ology 13 (2013) e1–e94

P151.

Role of somatostatin receptors scintigraphy in neuroendocrine neo-plasms follow-up

E.Merola 1, N. Cicchese 1, F. Desideri 1, E. Iannicelli 2, F. Panzuto 1, G. Delle Fave 1.

1DepartmentofDigestiveandLiverDisease, S.AndreaHospital, Rome, Italy2Department of Radiology, S. Andrea Hospital, Rome, ItalyBackground: Somatostatin Receptor Scintigraphy (SRS) at diagnosis of

Digestive Neuroendocrine Neoplasms (DNENs) helps to select pts fortherapy with somatostatin analogs, but its role in follow-up is unclear.

Aim: To compare, in a series of sporadic pancreatic (PNENs) and intestinalNENs (INENs), sensitivity and specificity of SRS and CTscan (CT) in detectingprogressive disease (PD) (RECIST criteria) and presence of metastases.

Methods: retrospective analysis of consecutive PNENs and INENs pts,positive at SRS (1995-2011). After diagnosis, CT was usually repeated every6 months, SRS yearly. Follow-up time was divided into 12 month-units,analyzed separately, in which pts had at least 1 CT and 1 SRS. Sensitivityand specificity were compared by McNemar test (P< 0.05).

Results: 91 pts (39 M, median age 53): 41 PNENs, 50 INENs. MedianKi67 3%. Total observation units: 280 (median 3). Median progression-freesurvival: 44 months. PD detection (SRS vs CT): sensitivity 35.8% vs 97.4% (P<0.001), specificity 95.7% vs 97.8% (P¼0.6). IPD as size increase (SRS vs CT):sensitivity 10.5% vs 94.7% (P<0.001), specificity 98% vs 100% (P¼0.2). PD aslesions’ number increase (SRS vs CT): sensitivity 41.3% vs 96.8% (P<0.001),specificity 98.2% vs 98.2% (p¼1). Liver lesions detection (SRS vs CT): sen-sitivity 79% vs 97.9% (P<0.001); specificity 97.4% vs 99.1% (P¼0.6). Lymphnodal metastases detection (SRS vs CT): sensitivity 28.8% vs 94.9%(P<0.001); specificity 97.5% vs 99.5% (P¼0.2). Extra-abdominal lesionsdetection (SRS vs CT): sensitivity 50% vs 86.4% (P¼0.05); specificity 97.9%vs 99.6% (P¼0.2).

Conclusions: In DNENs, SRS has a pivotal role at diagnosis to decidetherapy, but in follow-up CT may be sufficient.

P152.

Middle-segment preserving subtotal pancreatectomy for treatingmultifocal lesions in pancreas

Y. Miao, Z. Qian, C. Dai, K. Jiang, J. Wu, W. Gao, Q. Li, F. Guo, J. Chen,J. Wei, Z. Lu.

Department of General Surgery, The First Affiliated Hospital of NanjingMedical University, Nanjing, ChinaBackground: Middle-segment preserving subtotal pancreatectomy

(MPSTP) was regarded as a reasonable choice for treating multifocal body-sparing lesions of the pancreas in benign or low-grade malignant disease.

Aims: To investigate the short-term outcomes, especially its effect onendocrine function of pancreas after this organ-preserving procedure.

Methods: From September 2011 to May 2012, five patients underwentMPSTP in our institution, a high-volume center in China. Perioperativedata were retrospectively analyzed.

Results: Patients were 3 women and 2 men, with a median age of 50year-old (37-81 year-old). One patient had past history of diabetes. Pre-operative CT examinations revealed multicentric lesions located in headand tail of the pancreas. Four patients underwent pylorus-preservingpancreaticoduodenectomywith distal pancreatectomy (DP), including twowith spleen additionally reserved. The other patient underwent Beger'sprocedure and spleen-preserving DP. Median operation time and esti-mated intraoperative blood loss were 330min (250-600min) and 800mL(400-5500mL), respectively. Pathologic examination demonstrated threecases of metastatic lesions (renal clear cell carcinoma, dermatofi-brosarcoma protuberans, and malignant pheochromocytoma) to the pan-creas, one chronic pancreatitis and one neuroendocrine tumor.Postoperative complications included two cases of pancreatic fistula, threedelayed gastric emptying, one abdominal fluid collection and one pleuraleffusion. Follow-up studies revealed deteriorated diabetic status in onepatient, and the rest four kept well-controlled serum glucose level withoutany medication. No symptoms of hypoglycemia was identified.

Abstracts / Pancreate54

Conclusion: MPSTP is a safe and feasible procedure for benign or low-grade malignant multifocal lesions in pancreas, while for most important,patients seem to have a more stable serum glucose level after surgery.

P153.

Surgical management of stenotic pancreaticojejunostomy after pan-creatic surgery

Y.Miao, Z. Qian, C. Dai, K. Jiang, J.Wu,W. Gao, Q. Li, F. Guo, J. Chen, J.Wei, Z. Lu.

Department of General Surgery, The First Affiliated Hospital of NanjingMedical University, Nanjing, ChinaBackground: Stenosis of pancreaticojejunostomy (P-J) is one of the

long-term complications after pancreatic surgery with pancreaticojejunalanastomosis. As patients with long-term survival increase, this complica-tion increasingly draws people's interests.

Aims: To introduce a simple and effective surgical intervention for P-Jstenosis.

Methods: Two patients with past history of pancreatic resection wereidentified with P-J stricture. Laparotomy was carried out and P-J waspartially re-did to restore patency of the anastomosis.

Results: Repeated onset of pancreatitis was the chief complaint of bothpatients. The original pancreatic surgeries are pancreaticoduodenectomyandmiddle segment pancreatectomy for benign conditions. Preoperative CTexaminations showed a dilatedWirsung's ductwithout identifiable mass orstones. The P-J was partially cut open at the anterior aspect of the anasto-mosis, leaving the posterior side intact. Stricture at the side of pancreaticstumpwas incised to expose the dilated duct, and a compatible openingwasmade at the jejunal side. After ruling out recurrence by frozen section,a partially new-made P-J was accomplished by placing stitches betweenpancreatic parenchyma and full thickness of jejunal wall. The pancreaticduct and jejunal mucosa should be diligently approximated together. Fol-low-up studies showed no recurrent symptoms after the second surgery.

Conclusion: P-J stenosis is not a rare complication after pan-creaticojejunal anastomosis. Surgery remains a safe and reliable method inrelieving the anastomotic stricture. We thought our choice of partialreconstruction of the P-J anastomosis will effectively diminish the stenosiswhile simplify the surgery to the maximum extent.

P154.

1010 consecutive cases of pancreaticoduodenectomy

Y. Miao, Z. Xu, Z. Qian, C. Dai, K. Jiang, J. Wu, W. Gao, Q. Li, F. Guo,J. Chen, J. Wei, Z. Lu.

Department of General Surgery, The First Affiliated Hospital of NanjingMedical University, Nanjing, ChinaBackground: Pancreaticoduodenectomy (PD) is one of the most chal-

lenging procedures in general surgery. Better outcomes were reported inexperienced hands and in high-volume centers.

Aim: To investigate short- and long-term outcomes after PD for peri-ampullary lesions in a tertiary teaching hospital in China.

Methods: From January 1986 to April 2012, 1010 patients underwentopen PD in our hospital, including 711 cases of classic PD and 299 pylorus-preserving PD (PPPD). Thirty-seven cases were combined with resection ofadditional organs or major vessels. Data were reviewed and analyzed inretrospective way.

Results: There were 612 male and 398 female patients in this group,with mean age of 57.3�11.8 year-old. The most common pathologicaldiagnosis were pancreatic adenocarcinomas (392/1010, 38.8%), ampullaryadenocarcinomas (262/1010, 25.9%) and duodenal adenocarcinomas (144/1010, 14.3%). Intraoperative data showed a mean operation time of312�73min and a mean estimated blood loss of 575�307mL. The mostfrequent postoperative complications were grade B+C delayed gastricemptying (226/1010, 22.4%), hemorrhage (102/1010, 10.1%), pancreaticfistula (101/1010, 10%), chyle fistula (71/1010, 7.0%), and intraabdominal