ology 13 (2013) S1–S80

[P-139].

Laparoscopic spleen-preserving distal pancreatectomy: Comparativestudy of spleen preservation with splenic vessel resection and splenicvessel preservation

Jung Woo Lee, Ki Byung Song, Kwang Min Park, Jae Hoon Lee,Ji Woong Hwang, Jong Hee Yoon, Jeongsu Nam, Dong Joo Lee,Young Joo Lee, Song Cheol Kim

Department of Surgery, University of Ulsan College of Medicine andAsan Medical Center, Seoul, South Korea

Background/aim: Spleen-preserving laparoscopic distal pancreatec-tomy (SPLDP) can be performed with splenic vessel resection (SVR) orsplenic vessel preservation (SVP). The purpose of this comparative studywas to evaluate the clinical outcomes of patients who underwent SPLDPwith SVR or SVP at a single institution.

Methods:We retrospectively reviewed the records of 246 patients whounderwent SPLDP at Asan Medical Center, Seoul, Korea, for benign or low-grade malignant tumors found in the body or tail of the pancreas betweenNovember 2005 and November 2011.

Results: In total, 206 patients (83.7%) were managed by SVP. SVR wasperformed in the remaining 40 (16.3%) cases. There were no significantdifferences between the SVP and SVR groups in terms of intraoperativeblood loss (378�240 vs. 328�204 ml, respectively; P ¼ 0.240) and oper-ating time (193.4�59.1 vs. 204.4�51.8 min, respectively; P ¼ 0.492). Sixty-seven (32.5%) and 10 patients (25%) had complications in the SVP and SVRgroups, respectively (P ¼ 0.347). At three days after surgery, the rates ofsplenic infarction were 16.0% (33/206) in the SVP group and 52.5% (21/40)in the SVR group, but all recovered within 12 months on postoperativecomputed tomography. The time of recovery from splenic infarction was3.6�3.1 months and 4.7�3.7 months in the SVP and SVR groups, respec-tively. At six months, the rates of gastric varices were 1.9% in the SVP groupand 35% in the SVR group (P<0.001) with no progression at 12months. Nogastrointestinal bleeding occurred at a median follow-up of 34 months(range, 12–84).

Conclusions: SPLDP with SVR can be used for patients with large andbenign or low-grade malignant tumors that distort and compress vesselcourse, as the higher rate of early splenic ischemia and perigastric varicesis acceptable.

Keywords: Warshaw, Spleen-preserving distal pancreatectomy,Laparascopic

Abstracts / PancreatS64

[P-140].

Is International study group on pancreatic fistula (ISGPF) classifica-tion needed to be modified?

Jae Keun Kim, Joonseong Park, Dong Sup Yoon

Surgery, Gangnam Severance Hospital, Seoul, South Korea

Background/aim: Pancreatic fistula is a main complication afterpancreatic resection. This has been considered as a standard of grading inpancreatic fistula, however ISGPF classification is not consistent withclinical pancreatic fistula. This study aimed to improve the clinical rele-vance of ISGPF by Modified ISGPF classification.

Methods: From Jan. 2006 To Mar. 2013, 257patients with pancreasresection were included in this study. Drain amylase and lipase level weremeasured after the operation. ISGPF grade B and C were considered aclinical fistula. Definition of ISGPF grade A was modified with concentra-tion of amylase and lipase on each postoperative day.

Results: Eighty one patients (35.0%) were identified pancreatic fistulaunder ISGPF classification. 68 patients (26%) were Grade A. 23 patients (9%) were clinical fistula. When modified ISGPF classification (amylase >300on or after postoperative day 5) was applied to our cohort, 48 patients(19%) were identified pancreatic fistula. 25 patients (10.0%) were grade A.lipase concentration in drain on each postoperative days was more accu-rately predicted pancreatic fistula than amylase in concentration in drain.

Conclusions: Modified ISGPF classification may improve clinical rele-vance of ISGPF. Drain lipase was correlated with clinical pancreatic fistula.

Further consensus meetings and investigation need to modify the ISGPFclassification.

Keywords: Pancreatic fistula, Pancreaticoduodenectomy, Postoperativecomplication

[P-141].

Laparoscopic distal pancreatectomy: What factors are related to thelearning curve?

Claudio Ricci, Riccardo Casadei, Salvatore Buscemi,Giovanni Taffurelli, Marielda D’ambra, Carlo Alberto Pacilio,Francesco Minni

Surgery, S.orsola-malpighi Hospital, Bologna, Italy

Background/aim: Factors related to the learning curve for laparoscopicdistal pancreatectomy have rarely been evaluated.

Methods: A retrospective study of 32 patients who underwent alaparoscopic distal pancreatectomy performed by a single high volumepancreatic surgeon experienced in advanced laparoscopic surgery. Pre-,intra- and postoperative data were collected. The primary endpoint wasoperative time. The secondary endpoints were conversion rate, reopera-tion rate, overall postoperative morbidity and mortality, postoperativepancreatic fistula, postpancreatectomy haemorrhage, length of hospitalstay and unplanned splenectomy.

Results: The operative time and the cumulative sum of the procedurespresented a significant logarithmic correlation (P¼0.048), but not a linearcorrelation (P¼0.091). The learning curve was said to have been completedafter 17 procedures (AUC ¼0.714; P¼0.040). Multivariate analysisconfirmed that the completion of the learning curve (a cut-off of 17 pro-cedures) significantly reduced operative time by 18% (effect 0.82; C.I. 95%-0.71–0.95; P¼0.009) but extended resection increased it (effect 1.24; C.I.95 %-1.03–1.49; P¼0.023). Conversion rate, reoperation rate, overall post-operative morbidity and mortality, postoperative pancreatic fistula, post-pancreatectomy haemorrhage, and length of hospital stay were notsignificantly related to completion of the learning curve. Unplannedsplenectomy was significantly more frequent in the first 17 procedures.

Conclusions: Operative time seems to be the main factor related to thecompletion of the learning curve for laparoscopic distal pancreatectomy.The learning curve could be considered completed after 17 procedures ifperformed by surgeons experienced in advanced laparoscopic techniquesand in high volume centres for pancreatic surgery.

Keywords: Pancreas, Distal pancreatectomy, Laparoscopy, Learningcurve

[P-142].

Perioperative care with fast-track management in patients undergo-ing pancreaticoduodenectomy

Shinjiro Kobayashi, Ryuiti Ooshima, Satoshi Koizumi,Masafumi Katayama, Joe Sakurai, Hiroshi Nakano,Toshihide Imaizumi, Tahehito Otsubo

Division of Gastroenterological and General Surgery, St. MariannaUniversity School of Medicine, Kawasaki, Kanagawa, Japan

Background/aim: In recent years, the postoperative period on unusualstatus is considered to be shortened. Allowing patients to return to dailyliving earlier leads to early recovery, reduces postoperative complicationsand decreases hospital days. We investigated the applicability and use-fulness of fast-track management in perioperative care in patients un-dergoing pancreaticoduodenectomy.

Methods: Eighty-nine patients who received the conventional periop-erative management from 2005 to 2009 were included as the Conventionalgroup (historical control group). Seventy-nine patients who received theperioperative care with fast-track management from 2010 to 2012 wereincludedas the Fast-track group. To evaluate the efficacyofperioperative carewith fast-track management, the incidence of postoperative complicationsand the length of hospital stay were compared between the two groups. In