Abstract Journal HPB Surgery

Journal HPB Surgery HP001 EVALUATION OF THE UTILITY OF STAGING SYSTEMS, PRONOSTIC MODELS, AND INDEPENDENT PRE-OPERATIVE AND POST-RESECTIONAL VARIABLES UPON SURVIVAL CHARACTERISTICS FOR RESECTED PERI-HILAR CHOLANGIOCARCINOMA PATIENTS NICHOLAS BIRD, NICOLA MANU, REBECCA TELFER, ROBERT JONES, LEONARD QUINN, STEPHEN FENWICK AND HASSAN MALIK Aintree University Hospital, Liverpool, United Kingdom (Great Britain) Purpose: Surgical resection is the only potentially curative treatment for cholangiocarcinoma patients. Multiple prognostic systems have been utilized to provide prognostication for the patient and to guide management strategies post-resection. The objective of this study was to evaluate independent prognostic variables and prognostic models in a modern single-centre resectional cohort. Methodology: Patients diagnosed with hilar cholangiocarcinoma, referred to a supra-regional tertiary referral centre between February 2009 and February 2016, were retrospectively analyzed from a prospectively held database linked to Hospital Episode Statistics and Somerset Cancer Registry data. Results: Two-hundred and one patients were assessed for suitability for surgery. Eighty-three (48 2 %) patients considered to have potentially resectable disease underwent surgical assessment of resectability. Fifty-six patients (27.9 %) proceeded to resection. Multivariate analysis demonstrated pre-operative Serum CA 19-9 (p = 0.007), radiological arterial involvement (p = 0.005) and AMC nomogram score (p = 0.032) retained significance in association with OS. Nodal status (p = 0.007) and tumour grading (p = 0.001) retained significance in association with both OS and RFS. An augmented multivariate model outperformed the other prognostic systems for OS (Concordance Index = 0.71). Conclusion: The AMC nomogram has an improved prognostic capability, compared to the other staging systems, and has been externally validated for the first time in this cohort. Augmentation of the AMC nomogram by addition of significant independent pre-operative covariates from this cohort produced a significantly improved prognostication model for OS. HP002 USE OF THE 2018 TOKYO GUIDELINES IN SCREENING FOR ACUTE BACTEREMIC CHOLANGITIS ANDREI BELYAEV, SOF’YA ZYUL’KORNEEVA AND COLLEEN BERGIN Auckland City Hospital, Auckland, New Zealand Background: Acute bacteraemic cholangitis (ABC) complicated by septic shock is associated with up to 40% mortality. Early diagnosis, initiation of antimicrobial therapy and urgent biliary decompression improves survival of patients with ABC. The predictive power of the 2018 Tokyo guidelines (TG18) criteria for moderate acute cholangitis (AC) in diagnosing ABC is unknown. The aim of this study was to investigate the predictive power of TG18 diagnostic criteria for moderate AC in screening patients for ABC. Methods: This was a retrospective cohort study in which patients with a confirmed diagnosis of ABC were compared with those without biliary bacteraemia (the non-ABC group). Results: Forty seven ABC patients with a total 67 biliary bacteraemic episodes and 53 non-ABC patients with 67 hospital admissions met eligibility criteria. The TG18 diagnostic criteria for moderate AC used in screening for ABC had a sensitivity of 62.7% (42/67) (95% confidence interval (CI): 50-74.2%), specificity of 71.6% (48/67) (95% CI: 59.3-82%), correctly classified in 67.2% of patients, an area under receiver operating characteristic curve of 0.67 (95% CI: 0.59-0.75). With a prevalence of biliary bacteraemia of 23%, the positive predictive value for TG18 criteria was 39.8% (95% CI: 30.2-50.2%), negative predictive value 86.5% (95% CI: 82-90.1%). Conclusion: TG18 criteria for moderate AC have low sensitivity, specificity and positive predictive values for diagnosing ABC. Development of diagnostic criteria for ABC is urgently required. HP003 SARCOPENIC OBESITY IS A SIGNIFICANT RISK FACTOR FOR POSTOPERATIVE MORBIDITY AFTER PANCREATIC SURGERY CHATHURA RATNAYAKE, CAMERON WELLS, MAGDA OLSSON, JOHN WINDSOR AND SANJAY PANDANABOYANA University of Auckland, Auckland, New Zealand Background: This study aimed to compare the current indices of preoperative sarcopenia (SARC) in their ability to reliable predict postoperative morbidity following pancreatic resection. Materials and Methods: A prospectively collected database was retrospectively examined in a single institution including a total of 89 consecutive patients who had undergone pancreatic resection between 2014 and 2018. SARC indices including skeletal muscle index (SMI), psoas muscle index (PMI) and skeletal muscle attenuation (SMA) were calculated by two investigators (correlation coefficient = 0.98) using preoperative computed tomography (CT) images. Results: Eighty-nine patients comprised the cohort with a median age of 65 (range 31-88) and 71% (63/89) underwent pancreaticoduodenectomy. SARC was diagnosed preoperatively in 44 patients (49%) using the skeletal muscle index (SMI), 31 patients (35%) using psoas muscle index (PMI) and 25 patients (28%) using skeletal muscle attenuation (SMA). The incidence of postoperative morbidity was 64% (57/89) of patients. The rate of postoperative morbidity did not differ between SARC and non-sarcopenic (NSARC) patients using all three preoperative CT measures (SMI SARC 28/44, NSARC 29/45 P = 1.000; PMI SARC 17/31 NSARC 40/58, P = 0.806; SMA SARC 17/25 NSARC 40/64, P = 0.247). However, sarcopenic obesity was determined as a significant independent risk factor for postoperative morbidity on multivariate analysis with the highest specificity (81%). Conclusion: Preoperative sarcopenic obesity is a significant negative risk factor for postoperative morbidity following pancreatic resection. However, incidence of SARC is variable depending on the SARC index used suggesting the need for standardisation of SARC indices. HP004 ROUTINE GALLBLADDER HISTOLOGY: IS IT NECESSARY? RACHEL HUNTER, MEGAN THOMAS AND SAXON CONNOR Christchurch Hospital, Canterbury, New Zealand Purpose: Cholecystectomy is one of the most common general surgical operations performed in New Zealand. Currently routine histopathological analysis (HPA) is conducted on all gallbladders specimens to screen for incidental gallbladder cancer. The rates of gallbladder cancer in the Western population is low and the volume of gallbladders sent puts a significant burden on pathology resources. Recent research has suggested that selected cholecystectomy specimens do not need to be sent for HPA. This study is the first in New Zealand to investigate selective gallbladder HPA. Methodology: A retrospective analysis of all gallbladder specimens received by the Christchurch pathology department from 1995-2015 was performed. Histological data was obtained from pathology coded and referenced against case notes for selective patients. Additional information was obtained from clinical coding and patient records. Results: After exclusions 8970 gallbladder specimens were included in the analysis. Of these 18 were found to contain incidental gallbladder cancers (0.20%). The ages of those diagnosed with incidental gallbladder cancers ranged from 46 to 91 years. 17 out of 18 patients with incidental finding of gallbladder cancer had an radiological abnormality in addition to gallstones on their pre-operative imaging. Based on the patient data if gallbladders of those under 45 with no radiological abnormalities were not sent for HPA no incidental gallbladder cancers would be missed. Conclusion: Selective gallbladder HPA is appropriate in the New Zealand population undergoing cholecystectomy. Further work is Editorial material and organization © 2019 Royal Australasian College of Surgeons. Copyright of individual abstracts remains with the authors. ANZ J. Surg. 2019; 89 (S1), 93–104