The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 503
Slide Session
K-BP-31 Pancreatobiliary
Neutrophil-Lymphocyte Ratio Predicts Survival in Patients with Advanced Cholangiocarcinoma on Chemotherapy
Ban Seok Lee1, Sang Hyub Lee1, Dong Kee Jang1, Kwang Hyun Chung1, Ji Kon Ryu1, Yong-Tae Kim1
Seoul National University Hospital, Korea1
Background: Blood neutrophil-to-lymphocyte ratio (NLR) has been reported to be a prognostic marker in several kinds of cancers. However, no study investigated the prognostic role of NLR in patients with advanced cholangiocarcinoma on chemother- apy.
Methods: A total of 221 patients with pathologically-confirmed locally advanced or metastatic cholangiocarcinoma receiving fi rst-line palliative chemotherapy were enrolled. Associations between baseline clinical and laboratory variables, including CA 19-9, CEA, NLR, and platelet-lymphocyte ratio (PLR) and survival were investigated.
Optimal cut-points of CA19-9, CEA, NLR, and PLR were determined by martingale re- sidual analyses. Cox-regression analysis was used for multivariable survival analyses.
Results: Best cut-point of NLR for the prediction of survival was 5 in the martingale residual plot. Median overall survival (OS) and progression-free survival (PFS) in pa- tients with NLR = 5 were 11 and 7 months whereas 7 and 2 months in patient with NLR >5 (P= 0.001). In the multivariable analysis, signifi cant adverse prognostic factors for OS were tumor location (intra;perihilar;distal, HR=1;1.4;1.9, respectively) and NLR
> 5 (HR=1.84). CEA > 20 ng/ml and NLR > 5 were associated with worse PFS (HR 1.49 and 1.82) whereas gemcitabine-based chemotherapy predicted better PFS (HR 0.56).
Among 50 patients with initial NLR > 5, 33 patients had NLR = 5 after 2 cycles of chemotherapy, and they had signifi cantly better survival than the others (HR 0.48, P=
0.016).
Conclusions: NLR independently predict survival in patients with advanced cholangio- carcinoma undergoing chemotherapy. Considering cost-effectiveness and easy availa- bility, it may be the useful biomarker for the prognosis prediction.
K-BP-32 Pancreatobiliary
Predictable Factors for Anomalous Union of Pancreaticobiliary Duct Related Pancreaticobiliary Malignancy
Jin-Seok Park1, Tae Jun Song1, Do hyun Park1, Sang Soo Lee1, Dong Wan Seo1, Sung Koo Lee1, Myung-Hwan Kim1
Asan Medical Center, Korea1
Background: To determine appropriate treatment of anomalous union of pancreatic- obiliary duct (AUPBD), evaluation of AUPBD-related pancreaticobiliary malignancies is essential. The aim of this study is to determine the incidence of AUPBD-related pan- creaticobiliary malignancies and to propose their predictable factors.
Methods: We retrospectively reviewed data from 229 patients with AUPBD between January 1999 and December 2013. The incidence of AUPBD-related pancreaticobiliary diseases according to the presence of bile duct dilatation and the predictable factors for pancreaticobiliary malignancies were evaluated.
Results: Among 229 patients, 152 patients had AUPBD with bile duct dilatation (=10mm) (dilated group) and 77 patients had AUPBD without bile duct dilatation (<10mm) (non-dilated group). In non-dilated group, intrahepatic cholangiocarcinoma (non-dilated group vs. dilated group; 3.9%vs.0%, P value=0.014) and pancreatitis (10.4%vs.1.3%, P value=0.003) occurred more frequently than in dilated group. On the other hand, although extrahepatic cholangiocarcinoma tended to be more occurred in dilated group (1.3%vs.3.9%, P value=0.271), there were no signifi cant differences in most of pancreaticobiliary diseases between two groups, In univariate analysis to determine predictable factors for AUPBD-related pancreaticobiliary malignancies, age, type of AUPBD, and refl uxed pancreatic enzyme showed signifi cant differences.
In multivariate analysis, the old age (Odd ratio, 1.042; 95% CI, 1.011-1.073; P val- ue=0.007), B-P type (Odd ratio, 3.327; 95% CI, 1.031-10.740; P value=0.044), and the high level of biliary lipase level (Odds ratio=4.132, CI=1.420-12.021, P value=0.009) showed a signifi cant association with AUPBD-related pancreaticobiliary malignancies.
Conclusion: Age, type of AUPBD, and biliary lipase level are signifi cantly related to AUPBD-related pancreaticobiliary malignancies. As a result, bile duct resection with cholecystectomy might be considered as a primary treatment of AUPBD patients without bile duct dilatation, especially in patients with old age (=45 year), high level of biliary lipase (=45,000 IU/L), and/or B-P type of AUPBD.
K-BP-33 Pancreatobiliary
Effect of Rowachol on Prevention of
Postcholecystectomy Syndrome After Laparoscopic Cholecystectomy: Prospective Multicenter Randomized Controlled Trial
Lee Jun Kyu1, In Woong Han1, Seung Eun Lee2
DongGuk University Ilsan Hospital, Korea1, Chung- Ang University Hospital, Korea2
Background: Postcholecystectomy syndrome (PCS) is characterized by abdominal pain following gallbladder removal. The purpose of this trial is to determine whether Rowachol will be useful in the prevention of PCS and in symptoms improvement after laparoscopic cholecystectomy (LC).
Methods: from 2012 to 2013, this prospective, randomized, single blind, placebo-con- trolled study had balanced random assignment Rowachol and placebo in Dongguk University Ilsan Hospital, and Chung-Ang University Hospital. A total of 138 patients, with various gallbladder diseases after LC, were enrolled and randomized. Rowachol or placebo 100mg three times daily was given to each group of patients for 3 months.
Outcomes were assessed in visit over 3 months after surgery with right upper quad- rant (RUQ) pain on European Organization for Research and Treatment of Cancer QLQ-C30.
Results: There are no differences in aspect of demographics, preoperative clinical fi ndings, and surgical fi ndings between each group. Incidence of PCS in placebo group (n = 9, 14.3%) was higher than that in Rowachol group (n = 3, 4.7%) with statistically marginal signifi cance (p = 0.089). After risk factor analysis for PCS, the patients with PCS showed a higher diffi culty score to perform LC, more frequent pathology with acute cholecystitis, and absence of postoperative Rowachol treatment compared to those without PCS. Among these, higher diffi culty score to perform LC (HR = 5.780, 95% CI 1.355- 24.390, p = 0.018), and Absence of postoperative Rowachol treatment (HR = 2.537, 95% CI 1.102- 10.386, p = 0.048) were identifi ed independent risk fac- tors to develop PCS after multivariate analysis.
Conclusion: Rowachol can be beneficial for prevention of PCS and symptoms im- provement after LC.
K-BP-34 Pancreatobiliary
Risk Factors for Gallstone Formation in Patients Who Underwent Gastrectomy Due to Gastric Cancer
Kyu-Hyun Paik1, Hyung Woo Kim1, Jong-Chan Lee1, Yoon Suk Lee1, Jin-Hyeok Hwang1, Sang-Hoon Ahn2, Do Joong Park2, Hyung-Ho Kim2, Jaihwan Kim1
Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Korea1, Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Korea2
Background: Previous studies reported increased incidence of gallstone formation af- ter gastrectomy. However, there were few reports about other risk factors except sur- gical technique. The purpose of this study is to investigate the risk factors of gallstone formation after gastrectomy.
Methods: From June 2003 to December 2008, 1,527 patients who underwent gastrecto- my due to gastric cancer but had no gallstones before surgery were identifi ed. Electronic medical records were retrospectively reviewed. Gallstones were assessed by computerized tomography or ultrasound that was carried out as surveillance for recurrence.
Results: Male were 1,015 (66.5%) and median age were 59.0 years. Median follow-up periods were 47.3 months. According to the surgical technique, 267 (17.5%), 754 (49.4%), 459 (30.1%), and 47 (3.1%) underwent total gastrectomy (TG), subtotal gastrectomy with Billroth I anastomosis (STGBI), Billroth II anastomosis (STGBII), and proximal gas- trectomy (PG). Within follow-up periods, gallstone formations occurred in 108 of 1,527 patients (7.1%) and only 9 patients (0.6%) experienced symptomatic cholecystitis. By multivariate Cox regression analysis, age (HR 1.02, 95% CI 1.00-1.04), male (1.75, 1.08- 2.83), decreased body mass index after surgery = 1.0kg/m2 (2.00, 1.22-3.27), STGBII (1.64, 1.04-2.58), and TG (2.27, 1.41-3.65) compared to STGBI were associated with gallstone formation. PG did not show signifi cant differences compared to STGBI.
Conclusions: After gastrectomy, there were considerable patients with newly de- veloped gallstones. However, prophylactic cholecystectomy should not be routinely recommended because of low risk of cholecystitis. In addition to well-known risk fac- tors like STGBII or TG, old age, male, decreased body mass index were associated with gallstones; however, PG was not.
