Abstracts / Pancreatology 13 (2013) S1–S80S42

Abdominal computed tomography (CT) showed a tumor in the pancreaticbody and obstruction of the splenic vein. The main pancreatic duct wassuppressed to ventral direction. Magnetic resonance imaging (MRI)confirmed a 28 mm x38 mm area of mild high intensity for T2W1(SPIR)in the body of the remnant pancreas. The preoperative diagnosis wasconsidered to pancreatic ductal carcinoma. We performed distal pancre-atectomy for remnant pancreas, as a result, total pancreatectomy. Thehistological diagnosis showed double cancer of poorly differentiatedendocrine neoplasm (55 mm) and Intraductal papillary-mucinous carci-noma (less than 10 mm). The tumor cells of poorly differentiated endo-crine neoplasm demonstrated positive reaction to Chromogranin byimmunohistochemical staining. After pancreatosplenectomy, the combi-nation chemotherapy using cisplatin and etoposide (VP-16) has beenperformed for about 18 months for lymph node metastasis. Since then,administration of mTOR inhibitor (Everolimus) has been started. Wereport a case of poorly differentiated endocrine neoplasm of the pancreaswith IPMC, and propose that combining surgery with systemic chemo-therapy may lead to a better prognosis.

Keywords: Poorly differentiated endocrine neoplasm, Pancreas

[P-071].

Resection after preoperative chemotherapy or chemoradiation ther-apy for unresectable pancreatic cancer – Single center experience

Yoshikazu Toyoki, Keinosuke Ishido, Daisuke Kudo,Norihisa Kimura, Taiichi Wakiya, Shingo Sakuraba, Kenichi Hakamada

Department of Gastroenterological Surgery, Hirosaki UniversityGraduate School of Medicine, Hirosaki, Japan

Background/aim: For patients with pancreatic cancer, curative treat-ment is only complete resection with adjuvant chemotherapy. However,many pancreatic cancer patients are unresectable cases. In this report, wewere analyzed for unresectable pancreatic cancer patients who underwentpreoperative therapy in our department.

Methods: From August 2010 to December 2012, 27 unresectablepancreatic cancer patients underwent chemotherapy or chemoradiation.Main criteria of unresectable pancreatic cancer were according to theNCCN guideline. Resection rates, complication during the treatments, andsurvival were analyzed.

Results: Fourteen patients had distant metastases (including distantlymph node meta.), 13 patients had locally advanced pancreaticcancer. Of 27 patients, 26 patients were underwent chemotherapyonly, and 1 patient was underwent chemoradiation. Of 27 patients, 9patients were underwent surgery. Seven patients were underwentsuccessful resection (7/27, 25.9%), whereas 2 patients were underwentexploration only. The 2-year survival rate after macroscopic resectionwas 45.7%.

Table 1The cutoff value for the lymph node ratio, the number of lymph node metastasis, and th

Cutoff value

Lymph node ratio <0.1, >0.1<0.2, >0.2<0.3, >0.3

Number of lymph node metastasis ¼0, >1<1, >2<2, >3<3, >4<4, >5<5, >6

Number of resected lymph nodes <10, >11<20, >21<30, >31

Conclusions: We believe that preoperative chemotherapy or chemo-radiation has potential benefits for unresectable pancreatic cancer patientsbecause of the associated improved resection rate and prognosis.

Keywords: Unresectable, Pancreatic cancer, Preoperative chemo-therapy

[P-072].

Assessment of nodal status for pancreatic cancer

Yusuke Yamamoto 1, Hisashi Ikoma 1, Ryo Morimura 1,Hirotaka Konishi 1, Yasutoshi Murayama 1, Syuhei Komatsu 1,Atsushi Shiozaki 1, Yoshiaki Kuriu 1, Takeshi Kubota 1,Masayoshi Nakanishi 1, Daisuke Ichikawa 1, Hitoshi Fujiwara 1,Toshiya Ochiai 2, Chohei Sakakura 1, Eigo Otsuji 1

1 Division of Digestive Surgery, Department of Surgery, KyotoPrefectural University of Medicine, Kyoto, Japan2Division of Digestive Surgery, Department of Surgery, North MedicalCenter Kyoto Prefectural University of Medicine, Kyoto, Japan

Background/aim: The aim of this study was to evaluate predictors ofsurvival in patients who underwent resection for pancreatic cancer (PC),focusing specifically on the prognostic value of nodal status.

Methods: Total of 56 patients underwent macroscopic curative resec-tion for PC between January 2001 and December 2009 was analyzed.Pancreaticoduodenectomy was performed in 37 patients, distal pancrea-tectomy in 16, and total pancreatectomy in 3, respectively. Nineteen fac-tors, including the number of LN metastasis, the number of dissected LN, Ncategory according to Japanese pancreatic society (JPS) classification, andlymph node ratio (LNR), were analyzed using univariate and multivariateanalyses.

Results: The number of lymph nodes evaluated was 27.3 þ 15.3(mean þ SD) and median number of that was 25. The number of lymphnodes metastasis was 2.8 þ 3.3 and median number of that was 2. Theoverall 5-year survival rate was 26.9%. Based on the minimum p valueapproach, the optimal cutoff value was 0.2 for LNR and two nodes forthe number of LN metastasis. Positive surgical margin (p ¼ 0.027) andLN ratio > 0.2 (p ¼ 0.025) were identified as an independent prognosticfactors. With regard to the subgroup analysis among the 33 patientswith regional LN metastasis, there was significant difference in survivalbetween patients with LNR >¼ 0.2 and LNR < 0.2 (MST 14 vs. 26 mo., p¼ 0.048), however, the differences in survival between N1 and N2 in JPSclassification are not statistically significant (MST 25 vs. 21 mo., p ¼0.85).

Conclusions: Our results suggested that the LNR might be more usefulthan other parameters as a predictor for survival after resection for PC.

Keywords: Pancreatic cancer, Lymph node ratio, Lymph node metas-tasis, Nodal status

e number of resected lymph nodes.

c2 score p Value

0.576 0.44811.385 0.00110.545 0.0023.831 0.0506.666 0.0104.664 0.0312.538 0.1111.656 0.1982.115 0.1462.047 0.1520.090 0.7640.005 0.943