,MRI, endoUS were the most useful
diagnostic modalities. Twelve patients with CDDW were treated conser-
vatively, 42 underwent pancreaticoduodenectomy(PD), pancreatico- and
cystoenterostomies (8), duodenum-preserving pancreatic head (DPPH)
resections(5) and PPD (15) without mortality. Full pain control was ach-
ieved after PPD in 93%, PD in 83%, and after DPPHR and draining proced-
ures in 18% of cases. New diabetes mellitus (5) and exocrine insufficiency
(5) developed after PD, and never registered after PPD. Weight gain was
significantly greater after PD and PPD comparing to other treatment
modalities.
Conclusion: PPD is the optimum method for treating the isolated form
of CDDW; Early detection of CDDW allows preserving the pancreas; Pure
form of GP is a disease of the duodenum and Whipple procedure is an
overtreatment for it.
P1-35.
Surgery in chronic pancreatitis e A single center experience from
Oslo
Anne Waage 1, Vemund Paulsen 2, Lars Aabakken 2, Knut Jørgen Labori 1,
Truls Hauge 3
1 plished in 7 and 4 cases, respectively. The median operating time was 9.43
Oslo University Hospital, Department of HPB surgery, Oslo, Norway
2 h. All but one patient were operated with tumour-negative resection
Oslo University Hospital, Department of Gastroenterology
Rikshospitalet, Oslo, Norway
3 was one case of in-hospital mortality but no further 30- or 90-day mor-
Oslo University Hospital, Department of Gastroenterology Ullevål,
Oslo, Norway
Background and Objectives: Despite numerous publications reporting
the benefits of surgery in chronic pancreatitis (CP), these patients have
been given limited attention among Norwegian surgeons, and CP patients
have until recently only occasionally been offered surgical treatment. In
2016, we established a monthly CP multidisciplinary team (MDT) meeting
in order to focus on CP with mandatory attendance by both surgeons,
gastroenterologists/endoscopists and radiologists. In the MDT meetings,
patients are being selected for a surgical, endoscopic or conservative
approach.
Materials and Methods: The surgical procedures are based on the CT/
MR findings. Partington-Rochelle procedure/gastrojeunostomy is selected
when there is a need for an isolated decompression of the pancreatic duct.
Frey procedure is the gold standard for combined decompression/resec-
tion procedures. Pancreatoduodenectomy or distal pancreatic resection is
performed when the pathology is located in the head or tail. In the cases of
recurrent acute pancreatitis, hereditary CP or general CP with affection of
the whole gland, total pancreatectomy is considered. All patients are
prospectively registered and followed at the surgical outpatient clinic,
focusing on the outcome of surgery on the pain syndrome and Quality of
Life (QoL).
Results: From January 2016 to February 2018, 169 CP patients were
discussed at the MDT meeting. Surgery was performed in 31 patients (11
Frey, 6 distal pancreatic resections, 6 total pancreatectomies (4 combined
with autolog islet transplantation), 5 pancreatoduodenectomies (one
converted from prior Bern procedure) and 3 Partington Rochelle/gastro-
jejunostomy). One patient was re-operated due to bleeding from the
gastroduodenal artery. Percutaneous drainage of an intraabdominal abcess
was performed in 2 patients. Median hospital stay was 11 days (range 3-
35). One patient died 20 months after surgery due to non-pancreatic
related illness. None were lost to follow-up. Median follow-up was 16
months. Overall 28 0f 31 (90%) showed benefits from surgery. 17 of 31
patients reported no pain on follow-up. Of the remaining 14 patients, 11
reported less pain with significant reduction in morphine equivalents and
improved QoL.
Conclusion: The results concerning surgery in our cohort are prom-
ising regarding the effects on pain syndrome and QoL in CP. There is a need
for MDT discussion in CP patients. Our findings suggest that more CP pa-
tients probably need to be evaluated for surgery.
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P1-36.
Results of portosystemic shunts during extended pancreatic
resections
Florian Oehme, Marius Distler, Benjamin Müssle, Christoph Kahlert,
Jürgen Weitz, Thilo Welsch
€t Dresden, Visceral, Thoracic and Vascular
Technische Universita
Surgery, Dresden, Germany
Background and Objectives: Patients with borderline resectable
pancreatic cancer are increasingly explored after neoadjuvant treatment
protocols. A complete resection then frequently includes the resection of
the mesentericoportal axis. Portosystemic shunting for advanced tumours
with infiltration of the splenic vein or cavernous transformation of the
portal vein can enable complete tumour resection and prevent portove-
nous congestion of the intestine. The aim of this study was to report the
results of this technique for selected patients.
Materials and Methods: Patients operated for pancreatic cancer at
our department between September 2012 and December 2017 using
intraoperative portosystemic shunting were included in this retro-
spective analysis. Kaplan-Meier analysis was used for survival
estimation.
Results: Some 11 patients with pancreatectomy and simultaneous
portosystemic shunting were included. The median age was 65.1 years. A
distal splenorenal shunt and a temporary mesocaval shunt were accom-
margins; 5 patients had relevant complicated postoperative courses. There
tality or graft-associated complications. Five patients were alive after a
median follow-up of 24.6 months. The median postoperative survival was
12 months.
Conclusion: Portosystemic shunting at the time of extended pancre-
atectomy is technically challenging but feasible and enables complete
tumour resection in cases in which standard vascular reconstruction is
limited by cavernous transformation or sinistral portal hypertension with
acceptable morbidity in selected cases.
P1-37.
Safety and feasibility of enhanced recovery after surgery in patients
undergoing pancreas resection and surgery drainage procedures
for pancreatic cystic lesions
Andrey Koshel 1, 2, Evgeny Drozdov 2, 3, Sergey Klokov 2, 4, Tatyana Dibina 4
1
City Clinical Hospital N
3 of B.I. Alperovich, Tomsk, Russian
Federation
2
Siberian State Medical University, Tomsk, Russian Federation
3
Tomsk Regional Oncology Hospital, Surgery, Tomsk, Russian
Federation
4
Medical Centre G.K Zherlov, Seversk, Russian Federation
Background and Objectives: Enhanced recovery after surgery (ERAS)
programs aim to hasten functional recovery and improve postoperative
outcomes. However, there is a paucity of data on ERAS programs in
pancreatic surgery. This study assessed whether ERAS program for
pancreatic surgery in patients with pancreatic cystic lesions is safe and
feasible.
Materials and Methods: A retrospective analysis of 270 consecutive
patients with pancreatic cystic lesions who underwent pancreas resection
and drainage procedures between 2007 and 2018 was carried out. Among
these patients, 99 were men and 171 were women, with a mean age of 54.5
years (range, 21e79). They include non-neoplastic cysts e pseudocysts
(n¼188), and neoplastic cysts (n¼82). Regarding tumor types, 34 patients
had SCN, 14 had pancreatic IPMN, and 34 had MCN. While 62 cysts were
identified as benign, 20 were malignant. 163 patients received conven-
tional perioperative management (the conventional group (CG), they were