Əsas səhifə Pancreatology The outpatient activity of a Macmillan pancreatic clinical nurse specialist in a tertiary...
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Abstracts / Pancreatology 13 (2013) e1–e20 P22. Investigating the prognostic value of venous and arterial invasion in pancreatic ductal adenocarcinoma with elastica van gieson staining N.I.J. Chan, A.K. Foulis, T. Harvey, C. Orange, C. Nixon, N.B. Jamieson. West of Scotland Pancreatic Unit, Glasgow University Department of Surgery and Pathology, Glasgow Royal Inﬁrmary, Alexandra Parade, Glasgow, UK Category: Malignant Background: Microvascular invasion in pancreatic ductal adenocarcinoma (PDAC) is known to be a poor prognostic indicator and risk of metastasis. Recent studies have highlighted the discrepancy in reporting vascular invasion and the need of improved techniques. Aims: To determine whether the standard detection rate of vascular invasion by means of haematoxylin and eosin (H&E) staining in PDAC can be enhanced by the use of elastica van Gieson (EVG), allowing the detection of vascular invasion to be performed more easily and be more comprehensive. To assess prognostic implications of enhanced vascular invasion detection on prediction of cancer-speciﬁc survival in PDAC. Methods: Retrospective analysis of 42 patients with PDAC who had undergone a pancreatico-duodenectomy with curative intent between 2001 – 2008 was performed. Serial sections were stained with H&E and EVG respectively. The incidence of venous and arterial invasion was recorded and compared between the two stains. Results: Venous invasion was identiﬁed in 24 patients (57%) with H&E compared to 37 patients (88%) with EVG. Arterial invasion was identiﬁed in 7 patients (17%) with H&E compared to 29 patients (69%) with EVG. Conclusions: The use of EVG in PDAC resulted in a signiﬁcantly higher rate of venous and arterial invasion to be identiﬁed. The presence of arterial invasion resulted in a signiﬁcantly improved prediction of overall survival when compared to routine H&E assessment. The study provides good evidence that EVG staining should be tested prospectively by incorporation into the pathological assessment of; venous and arterial invasion in patients undergoing potentially curative resection of PDAC. Take-home message: The use of an elastica van Gieson stain in pancreatic ductal adenocarinoma resulted in a signiﬁcantly higher rate of venous and arterial invasion to be identiﬁed compared to routine H&E staining. The presence of arterial invasion using the elastica stain resulted in a signiﬁcantly improved prediction of cancer-speciﬁc survival when compared to routine H&E staining. Abstract previously presented? yes (West of Scotland Surgical Association) Any disclosures? no () P23. The outpatient activity of a Macmillan pancreatic clinical nurse specialist in a tertiary pancreatic unit Mr.Philip Anthony Whelan BSC (Hons). Macmillan Nurse Pancreatic Specialist Unit, Royal Liverpool and Broadgreen University Teaching Hospital, United Kingdom Category: Malignant Background: The Clinical Nurse Specialist (CNS) plays a major role in the management of pancreatic cancer patients at all stages during their cancer journey. Since 2010 the CNS has had their own outpatient clinic template for the review of patients. Aim: To evaluate the outpatient activity of the Macmillan Pancreatic CNS in a tertiary Pancreatic Unit over a 6 month period. e13 Methods: An audit was undertaken of all patients reviewed in clinic by the CNS. Outcome data included demographics, tumour type, type of consultation, time of consultation, medications prescribed, referrals made, written information provided and tests ordered. Data was collected prospectively and analysed using EXCEL. Results: A total of 206 patients (61% male, median time of review 35 minutes, range 10 – 90 minutes) were seen in 42 outpatient clinics between March and August 2012. 155 patients (75%) were seen alone by the CNS. 95 (67%) of these patients were post-operative follow ups. The remaining 60 patients were inoperable, receiving palliative treatment and supportive care. 15 patients had a new inoperable cancer or diagnoses of recurrence. 80 patients (52%) required referrals to other services, 92 (59%) required medication changes and 110 (71%) required further investigations all of which were instigated by the CNS. 51 (25%) patients were seen after a clinician. The majority (72%) being new surgical patients Conclusion: The CNS has been found to take on increased responsibilities for post-operative surgical patients and patients undergoing palliative treatment and supportive care allowing the surgeon to better utilise their own clinic time. Take-home message: The CNS is an autonomous advanced practitioner who has a vital role to play in the complex management of patients with pancreatic cancer particularly as their care needs shift from potentially curative surgical treatment to supportive/ palliative care. Abstract previously presented? no () Any disclosures? no () P24. Pancreatoduodenal trauma in the UK Derek A. O'Reilly 1, 2, Deep J. Malde 1, Omar Bouamra 2, 3, Ambareen Kausar 1, Fiona Lecky 2, 3. 1 Department of Surgery, North Manchester General Hospital, UK The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK 3 Trauma Audit and Research Network (TARN), UK 2 Category: Benign and Inﬂammatory Background: The aim of this study was to assess the incidence, mechanisms of injury, initial operation rates and outcome of patients who sustained pancreatoduodenal (PD) trauma in the UK from a large trauma registry, over the period 1989-2011. Methods: The Trauma Audit and Research Network (TARN) database was searched for details of any patient with blunt or penetrating trauma to the pancreas, duodenum or both. Results: 889 of 350,000 (0.25%) trauma cases sustained PD trauma. Median age was 27 (IQR: 16-45) for blunt trauma and 28 (IQR: 21-40) for penetrating trauma. The male to female ratio was 2.6:1. Blunt trauma was the commonest type of injury seen, with a ratio of blunt to penetrating PD injury of 3.2:1. Road trafﬁc collision was the commonest mechanism of injury, accounting for 509 (57.3%) of cases. The Injury severity scores (ISS) were 25 (IQR: 16-35) for blunt trauma and 16 (IQR: 9-22) for penetrating trauma. The mortality rate for blunt PD trauma was 19.0%; it was 14.2% for penetrating PD trauma. Variables predicting mortality after pancreatic trauma were: increasing age, ISS, haemodynamic compromise and having undergone an operation. Conclusion: Pancreatic trauma is uncommon. The high proportion of cases due to blunt trauma differs from that of series from the USA and South Africa. Mortality is high in the UK but comparison with surgical series is difﬁcult because of selection bias in the latter datasets. Isolated pancreatic injuries are uncommon; most co-exist with other injuries. Take-home message: Isolated pancreatic injuries are uncommon; most co-exist with other injuries. Abstract previously presented? no () Any disclosures? no ()