Intraductal low papillary carcinoma (ILPC) without mass

s / Pancreatology 13 (2013) S2–S98 S48 ampullary carcinoma or carcinoma of the distal common bile duct from January 2011 to June 2012. End-to-side pancreaticogastrostomy was performed with insertion of pancreatic remnant through posterior gastric wall. Pancreatic remnant was fixed using single-layer purse string suture and additional sutures between pancreatic capsule and stomachwall. In all cases pancreatic remnant was soft with diameter of pancreatic duct up to 3mm. Results: Among 20 patients who underwent PD overall morbidity rate was 35%, mortality rate was 0%, with pancreatic fistula in 30% of patients (Grade A and B 20%; Grade C 10%) according to the International study group for pancreatic fistula classification. Conclusion: Pancreaticojejunostomy is still widely used method of reconstruction after pancreaticoduodenectomy, and pancreaticogastrostomy is yet to prove itself to be a valid alternative. Our initial experiences shows that PGA is safe and easy to perform, but further analysis and larger group of patients are needed in order to establish difference in postoperative pancreatic fistula formation between PG and PJ. Also, further randomized controlled studies are necessary in order to determine the best pancreaticoenteric anastomosis after pancreaticoduodenectomy. PI-102 Abstract id: 45. Pancreatojejunostomy with purse-string suture DezsT Kelemen, R obert Papp, Andr as Vereczkei. Department of Surgery, School of Medicine, University of P ecs, P ecs, Hungary Introduction: During the last decades operative mortality following pancreatic resections has considerably decreased. However pancreatic fistula is still one of the leading surgical complications, especially in case of pancreatojejunal anastomoses made with fragile pancreatic remnant. Aims: The authors investigated a modification of pancreatojejunostomy created with purse-string suture. The rationale of this method is to avoid extraluminal stitches put into the pancreas, which could be the possible origin of leakage of pancreatic juice. Patients & methods: The technique was applied at 8 patients, who were operated on radically for malignant pancreatic head or periampullary tumours. Pylorus-preserving Whipple procedure was preferred. End-toside pancreatojejunal anastomoses were performed with a single 3/0 PDS purse-string suture and with 4-5 additional fixation stitches. None of the latter ones were put into the external surface of the pancreatic parenchyma. Stenting of the main pancreatic duct was also applied in case of narrow duct and friable pancreas. Results: In the postoperative period one wound infection and one gastrointestinal bleeding from duodenojejunal anastomotic ulcer occurred. However the rate of pancreatic fistula-related morbidity was advantageous, compared to the previously used technique. Conclusion: Though this series is small, first experiences are encouraging. The method seems to be safe, easy to perform and it spares suture material. PI-103 Abstract id: 27. Intraductal low papillary carcinoma (ILPC) without mass Koji Yoshida , Toshiyasu Iwao , Yoshihiro Nakashima , Yamato Tada . 1 Kawasaki medical school, Japan Advanced Research Institute of Gastorenterologial Imagings, Japan Aizu Central Hospital, Japan Introduction: The remarkable progress of imaging modality makes it possible to detect small tumor, but cannot improve poor prognosis of pancreatic adenocarcinoma. Even in small pancreatic cancer, mostly it is advanced cancer. Aims: To improve its prognosis, it is necessary to diagnose in earlier stage, carcinoma in situ (CIS) or minute invasion (MI) to stroma before forming mass. Patients & methods: We treated 15 patients of early pancreatic cancer, 11 patients were CIS and 4 were MI. In all of 15 patients intraductal porion of caicinoma were widely spreading and low papillary lesion which has little mucin and litlle worrisome features of IPMN: 1) cyst 3cm, 2) thickened/enhancing cyst walls, 3) main duct size 5-9 mm, etc (international consensus guidelines 2012 for the management of IPMN and MCN). Results: This report presents the features of intraductal low papillary carcinoma (ILPC, n1⁄415). In 7 of the 15 patients tumor was located in the head of pancreas. 11 patients were asymptomatic and suspected pancreatic disease during the follow-up of other diseases (n1⁄47), on routine medical check up (n1⁄43). 8 of 11 CIS and all of MI patients have dilatation of branch pancreatic duct, which is detectable with imaging modality. Microscopic examination reveals that stromal fibrosis exists around carcinoma, even in CIS. Only in 4 patients diagnosis were confimed at first attempt of cytological examination. In remaining 11 patients more cytological examination was required. Conclusion: To detect ILPC, a thorough examination of pancreatography must be required in patients with slightly abnormal findings on imaging modalities. PI-104 Abstract id: 259. Primary clear cell carcinoma of exocrine pancreas Claudio Pasquali, Anna Caterina Milanetto, Lucia Moletta, Valbona Lico, Loredana Iaria, Rita Alaggio, Cosimo Sperti, Sergio Pedrazzoli. University of Padua, Italy Introduction: According to WHO classification, primary clear cell carcinoma of the pancreas is rare and is classified as a “miscellaneous” carcinoma. There is not an adequate systematic overview of this entity and the few reports lack detailed morphological and immunohistochemical data. Aims: To present a case of clear cell carcinoma of the pancreas with a single hepatic metastasis observed in 2009 in our Department. Patients & methods: A 65-year-old man presented with dyspepsia, a feeling of epigastric mass and high serum amylase. US showed a hypoechoic mass of the pancreatic head (3 cm), confirmed by abdominal MRI, which also detected two solid hepatic lesions. At 18FDG-PET the pancreatic mass had an increased tracer uptake (SUVmax 9.2). CA19-9 was 1726 kU/L. The patient underwent a palliative biliary and gastric bypass surgery and excision of one liver secondary. Results: Histology of the hepatic lesion showed a metastasis of a clear cell adenocarcinoma. The patient received palliative radiotherapy and chemotherapy (Gemcitabine and Carboplatin) and died 23 months later for disease progression. Conclusion: Only few cases of clear cell carcinoma have been reported in the English literature. Clinical features and survival data were not significantly different from that of ductal adenocarcinoma. PI-105 Abstract id: 151. Total laparoscopic pancreaticoduodenectomy for patients with tumor of the head of the pancreas and periampullare area Igor Khatkov , Viktor Tsvirkun , Roman Izrailov , Pavel Tyutyunnik . Moscow Scientific Research Institute of Gastroenterology. The Chair of Faculty Surgery of Moscow State University, Russia 2 Clinical hospital number 119, Moscow, Russia 3 Chair of Faculty Surgery of Moscow State University of Medicine and Dentistry, Russia