Middle-segment preserving subtotal pancreatectomy for treating multifocal lesions in pancreas

s / Pancreatology Introduction: Laparoscopic pancreaticoduodenectomy (LPDE) is an alternative to traditional surgery for patients with tumor of the head of pancreas and periampulary area. Aims: To show our experience in treatment of 46 patients with tumor of the head of the pancreas and periampullare area by using a total laparoscopic approach. Patients & methods: From January 2007 to January 2013 46 out of 54 patients underwent total laparoscopic pancreaticoduodenectomy (TLPDR) in our clinic. There were 29(63%) females and 17(37%) males, average age was 59,4(range, 45-76) years. In retrospective study we analyzed the main outcome measures: conversion rate, blood loss, operative time, length of hospital stay, postoperative morbidity and mortality. Results: For 8 patients procedure was palliative or converted because of the spread of the tumor infiltration at the mesenteric vessels or serious adhesive process in parapancreatic area. Median blood loss was 425 152,9 ml (range, 100-2100). The median operative time was 485 101,1min. Tumor localizations were: the head of pancreas(n-25), papilla(n-13); distal part of extrahepatic bile duct(n-4); duadenum(n-2) and chronic pancreatitis(n-2). The complication rate was 21(45,6%). CLAVEN-DINDOSTRASBERG classification: I, II(n-7); IIIA(n-7); IIIB(n-4);IV(n-1);V(n-2). R1(n-1). Conclusion: Laparoscopic resection for treating of the patients with cancer of biliopancreatoduodenal area is a feasible and effective procedure. After passing the initial learning curve (about 30 cases), laparoscopic approach permits tomake shorter an operative time, that comparablewith traditional approach with the same early postoperative results. Randomized controlled study are still necessary. PI-106 Abstract id: 92. Middle-segment preserving subtotal pancreatectomy for treating multifocal lesions in pancreas Zipeng Lu, Zhuyin Qian, Cuncai Dai, Kuirong Jiang, Junli Wu, Wentao Gao, Qiang Li, Feng Guo, Jianmin Chen, Jishu Wei, Yi Miao. The First Affiliated Hospital of Nanjing Medical University, China Introduction: Middle-segment preserving subtotal pancreatectomy (MPSTP) was regarded as a reasonable choice for treating multifocal body-sparing lesions of the pancreas in benign or low-grade malignant disease. Aims: To investigate the short-term outcomes, especially its effect on endocrine function of pancreas after this organ-preserving procedure. Patients & methods: From September 2011 to May 2012, five patients underwent MPSTP in our institution, a high-volume center in China. Perioperative data were retrospectively analyzed. Results: Patients were 3 women and 2 men, with a median age of 50 year-old (37-81 year-old). One patient had past history of diabetes. Preoperative CT examinations revealed multicentric lesions located in head and tail of the pancreas. Four patients underwent pylorus-preserving pancreaticoduodenectomy with distal pancreatectomy (DP), including two with spleen additionally reserved. The other patient underwent Beger’s procedure and spleen-preserving DP. Median operation time and estimated intraoperative blood loss were 330min (250600min) and 800mL (400-5500mL), respectively. Pathologic examination demonstrated three cases of metastatic lesions (renal clear cell carcinoma, dermatofibrosarcoma protuberans, and malignant pheochromocytoma) to the pancreas, one chronic pancreatitis and one neuroendocrine tumor. Postoperative complications included two cases of pancreatic fistula, three delayed gastric emptying, one abdominal fluid collection and one pleural effusion. Follow-up studies revealed deteriorated diabetic status in one patient, and the rest four kept wellcontrolled serum glucose level without any medication. No symptoms of hypoglycemia was identified. Conclusion: MPSTP is a safe and feasible procedure for benign or lowgrade malignant multifocal lesions in pancreas, while for most important, patients seem to have a more stable serum glucose level after surgery. PI-107 Abstract id: 267. The failure of pancreas function: How non-specific gastrointestinal symptoms can hide the metastatic involvement of pancreas in advanced malignancies. A case report Antonio Braucci, Antonello Niglio, Martino Trunfio, Carlo Molino. Cardarelli Hospital, Naples, Italy Introduction: Metastatic involvement of pancreas is uncommon and accounts for approximately 2% of pancreatic malignancies. Generally, metastatic blood dissemination from breast cancer causes frequent involvement of lung, bone, liver and brain. The detection of synchronous pancreatic metastases arising from a primitive breast carcinoma is infrequent. We present the case of a misdiagnosed secondary pancreatic involvement in advanced breast cancer. Aims: The aim of the study is to focus on the importance of imaging in order to obtain the right diagnosis and plan the best treatment in pancreatic malignancies. Patients & methods: A 68-years-old woman complaining general fatigue, lethargy, asthenia and jaundice presented with endocrine pancreas failure. Abdominal US showed an ampulloma of Vater’s papilla. After mammary US and FNAC, due to the increase in CA 15.3, a breast cancer in the left breast involving the ipsilateral axillary lymph stations was also diagnosed. She underwent surgery for both breast cancer and ampulloma of Vater’s papilla. Whipple’s procedure was performed during pancreatic time, while the breast time consisted in Patey’s mastectomy. Results: Pathological examination of pancreatic specimen did not confirm primary carcinoma of the duodenal papilla neither adenocarcinoma but showed a synchronous metastatic involvement of pancreas from a lobular breast cancer. Conclusion: This is one of the few reported cases in literature of an isolated pancreatic metastasis spread from breast cancer, in which the definitive diagnosis was obtained only after surgery. It is important to remember that nonspecific gastrointestinal symptoms in women in menopause can hide a secondary involvement of the gastrointestinal tract arising from the breast. PI-108 Abstract id: 261. A case of intraductal variant of acinar cell carcinoma Claudio Pasquali, Lucia Moletta, Anna Caterina Milanetto, Rita Alaggio, Cosimo Sperti, Sergio Pedrazzoli. University of Padua, Italy Introduction: Pancreatic intraductal neoplasms in the past few years had increasing importance, as the incidence of Intaductal Papillary Mucinous Neoplasms (IPMNs) have grown. Acinar cell carcinomas (ACCs) are typically solid tumors; however, a few cases of ACCs with intraductal growth pattern have been described. Aims: To report a case of an acinar cell carcinoma of the pancreatic head with a polipoid intraductal growth observed in our Unit. Patients & methods: A 42-year-old woman had recurrent epigastric pain, a mild increase of serum amylase and negative serum tumormarkers. US detected a hypoechoic area in the pancreatic head (diameter 1.5 cm), confirmed by CT scan, which also showed a dilated Wirsung duct. At 18FFDG-PET the mass had an increased tracer uptake (SUV max 7.5). In the suspicion of amalignant IPMN,we performed a pancreaticoduodenectomy. Results: Histology showed an acinar cell carcinoma of the pancreatic head with polypoid intraductal growth (T2 N0 M0). Immunohistochemistry: trypsin positive, mucin negative. The patient is still alive without disease 68 months after surgery and chemotherapy with Gemcitabine. Conclusion: A few cases of ACCs with intraductal growth pattern have been described in the literature and they can be easily mistaken for IPMNs. The behaviour of this variant is difficult to know; however, in the few cases reported, metastases at presentation are less common than typically seen in ACCs. 13 (2013) S2–S98 S49