Oral (pre-recorded)
OP05 Pancreas: Technical Outcomes 
Selection of Presentations from Abstract Submissions
OP05-01 Sharing Landmarks for Setting a Cutting Line Leads to Safe Laparoscopic Pancreaticoduodenectomy
Hitoe Nishino, Japan

H. Nishino, Y. Nagakawa, C. Takishita, H. Osakabe, M. Akashi, T. Nakajima, Y. Hosokawa, K. Katsumata, A. Tsuchida
Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Japan

Introduction: Since laparoscopic pancreaticoduodenectomy (LPD) combines various surgical procedures, securing the appropriate surgical field at each surgical site is required for safe dissection. Identification of the anatomical landmarks is also essential to set an appropriate cutting line. We developed effective retraction methods and anatomical landmarks for safe LPD that have been shared by all in our surgical team.
Methods: For each of the twenty-four different surgical sites, retraction method was developed in the surgical team. At each surgical site, the dissecting device was aligned with the axis of cutting line using 'three-way retraction' that needs both hands of the assistant and left hand of the operator. Anatomical landmarks to set a cutting line around the superior mesenteric artery (SMA) were shared in our surgical team; the proximal dorsal jejunal vein (PDJV), the inferior pancreatoduodenal vein (IPDV), the uncinate process ligament which fixes the pancreatic uncinate process to the dorsal side of the jejunal, the SMA nerve plexus without spreading of the nerve fibers (SMA bundle region), and the ligament of Treitz.
Results: Surgical outcomes of 1st-47th cases (hybrid LPD); operation time 551.6 minutes, blood loss 315.4 ml. 48th-70th cases (pure LPD); operation time 465.5 minutes, blood loss 164.5 ml. 71th-90th cases (pure LPD); operation time 401.8 minutes, blood loss 122.4 ml. 91th-111th cases (pure LPD, young surgeons participated in the surgery); operation time 483.0 minutes, blood loss 120.0 ml.
Conclusions: Sharing the retraction methods and anatomical landmarks in the surgical team to determine the cutting line leads to safe LPD.
OP05-02 Comparison of Surgical Outcomes of Laparoscopic and Robotic Pancreaticojejunostomy after Pancreaticoduodenectomy in Patient with a Soft Pancreas
Sung Hoon Choi, Korea, Republic of

S.H. Choi1, C.M. Kang2
1Surgery, CHA University/ Bundang CHA Medical Center, Korea, Republic of, 2Surgery, Yonsei University College of Medicine, Korea, Republic of

Objective(s): A soft pancreas remains a potent risk factor of postoperative pancreatic fistula (POPF) following pancreaticoduodenectomy (PD). Recently, minimally invasive PDs have been gradually expanding its application. This study aims to evaluate the effect of anastomotic technique of laparoscopic versus robotic pancreaticojejunostomy on POPF among patients with soft pancreas in multi-institutional database.
Methods: From January 2014 to December 2019, 155 patients with soft pancreas and small pancreatic duct less than 3 mm diameter underwent laparoscopic or hybrid PD (laparoscopic resection and robotic reconstruction) at two instituitions. All patients underwent duct-to-mucosa anastomosis for pancreaticojejunostomy. Surgical outcomes of 123 patients who underwent totally laparoscopic PD and 32 patients who underwent hybrid PD were compared.
Results: General demographics were comparable between laparoscopic and hybrid group. Proportion of periampullary malignancies were similar in both group (74.8 % vs. 75.0 %, p=0.981). Mean diameter of pancreatic duct was almost identical (1.98±0.69 mm vs. 1.84±0.63 mm, p=0.326) Mean pancreatic duct size was also comparable (1.98±0.69 vs. 2.08±0.96, p=0.475). Mean operative time and estimated blood loss were similar. POPF, delayed gastric emptying, and overall postoperative complication rates were not different in both group. Clincal relevant POPF rates higher than grade B were also comparable (8.8% vs. 9.4%). Length of hospital stay was also comparable (12.0 ± 9.1 vs. 12.0 ± 8.3 days, p=0.985).
Conclusion: Our study showed similar POPF and overall complication rates in both laparoscopic and hybrid PD group. Future higher volume study is needed to figure out real advantage of robot surgical system in PD.
OP05-03 The French Reconnection: A Conservative Surgical Treatment of Disconnected Pancreatic Duct Syndrome
Safi Dokmak, France

S. Dokmak1, A. Tetart1, B. Aussilhou1, A. Choupet1, V. Rebours2, M.-P. Vullierme3, O. Soubrane1, P. Levy2, A. Sauvanet1
1HBP Departement and Liver Transplantation, Beaujon Hospital, France, 2Pancreatic Diseases, Beaujon Hospital, France, 3Radiology, Beaujon Hospital, France

Background: Disconnected pancreatic duct syndrome (DPDS), a severe complication of acute necrotizing pancreatitis (ANP) can require surgery, usually by distal pancreatectomy, but frequently exposing to diabetes. We describe a new technique reconnecting the distal pancreas to the digestive tract.
Methods: This technique was proposed for DPDS in non-diabetic or non-insulin dependent diabetic patients with a distal pancreas exceeding 5 cm. The ruptured zone was identified and the distal side was anastomosed to the stomach or the jejunum.
Results: From 2013 to June 2019, 36 patients (median=49 years), underwent the “French reconnection”, indicated for chronic pain/recurrent pancreatitis (35;97%), persistent pancreatic fistula (33; 92%), or digestive compression/fistulisation (9; 25%). Preoperatively, median weight loss was 10 kg (4-27), median number of hospitalisation per patient was 5(1-8) and 24(67%) patients received endoscopic/percutaneous treatment. Surgery was performed after a median delay of 279(90-2000) days after ANP, through laparoscopy in 9 (25%) patients. The remnant pancreas (median length=70mm; 50-130) was anastomosed to the stomach (n=30) or the jejunum (n=6). Postoperatively, there were 13(39%) grade B/C pancreatic fistulas and 3 (10%) bleedings including one lethal (mortality=3%). Median hospital stay was 18(7-121) days. With a median follow up of 24(4-53) months, all pancreatic fistulas healed and the clinical success rate was 91%. Median BMI increased from 22 to 25 kg/m². Postoperative endocrine and severe exocrine insufficiencies were observed in 4 (15%) and 7(32%) patients, respectively.
Conclusions: The “French reconnection” is a good alternative to distal pancreatectomy for DPDS, allowing excellent control of symptoms and preserving pancreatic function.
OP05-04 Sub-adventitial Divestment Technique for Artery-involved Pancreatic Cancer: Technical Feasibility and Safety Profile
Baobao Cai, China

Z. Lu, B. Cai, J. Wei, J. Wu, W. Gao, Y. Gao, L. Yin, K. Jiang, Y. Miao
Pancreas Center, Nanjing Medical University, China

Introduction: Artery involvement is the major obstacle of curative operation for non-metastatic pancreatic cancer patients. Here we present the sub-adventitial divestment technique (SADIT) in therapeutic surgery of artery involved pancreatic cancer(ai-PC).
Methods: From April 2014 to June 2016, a total of 73 consecutive ai-PC patients identified with contrast-enhanced CT and surgical exploration received curative pancreatectomy with SADIT served as the study group (SADIT). To evaluate safety of SADIT, 247 concurrent pancreatic cancer patients without artery involvement who received curative pancreatectomy were enrolled as control (CTRL). Retrospective Analysis of peri-operative morbidity and mortality profile was performed to test the technical feasibility and safety.
Results: Gender, age, preoperative CA19-9 and serum albumin showed no difference between two groups. SADIT group tend to have more major vein resection and reconstruction, combined organ resection and extended lymph node dissection. Longer operation time was needed in SADIT group (SADIT vs CTRL: 265.4±101.4 min vs 228.7±90.2 min, p=0.003) without significant increase in surgical blood loss(SADIT vs CTRL: 347±323 mL vs 283±315 mL, p=0.131). Over-all morbidity, and the incidence of ISGPS post-operative pancreatic fistula, delayed gastric emptying and re-operation rate were of no difference between two groups, while SADIT group had more post-operative hemorrhage(SADIT vs CTRL: 52.1% vs 49.0%, 20.5% vs 19.0%, 17.8% vs 15.8%, 1.4% vs 1.6% and 16.4% vs 6.5%, p= 0.743, 0.904, 0.817, 1.000 and 0.015, respectively).
Conclusion: Sub-adventitial divestment technique is safe in surgery of artery involved pancreatic cancer. Valid prediction method for tumor biology is warranted to provide more beneficial therapeutic strategy.