Abstracts / Pancreatology 13 (2013) S2–S98 S87

Conclusion: The preoperative CT-based risk assessment and theintraoperative assessment done by experienced pancreatic surgeons hadcomparable POPF-predictive impacts.

PII-117 Abstract id: 130.

Change in attitudes of surgical leaders regarding a national concen-tration of Whipples

Juhani Sand 1, Johanna Laukkarinen 2, Isto Nordback 2.

1Division of Surgery, Gastroenterology and Oncology, TampereUniversity Hospital, Finland2Department of Gastroenterology and Alimentary Tract Surgery,Tampere University Hospital, Finland

Introduction: In 1990-94, we found in a nationwide survey in Finlandbased on individual patient records that hospital mortality and re-opera-tions were independently associated with annual hospital volumes. Afterthat we have repeatedly promoted the centralization of Whipples.

Aims: To analyze current attitudes of surgical leaders, the centraliza-tion and the national results of Whipples.

Materials & methods: The same questionnaire was send to all surgicalleaders in the country in 2002 and 2012.Whipples and hospital mortalitiesin different hospitals were searched from national databases in 2000-2001and 2010-2011 and compared to the earlier results.

Results: 93% of the surgical chiefs in 2002, compared to 100% in2012 were aware about the international results. 75% compared to 77%were aware about the similar national results. Centralization to all oronly few university hospitals increased popularity in the attitudes (69%vs. 96%; p<0.05). Centralization has occurred slowly in Finland, withlow nationwide hospital mortality (1990-1994 10%, 2001-10 4%, 2010-11 3%). Hospital mortality has remained lowest in the highest volumehospitals. Hospital mortality in volume >10/yr hospitals was 2%, 2%and 4% (in 1990-1994, 2001-10 and 2010-11) compared to 13%, 8% and5 % in voume <5/yr hospitals. The 150 annual operations in 2010-11were performed in 14 hospitals (compared to 24 hospitals for 110annual operations in 2000-2001 and 33 hospitals for 70 annual oper-ations in 1990-94) In 2011, 55% of the operations were performed intwo hospitals.

Conclusion:Despite good knowledge of benefits and favorable attitudein questionnaires, national centralization is a very slow process in a largeEuropean country with sparse population.

PII-118 Abstract id: 193.

Bleeding following pancreatic fistula is the leading cause for earlymortality after pancreatic resections

John Blomberg, Elena Rangelova, Christoph Ansorge, Marco DelChiaro, Ralf Segersv€ard.

Karolinska University Hospital, Sweden

Introduction: High volume centers today report <5 % so called 30-day or sometimes "in-hospital" mortality. However, the true post-operative mortality rate may be obscured by long hospital stays, latereadmissions due to complications, or when patients are transferred tother institutions.

Aims: The aim was to evaluate 90-day postoperative mortality andunderlying cause of death.

Patients & methods: All patients undergone pancreatic resection be-tween 2004-11 (n¼601) were retrieved from our prospective register: 433pancreaticoduodenectomies (PD), 113 distal (DP), and 55 total pancrea-tectomies (TP). Dates of death were retrieved from the Swedish populationregistry and the cause of death retrospectively analyzed from hospitalrecords.

Results: In total 27 patients (4.5%) died after pancreatic resectionswithin 90 days. According to type of resection the 30-, 60-, and 90-daymortality was 3.0 %, 3.2 %, and 4.3 % respectively after PD, 0.9 %, 2.7 %, 3.5 %

after DP, and 7.2 % after TP. Of 23 patients dying within 90 days after partialresection, 18 (78%) had a postoperative pancreatic fistula (POPF), and in 12(67%) of these an intraabdominal and/or gastrointestinal bleeding was thecause of death. Bleeding as the cause of death without POPF was observedin 2 out of 9 patients (22%).

Conclusion: POPF is the leading cause of death, mainly due to sec-ondary fatal bleeding. Efforts to decrease the incidence of POPF and to earlydiagnose and intervene on signs of bleeding are essential to decreasemortality after pancreatic surgery.

PII-119 Abstract id: 65.

Is the pancreaticoduodenectomy for cancer in cirrhotic patientsreasonable? Case-control study from the Surgical French Associationreport for pancreatic surgery 2010

Jean-Marc Regimbeau 1, Lionel Rebibo 1, Safi Dokmak 2, Jean-MarieBoher 3, Alain Sauvanet 2, Xavier Chopin-Laly 4, MustaphaAdham 4, Mickael Lesurtel 5, Jean-Marc Bigourdan 4, St�ephanieTruant 6, François-Ren�e Pruvot 6, François-Ren�e Paye 7, PhilippeBachellier 8, Jean-Robert Delpero 3.

1 CHU Amiens, France2 CHU Beaujon, France3 CHU Marseille, France4 CHU Lyon, France5 ZURICH, Switzerland6 CHU Lille, France7 CHU Saint-Antoine, France8 CHU Strasbourg, France

Introduction: The pancreaticoduodenectomy (PD) is the efficienttreatment to obtain long-term survival for adenocarcinoma of thepancreatic head (APH). The presence of cirrhosis is usually considered acontraindication for surgery based on old data.

Aims: The objective of this study was to evaluate postoperative out-comes of PD for APH in cirrhotic patients compared to non cirrhotic.

Materials & methods: It was a French retrospective multicenter studyin patients with APHwith cirrhosis during the period from January 2004 toMarch 2012. Matching on demographic criteria in 2: 1 with patients withAPH but non-cirrhotic from Surgical French Association report 2010 wasconducted among a selection of 1886 patients. We compared these 2groups in terms of postoperative morbidity and mortality, specific andnon-specific complications, and the overall survival rate.

Results: 32 cirrhotic patients were matched with 64 non-cirrhoticpatients. Mean age was 62.1 years. 81.2% of patients in the cirrhosis wereChild A. The overall complication rate was respectively 84.3% vs. 40.6% (p�0.001). The pancreatic fistula rate was 9.3% vs. 6.2% (NS). Fifteen patientsdeveloped specific complication of cirrhosis (46.8%) including 5 liverdecompensation. The postoperative mortality rate was 15.6% vs. 4.7% (NS).The major complication rate (Clavien �3) was 50% vs. 22.2% (p� 0.05). Therecurrence rate was 28.1% vs. 48% (NS). Mean follow-up was 13.8 vs. 13months (NS). Mean overall survival was 24 vs. 23 months (NS).

Conclusion: PD for APH in cirrhotic patients is feasible, but with anincreased risk of complications not specific to pancreatic surgery, but tocirrhosis.

PII-120 Abstract id: 285.

Pylorus resection in partial pancreatico-duodenectomy: Impact ondelayed gastric emptying

Thilo Hackert, Ulf Hinz, Stefan Fritz, Werner Hartwig, LutzSchneider, Oliver Strobel, Jens Werner, Markus B€uchler.

Dept. Of Surgery, University of Heidelberg, Germany

Introduction: Partial pancreatico-duodenectomy (PD) as the standardtreatment for pancreatic head pathologies is complicated by postoperativedelayed gastric emptying (DGE) in up to 45% of all patients.