Clinical features and risk factors of pancreatic cancer in chronic pancreatitis

Clinical features and risk factors of pancreatic cancer in chronic pancreatitis

Abstracts / Pancreatology 13 (2013) S1–S80 S38 Conclusions: Analysis of EUS-FNA specimens with combination of conventional cytological smear and cel...

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Abstracts / Pancreatology 13 (2013) S1–S80

S38

Conclusions: Analysis of EUS-FNA specimens with combination of conventional cytological smear and cell block may give higher diagnostic yield than cytological smear alone. Additional cell block may increase sensitivity and negative predictive value in the analysis of EUS-FNA specimen without decreasing specificity. Keywords: EUS-FNA, Cell block, Cytological smear

[P-058]. Clinical features and risk factors of pancreatic cancer in chronic pancreatitis Joon Hyuk Choi, Myung-Hwan Kim, Dong Wan Seo, Sang Soo Lee, Do Hyun Park, Sung Koo Lee Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea Background/aim: The relative risk of pancreatic cancer in chronic pancreatitis was reported as 13.3 compared with the prevalence in normal population. However, little is known about specific clinical features that can be warning sign of pancreatic cancer in chronic pancreatitis. The aims of this study were to compare clinical features of pancreatic cancer between with and without chronic pancreatitis and to find specific features in chronic pancreatitis preceding pancreatic cancer. Methods: We performed a chart review of patients with pancreatic cancer with underlying chronic pancreatitis who visited our institute, tertiary-referral hospital from 1989 to 2011 retrospectively. General clinical features such as age at diagnosis of pancreatic cancer, smoking, alcohol consumption were collected. Then, specific features of pancreatic cancer in chronic pancreatitis such as changes of pain, tumor marker, radiologic findings were compared to those of chronic pancreatitis patients without pancreatic cancer selected by using propensity score matching. Results: Total 40 patients were enrolled. In propensity score matched pairs (1:3 match) using covariates including age, sex, smoking, alcohol consumption, and follow-up periods and intervals, there were differences in clinical presentations including jaundice (OR: 18.3, p<0.001) and weight loss (OR: 4.6, p¼0.01) and increased level of CA 19-9 (OR; 3.4, p¼0.048). Conclusions: Our results showed some more clinical features that could be warning signs of pancreatic cancer in following chronic pancreatitis. Although there is not a consensus of screening for pancreatic cancer to date, patients with chronic pancreatitis should be rigorously followed for early detection of pancreatic cancer. Keywords: Chronic pancreatitis, Pancreatic cancer, Clinical feature, Risk factor

[P-059]. The role of endoscopic pancreatic stenting for the management of acute pancreatitis by periampullary cancer Moon Han Choi, Hyun Jong Choi, Dong Choon Kim, Tae Hoon Lee, Sang-Woo Cha, Young Deok Cho, Sang-Heum Park, Sun-Joo Kim, Jong Ho Moon Digestive Disease Center and Research Institute, Department of Internal Medicine, Soon Chun Hyang University School of Medicine, Bucheon and Seoul, South Korea Background/aim: Acute pancreatitis can be occurred by obstruction of the pancreatic duct in patients with periampullary cancer. However, the optimal treatment for acute pancreatitis by periampullary cancer has not been established. The aim of this study is to evaluate the role of endoscopic pancreatic stenting for the management of acute pancreatitis by periampullary cancer. Methods: Between March 2008 and February 2013, we attempted endoscopic pancreatic stenting in 32 patients with acute pancreatitis by periampullary cancer. The plastic stent (5 Fr or 7 Fr) was used in this study. After endoscopic pancreatic stent placement, technical and clinical success, complication rate, duration of stent placement, and recurrence rate of acute pancreatitis were assessed. Clinical success was defined as normalize of serum amylase and/or lipase, and relief of abdominal pain within one week.

Results: There were 20 men (62.5%) and 12 women (37.5%). The median age was 69 years (range, 49–91). The causes of periampullary cancer were pancreatic cancer in 23 patients (71.9%), ampulla of Vater cancer in 6 patients (18.8%), and metastatic tumor in 3 patients (9.3%). Surgical resection was performed in 5 patients (15.6%). Technical success was reached in 30 of 32 patients (93.8%). The clinical success rate was 96.7% (29/30). The median time to normalize of serum amylase and/or lipase was 5 days (range, 1–8). The median time to relief of abdominal pain was 3 days (range, 1–6). There were no procedure-related complications. During follow-up period, the median duration of stent placement was 77 days (range, 1–527) in unresectable cases, and 20 days (range, 7–38) in resectable cases, respectively. Stent migration was reported in 1 patient (3.4%). There were no recurrences of acute pancreatitis in all cases. Conclusions: The endoscopic pancreatic stenting in patients with acute pancreatitis by periampullary cancer may be useful for the palliative management of pancreatitis. Keywords: Periampullary cancer, Acute pancreatitis, Pancreatic stenting

[P-060]. Prognosis of stage I pancreatic cancer that was diagnosed pathologically after resection Jong Hee Yoon, Young Joo Lee, Kwang Min Park, Jae Hoon Lee, Ki Byung Song, Ji Woong Hwang, Jeongsu Nam, Jeong Woo Lee, Dong Joo Lee, Song Cheol Kim Hepatobiliary Pancreas, Asan Medical Center, Seoul, South Korea Background/aim: To analyze clinicopathologic and surgical features, and prognosis for stage I pancreatic cancer (PC). Methods: A retrospectively analysis was conducted on 45 patients with pathologic stage I PC between 2000 and 2012. Results: 45 patients were diagnosed as pathologically early pancreatic cancer. Male outnumbered women (ratio, 29:16). Mean age was 60.5. Mean size of tumor was 2.7 cm. Average preoperative serum level of CA199 was 141.9 u/ml. But only 17 patients (37.8%) had shown levels above normal upper limit, 37 u/m. There were 12 (26.7%) and 15(33.3) in perineural and lymphovascular invasion, respectively. Among recurred 22 patients (48.9%). 18 patients (81.8%) couldn’t survive. 2 patients transferred to other hospitals were dead. The most common site of recurrence was regional lymph nodes. Mean duration until relapse and death were 15.5 and 37 months. Median survival time (MST) and 5 year survival rate (5YSR) of stage I were 63 months and 50.8%. 24 patients (53.3%), they received adjuvant chemotherapy (AdCTx.). MST and 5YSR of the patients who received it was 65.1 months and 54%, MST and 5YSR of the patients who didn’t receive it was 58.1 months and 50.3%. But there was no statistically significant difference (p¼ 0.529). Comparing stage I and IIA, there was statistically significant difference (p ¼ 0.001). MST and 5YSR of stage IIA was 22 months and 22.1%, respectively. Conclusions: The prognosis of stage I pancreatic cancer is superior to stage IIA. It is important that small and asymptomatic pancreatic neoplasms is detected and removed surgically early. Screening tests are needed. Image study as CT will play a role to early detection. Since, serum level of CA19-9 was not really help to find stage I PC. Majority of the recurred patients couldn’t survive. The effectiveness of AdCTx in stage I PC was not clear toward preventing recurrence. More study is needed to clarify the effectiveness of AdCTx. Keywords: Early pancreatic cancer, Prognosis

[P-061]. Does modified Braun enteroenterostomy improve alkaline reflux gastritis and marginal ulcer after pancreaticoduodenectomy? An Ping Su, Bo Le Tian Department of Hepatobiliopancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China