Hayato Sasaki

Elevated perioperative serum CA 19-9 levels are independent predictors of poor survival in patients with resectable cholangiocarcinoma.

Identification of prognostic markers is important to establish a perioperative therapeutic strategy for resectable cholangiocarcinoma (CC). The aim of this study was to investigate whether perioperative serum carbohydrate antigen 19‐9 (CA19‐9) levels can predict survival of patients who underwent surgical resection for CC.

Does preoperative biliary drainage compromise the long‐term survival of patients with pancreatic head carcinoma?

The aim of this study was to determine the impact of preoperative biliary drainage (PBD) on long‐term survival in patients with pancreatic head carcinoma after surgical resection.

Hepatobiliary and Pancreatic: Long-term survival of serous cystadenocarcinoma of the pancreas with synchronous liver metastases after aggressive surgical resection

Figure 2 The tumor consisted of numerous round or irregular microcysts. The cysts were lined by a single layer of bland cuboidal epithelial cells with clear cytoplasm (original magnification × 200) (a). Microscopic findings included vascular invasion (arrow) (original magnification × 200) (b). Figure 1 Abdominal computed tomography (CT) showed a 15 × 10 cm hypervascular mass located at the body and tail of the pancreas, giving a characteristic honeycomb appearance (arrows) (a). CT also showed liver metastasis located in Couinaud’s segment 5 (arrow) as well as segments 3 and 8 (b).

An Increased Number of Perineural Invasions Is Independently Associated With Poor Survival of Patients With Resectable Pancreatic Ductal Adenocarcinoma.

Objectives The aim of this study was to investigate the impact of the number of perineural invasions (PNIs) in resected specimens on the survival of patients with pancreatic ductal adenocarcinoma (PDAC). Methods A retrospective cohort study of 209 patients underwent surgical resection for PDAC between 1999 and 2013 was performed. The severity of PNI was evaluated by counting the number of PNIs in all sections with PDAC. The relationships of the number of PNIs with disease-free survival (DFS) and overall survival (OS) were analyzed. Results At least 1 PNI was observed in 197 (94%) of 209 patients. Significant differences in DFS and OS were found between groups when analyzed by the median number of PNIs (≥25 vs <25) (DFS: P < 0.0001; OS: P < 0.0001) and among tertiles greater than 40 versus 40 to 14 versus less than 14 (DFS: P < 0.0001, OS: P < 0.0001). By multivariate analysis, an increased number of PNIs (>40 vs 40–14 vs <14) was identified as an independent risk factor for poor DFS (P < 0.0001) and OS (P < 0.0001). Conclusions The severity of PNI evaluated by counting the number of PNIs in resected specimens was useful for predicting the prognosis of patients with resectable PDAC.

Long‐term survival of serous cystadenocarcinoma of the pancreas with synchronous liver metastases after aggressive surgical resection

Figure 2 The tumor consisted of numerous round or irregular microcysts. The cysts were lined by a single layer of bland cuboidal epithelial cells with clear cytoplasm (original magnification × 200) (a). Microscopic findings included vascular invasion (arrow) (original magnification × 200) (b). Figure 1 Abdominal computed tomography (CT) showed a 15 × 10 cm hypervascular mass located at the body and tail of the pancreas, giving a characteristic honeycomb appearance (arrows) (a). CT also showed liver metastasis located in Couinaud’s segment 5 (arrow) as well as segments 3 and 8 (b).

Postpancreatoduodenectomy Hemorrhage Treated by Combined Transcatheter Arterial Embolization and Superior Mesenteric Artery to Iliac Artery Bypass: Report of a Case

Postpancreatectomy hemorrhage is a potentially life-threatening complication. We report herein our experience with a 65-year-old man with locally advanced pancreatic adenocarcinoma who underwent pancreatoduodenectomy with lymphadenectomy following neoadjuvant chemoradiotherapy. On postoperative day 45, he developed massive hematemesis. Angiography revealed active bleeding from the common hepatic artery, and transcatheter coil embolization of that vessel was successfully performed. On postoperative day 64, he again developed massive hematemesis. Angiography revealed active bleeding from the proximal superior mesenteric artery. Immediately after coil embolization of that vessel, bypass grafting between the superior mesenteric artery and the right common iliac artery was performed, using a greater saphenous vein graft. The combination of embolization and bypass grafting is an option for treatment of bleeding from the superior mesenteric artery in an emergent situation.

Mo1658 Prognostic Impact of Para-Aortic Lymph Node Micrometastasis in Pancreatic Ductal Adenocarcinoma

Background The aim of the present study was to clarify the prognostic impact of para-aortic lymph node metastasis in pancreatic ductal adenocarcinoma.

Mo1574 Prognostic Impact of Human Equilibrative Nucleoside Transporter 1 and Ribonucleotid Reductase Submit 1 Expression in Cholangiocarcinoma Patients Treated With Adjuvant Gemcitabine-Based Chemotherapy

Background: The efficacy of AGC varies among individuals and the resulting survival rates are still unsatisfactory. Objective: The aim of this study was to investigate predictive value of intratumoral human equilibrative nucleoside transporter 1 (hENT1) and ribonucleotid reductase submit 1 (RRM1) expression for advanced cholangiocarcinoma patients treated with adjuvant gemcitabine-based chemotherapy (AGC) after surgical resection. Methods: Intratumoral hENT1 and RRM1 expression was investigated immunohistochemically in 127 patients with advanced cholangiocarcinoma who underwent surgical resection (including 68 with AGC, and 59 without AGC). Impact of hENT1 and RRM1 expression on diseasefree survival (DFS) and overall survival (OS) were evaluated by univariate and multivariate analyses. Results: High intratumoral hENT1 and RRM1 expression was observed in 86 (68%) and 67 (53%) patients, respectively. Univariate analysis of data from 68 patients with AGC revealed that high hENT1 and low RRM1 expression were significantly associated with longer DFS (hENT1, P = 0.005; RRM1, P = 0.015) and longer OS (hENT1, P = 0.036; RRM1, P = 0.035). In multivariate analysis, moderately or poorly differentiation, (P = 0.007), low hENT1expression (P = 0.044) and high RRM1 expression (P = 0.009) were identified as independent risk factors for poor DFS, and moderately or poorly differentiation, (P = 0.045), lymph node metastasis, (P = 0.011) and high RRM1 expression (P = 0.009) were identified as independent risk factors for poor OS. In contrast, hENT1 and RRM1 expression did not correlate with DFS and OS in 58 patients without AGC. Conclusions: Intratumoral hENT1 and RRM1 expression predicts survival of advanced cholangiocarcinoma patients treated with AGC.

Su1826 Increased Number of Perineural Invasion Is Independently Associated With Poor Survival of Patients With Resectable Pancreatic Cancer

Background and Aim: Pancreatic ductal adenocarcinoma (PDAC) is characterized by aggressive biology and poor prognosis even after resection. Long term survival is very rare and cannot be reliably predicted. Experimental data suggest an important role of epithelialmesenchymal transition (EMT) in invasion and metastasis of PDAC. Tumor budding is regarded as the morphologic correlate of local invasion and cancer cell dissemination. The aim of this study was to evaluate the biologic and prognostic implications of EMT and tumor budding in PDAC of the pancreatic head. Methods: Patients were identified from a prospectively maintained database and baseline, operative, histopathologic and follow-up data extracted. Serial tissue slices stained for Pan-Cytokeratin (PCK) served for analysis of tumor budding, and E-Cadherin (ECad), Beta-Catenin (BCat) and Vimentin (VIM) staining for analysis of EMT. Baseline, operative, standard pathology and immunohistochemical parameters were evaluated for prediction of long term survival (>= 30 months) in uniand multivariate analysis. Results: Intraand intertumoral patterns of EMT marker expression and tumor budding provide evidence of partial EMT induction at the tumor-host interface. Lymph node ratio (LNR) and E-Cadherin expression in tumor buds were independent predictors of long term survival in multivariate analysis. Conclusions: Detailed immunohistochemic assessment confirms a relationship between EMT and tumor budding at the tumorhost interface. A small group of patients with favorable prognosis can be identified by combined assessment of LNR and EMT in tumor buds.

Su1651 Activation of Pancreatic Enzyme Plus Bacterial Infection Plays an Important Role in the Pathogenic Mechanism of Clinically Relevant POPF After Pancreaticoduodenectomy

Introduction: Pancreatoduodenectomy (PD) has become a standard operation with low mortality in high-volume centers, however perioperative morbidity remains substantial, mainly due to postoperative pancreatic fistula (POPF). Development of preoperative protective measures is hampered by a lack of strictly preoperative risk stratification. Predictive power of single parameters can be enhanced by optimally weighed combination of risk factors in an artificial neuronal network (ANN). Methods: A panel of clinical and radiological parameters were assessed retrospectively from patients with pancreatoduodenectomy in our institution and risk factors analysis for the endpoint POPF (clinically relevant Grade B/C of ISGPS definition) were identified. Preoperatively available parameters were used for prediction of a high risk pancreas in an ANN. Internal validation of the thereby identified risk group was performed by testing for POPF and other relevant complications. Results A total of 471 patients with PD operated from 2001 to 2012 were included. Out of twelve clinical and radiological risk factors for POPF B/C, the most powerful was a soft pancreas. When an ANN was trained to predict a soft high-risk pancreas, correct prediction was achieved in 83% in the test group. Patients predicted to have a high-risk pancreas had a significantly higher rate of POPF and severe complications compared to the low-risk group (POPF B/C (38% vs 8%, p=0.000), intraabdominal abscess (23% vs 10%, p=0.000), severe complications (26% vs 13%, p=0.003), severe postpancreatectomy hemorrhage (18% vs 6%, p=0.012)), as well as a five-fold elevated mortality (5% vs 1%, p=0.034). Conclusion Clinical and radiological parameters combined in an ANNmodel can correctly predict a high-risk pancreas and severe complications already before the operation.