ology 13 (2013) e1–e20 e13

P22.

Investigating the prognostic value of venous and arterial invasion inpancreatic 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 ofSurgery and Pathology, Glasgow Royal Infirmary, Alexandra Parade,Glasgow, UK

Category: Malignant

Background: Microvascular invasion in pancreatic ductal adenocarci-noma (PDAC) is known to be a poor prognostic indicator and risk ofmetastasis. Recent studies have highlighted the discrepancy in reportingvascular invasion and the need of improved techniques.

Aims: To determine whether the standard detection rate of vascularinvasion by means of haematoxylin and eosin (H&E) staining in PDACcan be enhanced by the use of elastica van Gieson (EVG), allowing thedetection of vascular invasion to be performed more easily and bemore comprehensive. To assess prognostic implications of enhancedvascular invasion detection on prediction of cancer-specific survival inPDAC.

Methods: Retrospective analysis of 42 patients with PDAC who hadundergone a pancreatico-duodenectomy with curative intent between2001 – 2008 was performed. Serial sections were stained with H&E andEVG respectively. The incidence of venous and arterial invasion wasrecorded and compared between the two stains.

Results: Venous invasion was identified in 24 patients (57%) withH&E compared to 37 patients (88%) with EVG. Arterial invasion wasidentified in 7 patients (17%) with H&E compared to 29 patients (69%)with EVG.

Conclusions: The use of EVG in PDAC resulted in a significantlyhigher rate of venous and arterial invasion to be identified. The pres-ence of arterial invasion resulted in a significantly improved predictionof overall survival when compared to routine H&E assessment. Thestudy provides good evidence that EVG staining should be testedprospectively by incorporation into the pathological assessment ofvenous and arterial invasion in patients undergoing potentially curativeresection of PDAC.

Take-home message: The use of an elastica van Gieson stain inpancreatic ductal adenocarinoma resulted in a significantly higher rate ofvenous and arterial invasion to be identified compared to routine H&Estaining. The presence of arterial invasion using the elastica stain resultedin a significantly improved prediction of cancer-specific survival whencompared to routine H&E staining.

Abstract previously presented? yes (West of Scotland Surgical Associ-ation) Any disclosures? no ()

P23.

The outpatient activity of a Macmillan pancreatic clinical nursespecialist in a tertiary pancreatic unit

Mr.Philip Anthony Whelan BSC (Hons).

Macmillan Nurse Pancreatic Specialist Unit, Royal Liverpool andBroadgreen University Teaching Hospital, United Kingdom

Category: Malignant

Background: The Clinical Nurse Specialist (CNS) plays a major role inthe management of pancreatic cancer patients at all stages during theircancer journey. Since 2010 the CNS has had their own outpatient clinictemplate for the review of patients.

Aim: To evaluate the outpatient activity of the Macmillan PancreaticCNS in a tertiary Pancreatic Unit over a 6 month period.

Abstracts / Pancreat

Methods: An audit was undertaken of all patients reviewed in clinic bythe CNS. Outcome data included demographics, tumour type, type ofconsultation, time of consultation, medications prescribed, referrals made,written information provided and tests ordered. Data was collectedprospectively and analysed using EXCEL.

Results: A total of 206 patients (61% male, median time of review 35minutes, range 10 – 90 minutes) were seen in 42 outpatient clinicsbetween March and August 2012. 155 patients (75%) were seen alone bythe CNS. 95 (67%) of these patients were post-operative follow ups. Theremaining 60 patients were inoperable, receiving palliative treatmentand supportive care. 15 patients had a new inoperable cancer or diag-noses of recurrence. 80 patients (52%) required referrals to other services,92 (59%) required medication changes and 110 (71%) required furtherinvestigations all of which were instigated by the CNS. 51 (25%) patientswere seen after a clinician. The majority (72%) being new surgicalpatients

Conclusion: The CNS has been found to take on increased responsi-bilities for post-operative surgical patients and patients undergoingpalliative treatment and supportive care allowing the surgeon to betterutilise their own clinic time.

Take-home message: The CNS is an autonomous advanced practi-tioner who has a vital role to play in the complex management of patientswith pancreatic cancer particularly as their care needs shift from poten-tially 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.

1Department of Surgery, North Manchester General Hospital, UK2 The University of Manchester, Manchester Academic Health ScienceCentre, Manchester, UK3 Trauma Audit and Research Network (TARN), UK

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 whosustained pancreatoduodenal (PD) trauma in the UK from a large traumaregistry, over the period 1989-2011.

Methods: The Trauma Audit and Research Network (TARN) databasewas searched for details of any patient with blunt or penetrating trauma tothe 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) forpenetrating trauma. The male to female ratio was 2.6:1. Blunt trauma wasthe commonest type of injury seen, with a ratio of blunt to penetrating PDinjury of 3.2:1. Road traffic collision was the commonest mechanism ofinjury, 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 penetratingtrauma. The mortality rate for blunt PD trauma was 19.0%; it was 14.2% forpenetrating PD trauma. Variables predicting mortality after pancreatictrauma were: increasing age, ISS, haemodynamic compromise and havingundergone an operation.

Conclusion: Pancreatic trauma is uncommon. The high proportionof cases due to blunt trauma differs from that of series from the USAand South Africa. Mortality is high in the UK but comparison withsurgical series is difficult because of selection bias in the latter datasets.Isolated pancreatic injuries are uncommon; most co-exist with otherinjuries.

Take-home message: Isolated pancreatic injuries are uncommon;most co-exist with other injuries. Abstract previously presented? no ()

Any disclosures? no ()