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(>Grade III, 22% vs. 48%, p30 min) were included in a double-blinded RCT at a single tertiary care center (2006-2009). Based on the power calculation, 51 patients received intravenous PTX treatment starting 12hr before until 72hr after surgery, while 50 control patients received a saline infusion. Primary endpoint was liver regeneration as assessed by 3D-volumetry based on MR tomography 8 days postoperatively compared with preoperative images. Transaminases, cytokines and postoperative complications were recorded. Results: Although overall liver regeneration was similar in both groups, PTX showed a beneficial effect on liver regeneration in patients with a low remnant liver volume (remnant-liver-volume/ total-bodyweight ratio RLV/TBW-ratio 30%) failed to identify beneficial effects of PTX although the transaminases levels were decreased. Conclusion: This is the first randomized controlled trial showing beneficial effects of PTX primarily regarding liver regeneration in patients with low remnant liver volume and secondarily concerning I-/Rinjury at the 2nd postoperative day. No effect on postoperative complications could be demonstrated by PTX, might be due to the sample size which was not calculated on patient’s outcome. Therefore, routine use of PXT cannot yet be recommended for liver resection and transplantation. 12.4 Novel and simple preoperative score predicting outcome following liver resection S. Breitenstein, M.-L. De Oliveira, D. Raptis, K. Slankamenac, P. Kambakamba, J. Nerl, P.-A. Clavien (Zurich) Objective: To develop and validate a simple score to predict serious complications following liver resection using readily available pre-operative risk factors. Background: Liver surgery is associated with a substantial rate of complications. Early identification of patients at risk of serious complications is important to adjust therapeutic strategies, to improve quality, and evaluate cost. Methods: Complications were prospectively assessed in 615 consecutive non-cirrhotic patients undergoing liver resection (2002-2008) at one institution. In randomly selected 60% of the population, multivariate logistic regression analysis was used to develop a score to predict severe complications defined as complications grade III, IV and V (according to Clavien/Dindo classification). The new score was validated by calibration within the remaining 40% of the patients. Results: Serious complications occurred in 159 of the 615 patients (26%) after liver resection, 90 (15%) grade III, 48 (8%) grade lV, and 21 (3%) grade V. Four preoperative parameters were identified as independent predictors such as transaminases levels (AST), ASA, extend of liver resection and additional hepatico-jejunostomy. The prediction score was developed involving 369 patients (60%) based on the 4 predictors and ranged from 0 to 10 points. The risk to develop serious postoperative complications was 16% in the “low risk” group (0-2 points), 37% in the “intermediate risk” group (3-5 points) and 60% in the “high risk” group (6-10 points). The predicted mean absolute risk for serious complications was 27% in the validation population (n=246), while the observed risk was 24%. Predicted and observed risks were similar throughout the different risk categories (p=0.8). The score was significantly associated with hospital and ICU stay. Costs of the procedure doubled in the high risk group. Conclusion: This novel and simple score accurately predicts postoperative outcome and cost in patients undergoing liver resection. The use of this score allows early identification of patients at risk of complications and may impact not only on decision-making for surgical intervention but also on quality assessment and reimbursement. 12.5 Portal vein resection at pancreaticoduodenectomy for pancreatic adenocarcinoma: are the outcomes worse? V. Banz 1,2 , D. Croagh 2 , C. Coldham 2 , J. Buckels 2 , J. Isaac 2 , D. Mayer 2 , P. Muiesan 2 , S. Bramhall 2 , D. Mirza 2 ( 1 Berne, 2 Birmingham/UK) 14 swiss knife 2010; 7: special edition Objective: Despite improvements in patient selection, imaging and perioperative care for patients with adenocarcinoma of the pancreas, 5-year survival rates remain low. Surgery and more recently adjuvant chemotherapy provides the only potential cure. Selected patients with partial encasement of the portal vein (PV) undergo simultaneous vein resection at pancreaticoduodenectomy (PD). This study analyses outcomes for PD with or without PV resection in patients with pancreatic ductal adenocarcinoma (PDA). Methods: A retrospective analysis of prospectively collected data on patients requiring PD for histologically proven adenocarcinoma between 1/1997 and 9/2009 identified 326 patients with PDA, 51 (15.6%) of whom required PD with PV resection. Patients with cholangiocarcinoma, duodenal and ampullary carcinoma were excluded. Patients were analysed in two groups: PD+PV resection vs. PD alone. Multivariate analysis was used to identify predictive variables (age, gender, hospital and ITU stay, pylorus preserving or not, blood product use, postoperative complications, tumour grade, stage and size, resection margin and site, lymphnode status, histological involvement of resected PV) influencing survival. The Kaplan-Meier method was used to estimate patient survival after surgery. Results: Mean age for patients with PV resection was 66.4 (range 46-80) years, 47% were male. Both groups had similar patient demographics, perioperative and tumour characteristics. Postoperative morbidity rates were similar for patients with and without PV resection (27.5 vs. 28.4%, p=0.287). 30day mortality was significantly higher in patients with PV resection (13.7%, n=7) vs. PD alone (5.1%, n=14), p=0.021. Overall survival however was similar in both groups (median survival PD alone 14.8 months vs. 14.5 months PD+PV, p=0.411). Multivariate analysis identified age (p=0.048), tumour grading (p=0.046) and stay on the intensive care unit (p
time-efficient all-in-one 3D visualization of the vascular and biliary trees of the liver, enhancing the preoperative planning in hepatobiliary surgery. 12.8 Long term outcome after liver resection for giant HCC larger than 10 cm P. Allemann, A. Tempia, N. Demartines, N. Halkic (Lausanne) Objective: The outcome of both liver transplantation and interventional radiology as treatments for Hepatocellular Carcinomas (HCC) is improved and validated. However, these therapeutic options remains limited for tumors larger than 10cm and those patients are seen with an increased frequency in Hepatobiliary consultations to discuss resection. Currently, few data are available on long-term outcome after liver resection for giant HCC and the management of such tumors remains controversial. The aim of the present study was to evaluate the long-term survival and the time to recurrence after liver resection for giant HCC. Methods: From January 1995 to December 2009, 145 consecutive patients underwent liver resection for HCC in our department. A retrospective analysis of our prospective database was performed on all HCCs larger than 10cm, confirmed by anatomopathology. A total of 25 patients fulfilled this criteria and were included in the study. Three patients were excluded: two due to mixed pathological pattern (HCC and cholangiocarcinoma) and one due to incomplete data. A total of 22 patients were included in the final analysis. Results: The median age was 72 years (range 36-88) and the men:women ratio was 8:3. Cirrhosis was present in 41% of the patients (four Hepatitis B Virus, two Hepatitis C Virus and three alcoholic cirrhosis), all in CHILD A stage. A biopsy was performed in 27%, with a sensitivity of 83%. Preoperative treatments were conducted in 45% (five portal embolisation and five arterial chemo-embolisation). The median tumor size was 13cm (range 10-21). A median of four liver segments (range 1-6) were resected (82% of major resection) with a median operative time of 212 minutes (range 115-480). A R0 resection was achieved in 100% of patients. The in-hospital mortality at 30 days was 0% and the morbidity rate was 18%. The median follow-up was 57 month (range 2-187). Recurrence was observed in 10 patients (45%) at a median time of 15 month (range 6-34). Of these patients, two were treated with interventional radiology and two were re-operated. At the time of the analysis, 65% of patients were alive, free of disease. The 5-years survival was 45% and the 10-years survival was 18%. Conclusion: Our limited serie suggest that liver resection may achieve good long-term survival and disease-free survival in patients with giant HCC larger than 10cm. 12.9 Early octreotide therapy significantly mitigates the severity of postoperative pancreatic fistula R. A. Droeser, M. R. Moussavian, P. Jeanmonod, A. Schmid, O. Kollmar, S. Richter, M. K. Schilling (Homburg Saar/DE) Objective: A number of prospective randomized trials indicate that prophylactic octreotide treatment does not decrease the incidence of postoperative pancreatic fistula (POPF, defined according to ISGPF criteria). We here study if early postoperative octreotide treatment (within the first 3 postoperative days) decreases the severity of POPF in developing fistula (defined as high lipase output on postoperative day 3). Methods: Between 2001 and 2008, 95 out of 684 patients undergoing pancreatic resection developed a POPF. In 33 patients fistula treatment was attempted with octreotide (300μg/d). Lipase activity in the pancreatic drainage was measured before start of treatment as well as on postoperative day 3, 5 and 7. Also lipase activity in the pancreatic drainage was measured in patients with a pancreatic fistula not receiving octreotide. For analysis lipase activity at POD5 and POD7 was normalized to POD3. Results: [Lipase]POD5/[Lipase]POD3 on POD 5 was 0.91 ± 0.17 for the octreotide group versus 0.97 ± 0.15 for the control group. On POD7, [Lipase]POD7/[Lipase]POD3 was 0.54 ± 0.07 in the octreotide group and 0.95 ± 0.16 (p
Page 1 and 2: Abstracts 97. Jahreskongress der Sc
Page 3 and 4: Der Jahreskongress der Chirurgische
Page 5 and 6: Abstracts Session Topic Page 02 Vis
Page 7 and 8: Visceral Surgery - Cholecystitis &
Page 9 and 10: performed were recorded. Descriptiv
Page 11 and 12: avec délai dans le diagnostic, ang
Page 13: group (conventional: n=13, RS=1.8 +
Page 17 and 18: (CHI=54 [6.49%]; SWI=27[4.98%]) wer
Page 19 and 20: Conclusion: Both procedures markedl
Page 21 and 22: 22.7 Transplantation of kidneys fro
Page 23 and 24: of the remaining 40 patients with a
Page 25 and 26: and 6/2009 and were prospectively f
Page 27 and 28: Conclusion: In our patient cohort,
Page 29 and 30: plantation. With the introduction o
Page 31 and 32: Results: SLN negative patients were
Page 33 and 34: Conclusion: This is the first study
Page 35 and 36: were grouped into four age groups a
Page 37 and 38: gain up to the 20 th procedure (Fig
Page 39 and 40: ��
Page 41 and 42: normal angiogenesis induced by cell
Page 43 and 44: 52.4 Sham-feeding of patients with
Page 45 and 46: Methods: Erfasst wurden Aggressions
Page 47 and 48: Conclusion: Pharmacological inhibit
Page 49 and 50: 54.19 Gene chip analysis of A20 exp
Page 51 and 52: 55.10 Optimized intrapleural cispla
Page 53 and 54: 62.7 Posttraumatic symptomatic cyst
Page 55 and 56: Conclusion: Only patients older 75
Page 57 and 58: no sign of occlusion. No further th
Page 59 and 60: packing as part of damage control s
Page 61 and 62: sonalführung und werden auch in de
Page 63 and 64: Figure 3 Figure 2 Figure 4 71.2 Tec
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formed 5 months later, again with a
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99.16 3-D endo-stomal ultrasound (
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tional recanalization. Conclusion:
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99.37 Extended Clavien-Dindo classi
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ial colitis was excluded by stool c
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99.55 Complexes de von Meyenburg(ha
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99.64 Traumatic abdominal wall hern
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99.75 Isolated dorso-medial disloca
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FRAGMIN ® DER ERFAHRENE WEGGEFÄHR
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Kalbermatten Daniel, PD Dr., CHUV C
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Meyer Antoine, Dr., Hôpital canton
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Covidien Switzerland Limited multip
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