700 Laparoscopic Pancreatic Resections in a French Center: Evolution of the Indications and Outcome

Introduction: Large monocentric series of laparoscopic pancreatic resection (LPR) are still lacking. This series studied evolution of indications and outcome of LPR. Methods: This is a retrospective monocentric study. Main contraindications were major vascular invasion and pancreatitis. Demographics, surgical, and postoperative outcome data were studied. We compared the first 350 LPR (2008-2016) and the last 350 LPR (2017-2020). Results: From 2008 to 2020, 700 LPR were performed including 191 PD (27%), 344 DP (50%), 92 CP (13%), 69 Enucleation (10%) and 4 TP (1%). The applicability of laparoscopy increased from 10% before 2010 to 40% in 2020. Mean age and BMI were 56 (17-87) and 25 kg/m2 (15-48), respectively and 406 were female (58%).The main indications: IPMN (169; 24%), NET (167; 24%) and pancreatic adenocarcinoma (124, 18%). The surgical outcomes showed conversion (3%), mean operative duration (207; 30-540 mn), blood loss (213; 0-2500 ml), transfusion (4%), mortality (9; 1.3%), overall morbidity (56%), POPF B/C (19%), bleeding (7%), re-intervention (7%), readmission (6%) and mean hospital stay 16(2-104). The second period versus the first period showed more comorbidities (39% vs 52%; p<0.0001), less noninvasive IPMN (39% vs 18%; p<0.001, less splenectomy (17% vs 9%,p=0.002), less conversion (4% vs 2%,p=0.046), less POPF (24% vs 15%,p=0.001), less bleeding (9% vs 5%,p=0.036), less re-intervention (10% vs 5%,p=0.004) and a shorter hospital stay (18 vs 13; p<0.001). Conclusion: This large series including all types of pancreatic resections showed more patients with comorbidities and evolution in the indications. The good outcome is furthermore improved with the experience

Home-to-work commuting, urban form and potential energy savings: A local scale approach to regional statistics

The link between transport energy consumption and land use patterns has been the focus of a considerable amount of academic works over the past decades. While many empirical researches are backed up with solid statistical techniques, most of them do not fully consider the influence of scale underlying empirical quantitative investigations. Using fine-scale home-to-work commuting data for Wallonia (Belgium), this paper re-evaluates Breheny’s (1995) assertion that urban structure should hold the characteristics of major cities if substantial energy savings are to be achieved. A local scale approach highlights efficient settlements in terms of transport energy consumption not only within major towns, butalso within remote rural areas. Furthermore, results suggest that influencing the urban form following local energy efficient examples rather than regional ones could also yield significant gains, without an extreme policy stance of re-urbanisation in major cities.Impact de la Structuration du territoire sur les émissions de GE

Retromesenteric Omental Flap as Arterial Coverage in Pancreaticoduodenectomy: A Novel Technique to Prevent Post-pancreatectomy Hemorrhage

Background: Post-pancreatectomy hemorrhage (PPH) occurs in 10-15% of patients following pancreaticoduodenectomy (PD), mainly in association with clinically relevant postoperative pancreatic fistula (CR-POPF). Prevention of PPH by arterial coverage (AC) with a round ligament plasty or an omental flap is controversial. This study evaluated clinically relevant PPH (CR-PPH) rate following AC with an original retromesenteric omental flap (ROF) in patients undergoing PD. Methods: This single center retrospective study included 812 open PD (2012-2021) and compared 146 procedures with AC using a ROF (AC-ROF) to 666 PD without AC (no AC). The Fistula Risk Score (FRS; Callery et al., J Am Coll Surg 2013) was calculated. CR-POPF and CR-PPH were recorded according to the ISGPS classification. Results: There were more patients with a high FRS (7-10) in the AC-ROF group: 18 (12%) vs. 48 (7%) with no AC (p<0.01). CR-POPF ocurred in 28 (19%) in the AC-ROF group versus 165 (25%), respectively (p=0.001). CR-PPH was less frequent in the AC-ROF group 5 (3%) versus 66 (10%) with no AC, respectively (p=0.01). There was no reoperations for PPH or POPF in the AC-ROF versus 25 (4%) with no AC (p=0.02). In the 65 patients (8% of the overall population) with FRS=7-10, the CR-PPH rate was 1/20 (5%) in the AC-ROF group vs. 7/45 (16%) in the no AC groupé (p=0.23). Conclusions: AC with ROF can reduce rates of CR-PPH following PD especially in patients at high risk for POPF. This simple and cost-free technique should be further evaluated to confirm these results

Spatial Planning as a driver of change in mobility and residential energy consumption

This paper analyses the impact of territorial structures upon energy consumption in the Walloon Region (Belgium). The rationale for this research is to consider the long-term influence of spatial planning decisions upon energy consumption in both residential building stock and home-to-work commuting. The analysis has been conducted on a regional scale (16,844 km2) and includes urban, peri-urban and rural settlements. Those settlements that perform well in mobility also appear to perform well in terms of building energy consumption. Even though this is not generally the case, it further reveals that some rural settlements characterized by low density show good performance in terms of energy efficiency. This permits a much more progressive approach in terms of spatial planning, whereby compact cities may be viewed as part of the solution, albeit not the whole solution.CPDT - Thème 2D Structuration du territoire et émissions de GE

Distal Pancreatectomy for Body-pancreatic Ductal Adenocarcinoma: Is Splenectomy Necessary?

Purpose: The value of splenectomy during distal pancreatectomy (DP) for body-pancreatic ductal adenocarcinoma (B-PDAC) has not been evaluated. This study aimed to assess the impact of spleen preservation (SP+) on morbidity and oncological outcomes following DP for B-PDAC. Method: Single-center cohort study including patients who underwent DP with SP+ according to Warshaw’s technique and DP with splenectomy (SP-) for B-PDAC from 2008 to 2019. Exclusion criteria were: distance <5cm between tumor and spleen hilum and multi-organ resection. Primary endpoints were disease-free (DFS) and overall survival (OS). Secondary endpoints were 90-day morbi-mortality using comprehensive complication index (CCI) and ISGPS definitions. Results: 129 patients were enrolled including 59 (46%) SP+ and 70 (54%) with splenectomy (SP-). Median age and BMI were 68 years and 24 kg/m2. SP+ and SP- patients were comparable regarding preoperative variables including neoadjuvant treatment (overall=24%), and laparoscopic approach (overall=39%). There was no 90-day mortality. Hospital stay was shorter after SP+ (11 vs. 16 days; p<0.001). SP+ patients experienced a lower CCI (8.7 vs. 16.6; p=0.004) with lower rates of grade B/C POPF (14% vs. 29%; p= 0.039) and deep organ space abscess (5% vs. 19%; p=0.041). The rate of R0 margins was similar in SP+ and SP- patients (75% vs. 71%, respectively; p=0.840), as well as invaded/harvested node ratio (0.0% vs. 0.0%; p=0.246), and AJCC staging (p=0.200). After a median follow-up of 63 months (IC95%:52-96), 1- ,3- and 5-year DFS and OS were 77%, 50% and 43% and 91%, 63% and 47%, respectively. On multivariate analysis, after doubly-robust adjustments on preoperative data, SP+ was associated with a better DFS (HR=0.315 [IC95%: 0.146-0.678]; p=0.0032), and had no influence on OS (HR=0.664 [IC95%: 0.317-1.392]; p=0.2782). After doubly-robust adjustments on pathological data and perioperative treatment, SP+ had no negative impact on DFS (HR=0.58 [IC95%: 0.3-1.13]; p=0.111) or OS (HR=0.9 [IC95%: 0.47-1.71]; p=0.738). Conclusion: SP+ DP for B-PDAC is associated with less postoperative morbidity than splenectomy, without impairing oncological outcomes. This study provides a rational to evaluate SP+ DP as a potential new oncological standard in B-PDAC