Oral (pre-recorded)
OP06 Pancreas: Miscellaneous 
Selection of Presentations from Abstract Submissions
OP06-01 Laparoscopic Frey Procedure - Multicenter Prospective Randomized Trial
Roman Izrailov, Russian Federation

A. Andrianov1, R. Izrailov1, V. Tsvirkun1, T. Dyujeva2, K. Dalgatov3, V. Egorov4, S. Tarasenko5, K. Nikolskaia6, E. Diubcova6
1Hi-Tech and Endoscopic Surgery, Moscow Clinical Scientific Center, Russian Federation, 2Pancreas and Liver Surgery, Sechenov University, Russian Federation, 3Hepatobiliary Surgery, Hospital of N.I.Piogov, Russian Federation, 4Hepatobiliary Surgery, IIliinskya Hospital, Russian Federation, 5Hepatobiliary Surgery, Ryazan State Medical University, Russian Federation, 6Disease of Pancreas, Moscow Clinical Scientific Center, Russian Federation

Indication: To compare the efficiency, advantages and selection criteria of laparoscopic Frey procedure.
Materials and methods:
The primary point of the trial: the frequency of complications in the early postoperative period after laparoscopic and open procedure (Clavien-Dindo classification (from grade II and above). From October 2018 to December 2019 Frey procedure were performed in 18 patients with chronic pancreatitis type C (classification of M.Buchler). All patients were divided for 2 group: I group - laparoscopic approach (n-9), II group - open approach (n-9). The age of the patients was 42 (25-69) years in I group and 44 (36-52) years in II group (p 0,8). The median size of the pancreatic head was 30 (23-38) mm in I group and 42 (31-73) mm in II group (p 0.6), the median diameter of the main pancreatic duct was 7 (4-10) mm and 8 (4-10) mm (p 0.16), respectively.
Results: All operations in I group were performed laparoscopic. The operating time was 375 (320-501) minutes in I group and 240 (179-280) minutes in II group (p 0,08). Blood loss was 70 (30-200) and 100 (50-450) ml (p 0.5), respectively. The postoperative stay period was 4 (4-8) days in I group and 7 (5-14) days in II group (p 0.45). There was 1 (11.15%) complications in II group. The follow-up was 4 (3-8) months in I group and 4 (3-7) months in II group. Pain relief was complete in all groups.
Conclusions: A prospective randomized trial demonstrates advantages of laparoscopic Frey procedure.
OP06-02 Association of Pre-existing Mental Illness with All-cause and Cancer-specific Mortality in Medicare Beneficiaries with Pancreatic Cancer
Anghela Paredes, United States

A. Paredes1, M. Hyer1, E. Palmer1, M. Dillhoff1, A. Ejaz1, J. Cloyd1, A. Tsung1, T. Pawlik2
1The Ohio State University Wexner Medical Center, Columbus, United States, 2Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, United States

Introduction: Among patients with pancreatic cancer, the association of mental illness with long-term outcomes remains unknown. We sought to analyze how preexisting mental illness before a pancreatic cancer diagnosis was associated with all-cause and cancer-specific mortality.
Methods: Individuals diagnosed with pancreatic adenocarcinoma were identified in the linked Surveillance, Epidemiology, and End-Results-Medicare database from 2004-2016. Patients were classified as having mental illness if an ICD9/10-CM code for anxiety, depression, bipolar disorder, schizophrenia or other psychotic disorder was recorded in at least one inpatient or two outpatient claims during the 3 years before cancer diagnosis.
Results: A total of 3,020 (6.9%) out of 43,576 patients were diagnosed with a mental illness prior to pancreatic cancer diagnosis. Among individuals with pre-existing mental illness, 21.9% were diagnosed with anxiety only, 44.3% with depression only and 15.9% with depression and anxiety; a smaller subset (18.0%) was diagnosed with severe mental illness (schizophrenia or other psychotic disorder). There was a 33% increase in all-cause mortality among patients with versus without pre-existing mental illness after adjusting for age, race, gender, stage, and surgical intervention (adjusted HR:1.33; 95%CI:1.28-1.38)(p< 0.001). In addition, patients with mental illness had a 30% increase in cancer-specific mortality (adjusted HR: 1.30, 95%CI:1.25-1.36) (p< 0.001).
Conclusion: Roughly 7% of patients with pancreatic adenocarcinoma had a pre-existing mental illness diagnosis. Individuals with mental illness were more likely to have worse overall and cancer-specific long-term outcomes. Surgeons and cancer caregivers need to be aware of mental illness to address mental health concerns among cancer patients as part of their care coordination.
OP06-05 Use of Chaplaincy Services among Patients with Hepatopancreatic Cancer
Elizabeth Palmer, United States

A. Paredes1, E. Palmer1, M. Hyer1, D. Tsilimigras1, T. Pawlik2
1The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, United States, 2Department of Surgery, The Ohio State University Wexner Medical Center, United States

Introduction: Hepatopancreatic (HP) can be extremely stressful, yet the supportive care needs of patients with these diagnoses are unknown. We sought to define overall utilization of chaplaincy services among patients with HP cancers at a large comprehensive cancer center.
Methods: Patients with HP cancer were identified; data on patients with breast or prostate cancer were also collected for comparison purposes. Details on demographic, as well as chaplaincy services were obtained and compared.
Results: Among 8,961 individuals (HP, n=1,419; breast or prostate, n=7,542), a sub-set of patients utilized chaplaincy services (HP, 51.7% vs. breast or prostate, 19.8%; p< 0.001). While patient sex and race were not associated with chaplaincy utilization (both p>0.05), married patients were less likely to use these services (OR 0.83, 95% CI 0.75-0.93). In contrast, patients who self-reported being “religious” (OR 2.05, 95% CI 1.78-2.36), as well as patients with an active DNR (OR 5.25, 95%CI 4.52-6.11) were more likely to use chaplaincy services. On multivariable analysis, patients with HP versus breast or prostate cancer were almost 3-fold more likely to use chaplaincy services (OR 2.80, 95% CI 2.45-3.21). Compared with breast or prostate cancer, individuals with HP cancer were more likely to use chaplaincy services to reduce distress (79.2% vs. 84.3%) and increase understanding of their medical condition (15.3% vs. 28.9%)(both p< 0.05).
Conclusion: Up to 1 in 2 patients with HP cancer utilized chaplaincy services. The availability of chaplaincy services may help address distress, as well as psychological and spiritual needs of patients with HP cancers.
OP06-06 Surgical Decision Making in Pancreatic and Duodenal Trauma
Patwinder Gill, Australia

P. Gill, K. Ruecker, A. Cocco, D. Marascia, C. Li, K. Gumm, B. Loveday, B. Knowles, B. Thomson
Royal Melbourne Hospital, Australia

Introduction: Pancreatic and duodenal injuries occur uncommonly but may cause significant morbidity and mortality. This study focuses on factors that may influence surgical decision making in this patient group.
Method: A retrospective review of patients admitted with pancreatic and/or duodenal injuries from 2000 - 2017 to a level 1 trauma service was undertaken. Demographic, injury and management data were collected.
The grade of pancreatic or duodenal injury was considered to be low (AIS 1-2) or high (AIS 3-5). Patients were analysed in two groups according to whether they were managed operatively or non-operatively. The operative group was then divided into patients managed with damage control versus those who had definitive surgery. Univariate and multivariate analysis were performed to identify factors which differentiated between these groups.
Results: 148 patients sustained pancreatic and/or duodenal injuries. Non-operative management was undertaken in 119 patients (80.4%). On multivariate analysis, injury to four or more abdominal organs was the only factor associated with requiring operative management (OR 1.87 (95%CI 1.29-2.71, p=0.01).
45 of the 119 patients (37.8%) required damage control surgery. On multivariate analysis, shock (OR 17.57 (95%CI 3.58-86.15, p=0.0000)) and major vessel injury (OR 3.14 (95%CI 1.25-7.92, p=0.02)) were associated with requiring a damage control approach.
Conclusion: Pancreatic and duodenal injuries are uncommon. Injury to multiple abdominal organs is associated with operative treatment of the pancreatic or duodenal injury. In patients with shock or major vessel injury, damage control surgery is likely to be required.
OP06-07 Signet Ring Carcinoma of the Pancreas: A Rare and Deadly Disease
Krishnaraj Mahendraraj, United States

K. Mahendraraj, N. Nissen, T. Brennan, G. Voidonikolas, A. Klein, T. Todo, K. Kosari, I. Kim
Surgery, Cedars-Sinai Medical Center, United States

Compared to pancreatic ductal adenocarcinoma (PDAC), signet ring carcinoma of the pancreas (SRC) is a rare mucin-producing exocrine malignancy, comprising less than 1% of all cases. Clinical information regarding this disease is scant.

Data on 103,341 patients with pancreatic cancer from the Surveillance Epidemiology and End Result (SEER) database (1973-2017) was analyzed.

SRC comprised 0.6% of all pancreatic cancers (621 cases). Both SRC and PDAC were more common in men, Caucasians and in the pancreatic head. SRC was more often poorly differentiated (81.3%) and had metastatic disease (68.1%). The majority of SRC were untreated (70%), while 14% had surgery and chemotherapy. Mean survival for SRC was significantly lower (0.47 years vs. 0.85 years), even with resection. However, SRC patients benefited more from primary radiotherapy than PDAC (1.05 vs. 0.93 years, p< 0.001). Multivariate analysis identified SRC size >4cm (OR 1.4), distant disease (OR 1.8), and poor differentiation (OR 1.6) as independent risk factors for mortality, p< 0.005. Survival advantage was seen with pancreatic body (OR 0.7) or tail location (OR 0.7), and radiation therapy (OR 0.36), p< 0.005

SRC presents with larger size, poor differentiation, and a higher rate of metastatic disease than PDAC, resulting in worse survival. Despite this, SRC patients amenable to radiation therapy derive greater survival advantage than PDAC. Resection was associated with the longest survival compared to other treatment modalities for SRC. These results suggest that combination surgery and radiotherapy may have an important role in improving survival for SRC patients.
[Data On 103,341 Patients With Pancreatic Cancer from the SEER Database (1973-2017)]
OP06-08 Impact of Timing of Chemotherapy for Pancreatic Cancer in the Elderly: A National Cancer Database Study
Neha Lad, United States

N. Lad, F. Kunzler, R. Jimenez, H. Asbun
Miami Cancer Institute, United States

Background: Recent data favor neoadjuvant chemotherapy for pancreatic adenocarcinoma (PDAC). The aim of this study is to evaluate the effect of timing of chemotherapy on overall survival of elderly patients undergoing pancreatic surgery for PDAC.
Methods: The NCDB was reviewed from 2004 to 2016. The effect of chemotherapy in elderly patients (≥75) was studied. Three major groups were analysed: adjuvant (ADJ), neoadjuvant (NEO) and neoadjuvant with adjuvant (BOTH).
Results: A total of 380,524 patients were diagnosed with PDAC. Of these, 130,039 were ≥75 years of age, and 18,291 patients (7.1%) underwent surgery. Chemotherapy was provided as follows: 5,640 underwent ADJ, 888 NEO and 345 BOTH. A majority being diagnosed at stage II patients in NEO (48%) and BOTH (53%) . The 3 year survival was 31.9% in BOTH (95% CI: 26.4 - 38.6), 24.7% in NEO (95% CI: 21.6 - 28.3) and 25.0% in ADJ (95% CI: 23.8-26.3). Univariate Cox regression shows a significantly improved survival in BOTH in comparison to ADJ (p=0.0081) and a trend in improvement in comparison to NEO (p=0.079). There was a tendency to improved survival when elderly patients that received only neoadjuvant vs those receiving adjuvant chemotherapy (p=0.23). On multivariate analysis comorbidities were identified as an independent factor negatively impacting survival. Chemotherapy given as BOTH was independently associated with improved survival (figure 1).
Conclusion: Elderly surgical patients undergoing BOTH neoadjuvant and adjuvant chemotherapy had improved survival. Therefore, BOTH should be given elderly patients if tolerated.
[Survival Curve for Elderly with receiving Adjuvant, Neoadjuvant and Both Cheemothreapy]