Mathew H. Chung

Management of Intraabdominal Hypertension by Percutaneous Catheter Drainage

The authors report a case of an 18-year-old man with T-cell acute lymphocytic leukemia who developed hemorrhagic pancreatitis after chemotherapy. He subsequently developed abdominal compartment syndrome (ACS). Computed tomography showed a large fluid-filled mass in the area of the pancreas. As a result of the instability of his condition, surgical decompression, the standard therapy for ACS, was believed to carry significant morbidity and potential mortality. The patient underwent ultrasound-guided drainage of the peripancreatic fluid, which decreased his abdominal pressures and improved his clinical status. Without this procedure, the patient may not have tolerated subsequent surgery.

Comparison of stapling techniques and management of the mesoappendix in laparoscopic appendectomy.

Many techniques for laparoscopic appendectomy have been proposed with few comparative studies. We performed a retrospective review of all patients undergoing laparoscopic appendectomy for uncomplicated appendicitis from 2006 to 2011. Techniques were: (1) transection of the mesoappendix and appendix with a single staple line (SSL); (2) transection of the mesoappendix and appendix with multiple staple lines (MSL); and (3) transection of the mesoappendix with ultrasonic shears and the appendix with a single staple line (USSL). A total of 565 cases were reviewed (149 SSL, 259 MSL, and 157 USSL). Patients treated with the SSL technique had decreased operative duration (P<0.001) and length of stay (P=0.003) despite equivalent disease presentations. Multivariate analysis demonstrated decreased operative duration with the SSL technique (P=0.001). Use of a SSL for transection of the mesoappendix and appendix is both a safe and efficient technique that results in reduced operative duration with excellent surgical outcomes.

Mo1633 Sarcopenia Does Not Impact Morbidity or Survival in Patients With Resectable Esophageal Adenocarcinoma

Introduction: Sarcopenia has been identified as a potential predictive variable for outcomes in selective surgical procedures and disease processes. The benefit of using sarcopenia for such purposes in oncologic surgery remains unclear. Methods: A retrospective review was conducted for all patients undergoing resection of esophageal adenocarcinoma with intention for cure at a single institution from 2006-2012. Lean psoas muscle area (LPMA) and LMPA/ BMI were calculated at the level of the L4 vertebral body using preoperative computed tomography correcting for muscle density. Patients were analyzed in tertiles based on these measurements. The primary outcome measures were anastomotic leak, 90-day morbidity (Clavien grade ≥ 3), and long-term overall survival. Multivariate analyses were performed for the primary outcome measures. A p value < 0.05 was considered significant. Results: One hundred six consecutive patients were identified and 100 patients had preoperative CT scans available for review. The mean patient age was 63±11 and 62% underwent neoadjuvant therapy. All surgical procedures were performed open and approaches included transhiatal (76%), Ivor-Lewis (11%), and three-field (13%) esophagectomy. The anastomotic leak rate was 10% and 90-day morbidity rate was 38%. Neither LPMA nor LPMA/BMI were significant predictors of anastomotic leak (LMPA p=0.503; LPMA/BMI p=0.268) or morbidity (LPMA p=0.787; LPMA/BMI p=0.528). Median overall survival was 2.8 years. Tertiles for LPMA (p=0.210) and LPMA/BMI (p=0.409) were not predictive of long-term survival (Fig. 1,2). Conclusion: Sarcopenia is not predictive of short term outcomes or longterm overall survival following esophagectomy for esophageal adenocarcinoma.

Impact of Chronic Pancreatitis on Pancreatic Resections for Malignancy

Background: Chronic pancreatitis has been shown to have potential benefit in pancreatic resections by reducing postoperative pancreatic fistula. We sought to investigate the impact of chronic pancreatitis on oncologic surgical outcomes. Materials and Methods: Consecutive partial pancreatectomies performed for malignant disease from 2005-2011 were reviewed. Patients were divided for analysis based on the presence of chronic pancreatitis. The primary outcome measures were need for intraoperative re-excision of margins and final margin status. Secondary outcome measures included pancreatic fistula rate and overall morbidity which were graded in standardized fashion. Significance was assessed for p<0.05. Results: One hundred fifty-four patients met criteria for study, 48 of which had chronic pancreatitis. Demographics, co-morbidities, diagnoses, and surgical technique were equivalent between groups. Though there was a trend towards increased re-excision of margins in the chronic pancreatitis group (p<0.08), there were no significant differences in any surgical outcome measures between groups including final margin status, pancreatic fistula rate, and overall morbidity. Multivariate analysis failed to identify chronic pancreatitis as a predictive factor for any of the chosen outcome variables. Conclusion: Despite potential for difficult dissection due to inflammatory changes in chronic pancreatitis, we found no differences in oncologic outcomes in patients undergoing pancreatectomy.