Abstracts / PancreatologS112

of AKT, a pro-survival kinase that may promote resistance to RAD001. Thus,PI3K may represent a novel potential therapeutic target for PETs.

Aims: Identification of novel therapy that overcomes resistance toRAD001 treatment.

Patients & methods: Western Blot to analyze PI3K/AKT/mTOR path-way; Colony Assay to analyze cell survival; Protein Synthesis Assay and 7-mGTP Cap Assay to evaluate protein synthesis.

Results: We tested the impact of novel PI3K inhibitors (BEZ235,BKM120 and BYL719) on cell proliferation and survival in two PET cell lines:BON-1 (responsive to RAD001) and QGP-1 (unresponsive to RAD001).BEZ235 was the most efficient drug in inhibiting PET cell proliferation.Furthermore, combination of BEZ235 with RAD001 exhibited additiveeffects on cell survival. Combined therapy was effective also in BON-1 thatacquired resistance to RAD001 after a chronic exposure to this inhibitor(BON-1 RR). Finally, we found that combined therapy was more efficientthan single agents in inhibiting the PI3K/AKT/mTOR axis.

Conclusion: Co-treatment with RAD001 and BEZ235 may represent asuitable therapy to counteract primary and acquired resistance to RAD001 inPETs.

F-086.

Laparoscopic distal pancreatectomy: Analysis of trends in surgicaltechniques, patient selection, and outcomes.

Giuseppe Malleo, Giovanni Marchegiani, Isacco Damoli, AlessandroEsposito, Tiziana Marchese, Roberto Salvia, Claudio Bassi, GiovanniButturini

Department of Surgery, The Pancreas Institute, University of VeronaHospital Trust, Italy

Background: Laparoscopic distal pancreatectomy (LDP) is increasinglybeing performed.

Aims: This study analyzed the time trends of demographic, operative,and pathologic variables, assessed the parameters potentially related to thelearning curve, and evaluated the long-term outcomes.

Patients & methods: LDP performed between 1999 and 2012 wereincluded in the study. The time trends were studied categorizing theoperative sequence in three equal groups, and the parameters related to thelearning curve were assessed using local regression techniques. All theanalyses were stratified by operation type (associated splenectomy vs.spleen-preserving procedures).

Results: The study population consisted of 100 patients. There were 57LDP with associated splenectomy and 41 spleen-preserving LDP, con-versionwas necessary in 2 cases. The time trend analysis showed that therewas not a tendency towards broadening the indications or selecting moredifficult cases. Similarly, the study of the learning curve components didnot show any variation over time. Only 78.9% of splenectomized patientsreceived prophylactic vaccinations, and one unvaccinated patient devel-oped an overwhelming post-splenectomy infection. At a median follow-upof 72.5 months the incidence of newly diagnosed diabetes was 13%, while21.6% of patients undergoing spleen-preserving LDP developed gastric andperigastric varices.

Conclusion: We weren’t able to identify parameters related to thepatient selection process and to the learning curve in LDP. These aremultidimensional phenomena that can be hardly inferred by singlemetrics. In the long-term, the results were satisfactory. The possibility ofserious infections following splenectomy has to be taken into account,such that a strict adherence to vaccine protocols is strongly recom-mended.

F-087.

Sixty total laparoscopic pancreaticoduodenectomies

Khatkov Igor, Tsvirkun Victor, Izrailov Roman, Tyutyunnik Pavel,Atroshchenko Andrey, Feydorov Ilia, Khisamov Artur, Andrianov Aleksey

MCSC, Russia

Background: Nowadays progress in pancreatic surgery is related withsuccessful applying of minimally invasive technology for periampullarearea’s cancer patients. Total laparoscopic pancreaticoduodenectomy (LPD)is still technically challenging. As a result just several centers in the worldhave experience more than 30 e 40 procedures.

Aims: to estimate our results of performing LPDPatients&methods: Single surgical team performed all procedures. 60

patients underwent LPD. There were 37 females and 23 males. Mean agewas 59,09 (range, 45-76) years. In a retrospective study we analyzed themain outcome measures: conversion rate, blood loss, operative time,length of hospital stay, number of lymph nodes, TNM stage, postoperativemorbidity and mortality.

Results:Median operative timewas 445min (range, 255e705min) andmedian blood loss was 300ml (range, 10 e 2100 ml). Diagnosis: benign andmalignant 6,6% (n¼4) and 93,4% (n¼56) respectively. The final pathologyexamination results: Pancreatic adenocarcinoma (n-51), seal ring cancer1,6% (n¼1), indifferent cancer 3,3% (n¼2), neuroendocrine tumor of theduodenum 1,6% (n¼1), chronic pancreatitis 3,3% (n¼2). Mean number oflymph nodes e 19. TNM: I e 30%; II e 46,1%; III e 17,3%. The complicationrate (Clavien-Dindo Classification) 38,3%: I or II e 11,6%; IIIA e 13,3%; IIIB e

6,6%; IV e 1,6%; V e 5%. Resected margins were positive in three cases.Conclusion: Laparoscopic approach permits to perform pan-

creaticoduodenectomy as open procedure. Time of procedure is decreasingwith growing of experience.

y 14 (2014) S1eS129

F-088.

Laparoscopic spleen-preserving distal pancreatectomy: Our techni-ques and outcomes

Hajime Matsushima, Tomohiko Adachi, Amane Kitasato, MasatakaHirabaru, Masaaki Hidaka, Akihiko Soyama, Kengo Kanetaka, MitsuhisaTakatsuki, Tamotsu Kuroki, Susumu Eguchi

Department of Surgery, Nagasaki University Graduate School ofBiomedical Sciences, Japan

Background: We select two procedures, Warshaw technique (WT) orsplenic vessels preservation procedure (SVP) for laparoscopic spleen-pre-serving distal pancreatectomy (LSPDP) according to the location andmalignant degree of pancreas tumors. In cases the tumor close to splenicvessels, WT is selected.

Aims: This study aimed to analyze the safety of each procedure, espe-cially regarding long-term outcomes.

Patients & methods: In both procedures, the pancreas was mobilizedfrom the median toward the splenic hilum following the dissection ofpancreas. In WT, the splenocolic ligament and left gastroepiploic vesselswere preserved as well as the short gastric vessels. The splenic circulationwas confirmed using laparoscopic ultrasonography. Between September2005 and January 2014, a total of 25 (7 males) patients diagnosed withbenign or low malignant tumors underwent WT (n¼18) or SVP (n¼7).

Results: The mean periods of postoperativemonitoring was 42months.The mean operative time, blood loss, and hospital stay inWT/SVP were 310