nd

3 Scientific Meeting Thursday 17 – Friday 18 March 2016 Chesford Grange Hotel Leamington Spa, Warwickshire

Programme

The 3rd GBIHPBA Scientific Meeting CONTENTS

Welcome from the President of GBIHPBA

Welcome from the President of GBIHPBA General Information Scientific Programme Abstracts – Oral Presentations Abstracts – Poster Presentations Company Exhibitors

GBIHPBA Council March 2016 President

Professor Rowan Parks

Secretary

Mr Mark Taylor

Past President

Mr Richard Charnley

Council Member

Mr Iain Cameron

Council Member

Mr Ian Pope

Council Member

Mr Raj Prasad

CONFERENCE VENUE The 3rd GBIHPBA Scientific Meeting will be held at: Chesford Grange Kenilworth, Warwickshire CV8 2LD Telephone: 01926 859331 Website: www.QHotels.co.uk/ChesfordGrange

It is my pleasure to welcome you to Chesford Grange for the third scientific meeting of the Great Britain and Ireland HPB Association. We have a distinguished team of national and international speakers and very much look forward to their presentations and contributions. The programme includes update lectures, surgical tips, sessions on managing common intra-operative complications and management dilemmas, as well as the ever popular mock MDTs where we expect a high level of trainee participation. We will also have a novel symposium with reflections on the various stages of an HPB career and a free paper session with plenty of opportunities to review poster presentations during lunchtime and coffee breaks. I would like to thank all the participants for their contributions and all delegates for supporting this meeting which I hope will be stimulating and enjoyable.

Professor Rowan Parks President GBIHPBA

INFORMATION Abstracts All selected abstracts can be found within this programme on pages Audio Visual All presentations are to be compiled using Power Point and should be saved to a USB stick. Please supply any video content which you may have separately either via USB or DVD. If using a Mac please bring the adapter from the video port connection on your Mac to convert to VGA. Speakers will be required to provide their presentations to the audio visual technician (MCL) in the room where they are presenting as soon as possible, on arrival. For those speaking in the morning, please ensure that your presentation is given in before the start of the morning session (by 09.30am on the Thursday and by 08:30am on the Friday), and for those presenting after lunch, please provide your presentation during the lunch break at the latest. Scott Evans or another member of MCL will be present in the Kenilworth Suite for the duration of the meeting. Cloakroom Facilities Please contact the hotel reception if you wish to store luggage. Certificate of Attendance & Receipt Your Certificate of Attendance (including CPD points) will be issued along with your receipt when you collect your delegate badge upon registration. Please keep this with you at all times. No other certificate will be issued after the Meeting. GBIHBPA Gala Dinner The GBIHPBA Gala Dinner will be held in the Kenilworth Suite in the Chesford Grange Hotel on Thursday 17 March. Dress: Lounge suits Time: 20:00

Hotel Check-in There will be a private check in desk next to the registration desk between 9am-10am on Thursday. Room keys can then be collected from the same desk either during the afternoon tea break (16:00 – 16:30) or after the conference ends from reception at 18:30. The hotel will happily store any luggage. Alternatively guests are advised to leave luggage in their cars until room keys are collected. You will need to check out of your room by 11am on Friday 18th March. Please settle any extras on departure by leaving a credit card swipe a reception which will charge any extras to your bedroom. Internet There is Wi-Fi connection throughout the Hotel. Lunches Lunches will be served each day in the Grange Exhibition area Poster Exhibition The poster exhibition will be displayed for the duration of the two day meeting. Posters should be put up where indicated on arrival on Thursday 17 March 2016. Posters should be taken down after 14.00 on Friday 18 March 2016 and we regret that we are unable to return any posters that are not collected from the Chesford Grange Hotel after this date. Poster Marking Poster marking will take place from 13.30 – 13.50 on Thursday 17 March and from 10.40 – 11.00 on Friday 18 March. Presenters are not required to be present. Refreshments Morning and afternoon coffee and tea will be available during the meeting in the exhibition area, situated in the Grange Exhibition area.

GBIHPBA Scientific Programme Thursday 17 March 2016 Location

Time

Event

The Grange

09.00 - 10.00

Registration and coffee

10.00 - 10.10

Welcome

Chairman:

Professor Rowan Parks, President GBIHBPA

10.10 - 11.15

Update on ERAS

Chairpersons:

Mr David Chang, Blackburn & Mr Dhanny Gomez, Nottingham

10:10 - 10.30

ERAS: Setting up a new service

Mr

Ravi

Ravindran

Edinburgh

10.30 - 10.50

ERAS: Hepato Pancreato Bilary

Mr

Robert

Sutcliffe

Birmingham

10.50 - 11.15

The Global Diversity of the practice of Pancreaticoduodenectomy

Professor

Charles M

Vollmer

Pennsylvania

The Grange

11.15 - 11.40

Morning Coffee

Kenilworth 1

11.30 - 13.00

Affiliates/Allied Health Professional Parallel Session

11.50 - 12.20

Troubleshooting in ERAS’– spotting potential post op complications during telephone reviews when they’ve been discharged home

12.25- 12.45

Supporting patients and family when the decision is taken not to offer surgery

11.40 - 13.00

Surgical Tips

Chairpersons:

Mr Neville Jameson, Cambridge & Mr Chris Halloran, Liverpool

11.40 - 12.05

Portal Lymphadenectomy

Professor

Thomas

van Gulik

Amsterdam

12.05 - 12.30

Pancreatic Anastomotic Techniques

Ms

Johanna

Laukkarinen

Finland

12.30 - 12.50

Laparoscopic distal pancreatectomy

Mr

Hassan

Elberm

Southampton

The Grange

13:00 - 14:00

Lunch in the Grange

Kenilworth 2 & 3

13.30 - 13.50 14.00 - 15.00

Poster marking Pancreatic MDT : Chairman Mr Richard Charnley

Panel: Ms Johanna Laukkarinen, Prof Chuck Vollmer, Mr Mark Peterson

14.00 - 14.15

4 cases

Kenilworth 2 & 3

Kenilworth 2 & 3

Kenilworth 2 & 3

The Grange

Faculty

Mr

Rahul

Deshpande

Manchester

14.15 - 14.30

Mr

Lloyd

McKie

Belfast

14.30 - 14.45

Mr

Damian

Durkin

Stoke

14.45 - 15.00 15.00 - 16.00

Management of common intraoperative complications

Mr Chairpersons:

Irfan Ahmed Aberdeen Mr Peter Driscoll, St Andrews & Mr Jawad Ahmad, Coventry & Mr Ian Beckingham, Nottingham

15.00 - 15.20

Mx of intraop bleeding in lap liver surgery

Mr

Krish

Menon

Kings, London

15.20 - 15.40

Pancreatic resection post neoadjuvant chemoradiation

Mr

Euan

Dickson

Glasgow

15.40 - 16.00

Approach to the Frozen Calot's

Mr

Christopher

Halloran

Liverpool

16.00 - 16.30

Coffee/ Tea

16.30 - 17.30

Update on Upper GI Research

Professor

Jane

Blazeby

Bristol

17.30 - 18.30

Reflections on the Stages of an HPB Surgeon's Career

Chairperson:

Mr Giles Toogood

Early Years

Mr

Christian

Macutkiewicz

Leeds

Middle of career

Mr

Iain

Cameron

Nottingham

Middle of career

Mr

Mark

Taylor

Belfast

The Finer Years

Mr

Merv

Rees

Basingstoke

The Grange

19.00 - 20.00

GBIHPBA Drinks Reception

Kenilworth Suite

20.00 - 23.00

GBIHPBA GALA Dinner

Leeds

GBIHPBA Scientific Programme Friday 18 March 2016 Location

Time

Event

The Grange

08.30 - 09.00

Registration

Kenilworth 2 & 3

09.00 - 10.40

Management Dilemmas

Chairpersons:

Mr Andreas Prachalias, London & Mr Ian Pope, Bristol

09.00 - 09.20

Turning a patient down for surgery

Mr

Guiseppe

Garcia

Leicester

09.20 - 09.40

Severe necrotising pancreatitis

Mr

Jeremy

French

Newcastle

09.40 - 10.00

Assessment of resectability of Hilar Cholangiocarcinoma

Professor

Thomas

van Gulik

Amsterdam

10.00 - 10.20

Combination Resection/Ablation in CLM

Professor

Graeme

Poston

Liverpool

10.20 - 10.40

Resection or Transplantation for HCC within Milan Criteria

Mr

Brian

Davidson

London

10.40 - 11.00

Coffee Chuck Vollmer Pennsylvania Prof Steve Wigmore, Edinburgh & Mr Stephen Fenwick, Liverpool & Prof Ashley Dennison

The Grange

Faculty

10.40 - 11.00

Poster marking

Kenilworth 2 & 3

11.00 - 11.30

Keynote Lecture: Current Insights in Pancreatic Fistulae

Professor

Kenilworth 2 & 3

11.30 - 13.00

Papers

Chairpersons:

The Grange

13.00 - 14.00

Lunch in the Grange

Kenilworth 2 & 3

14.00 - 14.20

Oncologist view of managing synchronous disease

Kenilworth 2 & 3

14.20- 15.20

Liver MDT : Chairperson Mr Giles Toogood

Dr Jamie Mills, Nottingham Professor Thomas van Gulik, Mr Merv Rees, Prof Graeme Poston & Dr Panel Jamie Mills

14.20 - 14.35

4 cases

8 Best papers (8 mins + 3 mins each)

Kenilworth 2 & 3

Mr

Michael

Silva

Oxford

14.35 - 14.50

Mr

Adrian

O'Sullivan

Cork

14.50 - 14.05

Mr

Donal

Maguire

Dublin

14.05 - 15.20

Ms

Megan

Finch-Jones

Bristol

Professor

Rowan

Parks

Edinburgh

15.20 - 15.30

Announcement of prize winners and closing remarks

11 CPD Points

Abstracts Papers: Friday 18 March 2016 11.30 – 13.00 (Kenilworth Suite)

A01 Recent AUGIS guidance on the management of acute gallstone diseases; compliance within a UK HPB centre. 1,2

1

W. Kyle Mitchell , Eyas Mohmed , Priyatma 1 1 1 Khincha , Gael Nana , Alex P. Navarro , Ian J. 1 Beckingham 1

Queen's Medical Centre, Nottingham, UK, Metabolic and Molecular Physiology, University of Nottingham, Nottingham, UK 2

Background: In 2015 the Association of Upper GI Surgeons (AUGIS) published a “Pathway for the Management of Acute Gallstone Diseases”, to encourage safer, faster and more cost effective management of acute gallstone (GS) disease by stratification and standardisation of treatment options. As yet no data has been published to demonstrate how closely recent practice in a UK HPB surgery centre follows these guidelines. The purpose of this study was to review the management pathway of patients who underwent cholecystectomy for GS disease in a large UK teaching hospital, to compare this to AUGIS guidance and to quantify complication rates. Methods: Retrospective review of consecutive patients undergoing cholecystectomy for GS disease (April to Dec 2013). Dataset included surgery/ indication; pre-operative imaging, LFTs; pre-/ post-operative ERCPs; complications (minimum follow-up 2 y). Patients were categorised as per AUGIS guidance and compliance with recommendations recorded. Complications with/ without guideline compliance were compared with Fisher’s exact test. Results: 382 patients underwent cholecystectomy for GS disease; 42% for biliary pain/ colic, 30% acute cholecystitis, 16% GS pancreatitis and 12% GS related jaundice/ cholangitis. Overall compliance with AUGIS guidance was 79%. Of 160 patients with biliary pain/ colic, compliance was 93%; 12 underwent MRCP that may be considered over-investigation. Of 116 patients operated for acute cholecystitis, compliance with guidance was 61% due to 45 patients not being operated during index admission. Frailty and patient choice reduced compliance. Subjectivity in severity stratification of

acute pancreatitis prevented exact determination of compliance. On-table cholangiography (OTC), not discussed in guidance for this group, was performed in 21% of cholecystectomies for pancreatitis. Of 45 patients with GS jaundice ± cholangitis, compliance was 68% with 34 undergoing pre-operative ERCP. Most of the others underwent OTC or pre-op MRCP. The overall postoperative complication rate was 16%, with 0.5% of patients with complications of untreated CBD stones. Guideline compliance did not appear to effect all-cause or CBD-stone related complications (P= 0.17, P=0.37 respectively). Conclusions: Management of GS disease in a UK HPB centre has been shown to be largely compliant with recent AUGIS guidance. This can achieve a low rate of complications, and especially of those related to post-operative CBD stones. Compliance is reduced by the challenge of providing early surgery in acute cholecystitis. Future guidance may comment on the role of pre- or intra-operative imaging for GS pancreatitis patients. A02 Why is there no such thing as a distal pancreatectomy? An audit showing significant loss of income due to inaccurate clinical coding of pancreatic surgery. 1,2

1

Ajay Belgaumkar , Jamie Skipworth , Gabriele 1 1 1 Spoletini , Roberto Valente , Brian Davidson , 1 1 Massimo Malagó , Dinesh Sharma , Charles 1 1 1 Imber , Zak Rahman , Giuseppe Kito Fusai 1

Royal Free Hospital, London, UK, Hampshire Hospital, Basingstoke, UK

2

North

Background: Pancreatic surgical procedures have been allocated to Human Resources Grouping (HRG) tariffs on a scale, according to the magnitude of resection and the presence/absence of co-morbidities and complications (CC). Accurate coding of patients’ diagnoses and operations into relevant OPCS-4 (Office of Population Censuses and Statistics Classification of Interventions and Procedures, version 4, 2014) codes is needed, to generate the correct category of HRG tariff. For example, pancreaticoduodenectomy is in the highest HRG Category 7(£11095 with CC or £7722 without CC). We evaluated the accuracy of clinical coding of pancreatic surgery and the financial impact of any discrepancies. Methods: A list of operations coded under the general heading of pancreatic surgery was provided by the hospital finance department for financial year 2014/15. The OPCS codes for each procedure and primary and secondary diagnoses (CC) and the generated HRG tariff for each patient were

compared with computerised clinical records of preoperative assessments, clinic encounters, operation notes and discharge summaries to assess concordance. Results: Of 97 patients recorded as undergoing pancreatic surgery, only 62% were correctly coded and were placed in the correct HRG Tariff category. 33% were “under”-coded, leading to a potential loss of £88,496, which was 10% of the total income from pancreatic surgery. 13/25 (52%) of distal pancreatectomies were coded as “Excision of Tail” or “unspecified pancreatic resection”, which are in HRG Category 4 (£4729 or £3527 without CC), compared with “subtotal” or “left pancreatectomy” which are Category 5 (£6375 or £5120 without CC). 13/66 (20%) of patients undergoing Whipple’s were incorrectly coded as having no CC, a loss of £43,589 income. Conclusions: This study identified over £88,000 of potential lost income over a financial year, due to undercoding of procedures and/or lack of recording of complications and co-morbidities. Documentation of co-morbidities, operative details and complications should explicitly correspond to OPCS terminology and be recorded in a clear and accessible format, to avoid confusion. For example, a “distal” pancreatectomy may be coded as “excision of tail of pancreas”, which leading to significant income loss. More broadly, HRG Tariff Categories for major pancreatic and liver surgery do not accurately reflect the costs incurred for each type of procedure and need to be modified. We propose a nationwide audit of coding of liver and pancreatic surgery to highlight this issue, in the context of ensuring adequate ongoing funding of tertiary centres offering specialised cancer services. A03 Management and outcomes of hepatic trauma before and during completion of the regional centralisation of trauma services in the UK 1

1

Jenifer Barrie , Saurabh Jamdar , Marisol Fragoso 2 2 2,3 iniguez , Omar Bouamra , Fiona Lecky , Derek 1 O'Reilly 1

Department of Hepato-pancreatobiliary Surgery, 2 Manchester, UK, The Trauma Audit & Research Network (TARN). The University of Manchester, Manchester Academic Health Science Centre, 3 Manchester, UK, EMRiS Group, HSR Section, School of Health and Related Research, University of Sheffield, Sheffield, UK Background: Improved outcomes for injured patients have been demonstrated since the reconfiguration of major trauma services in the UK

commenced. The aim of this study was to analyse the management and outcomes of hepatic trauma before and during this period of centralisation. Methods: The trauma audit and research network (TARN) database was searched for details of any adult patient who sustained hepatic trauma. Demographics, management and outcomes were evaluated over three study periods: 2005-2009 (period 1, before the formal introduction of major trauma centres {MTCs}), 2010-2012 (period 2, early phase of this process) and 2013-2014 (period 3, late phase). Results: 4682 patients sustained hepatic trauma over the decade studied. 70% were male, median age was 34 years (23-49) and 80% were due to blunt injuries. Demographics, epidemiology and clinical features, including injury severity, remained consistent over the three study periods. There were 1260 (27%) cases of hepatic trauma in period 1 compared to 1783 (38%) in period 2 and 1639 (35%) in period 3. Four MTCs went live in 2010 and by 2014 there were 30 established MTCs. 1316 (80.1%) of patients in period 3 were treated in a MTC compared to 1201 patients (67%) in period 2 (P 55 and contrast blush on CT scan) are now considered obsolete. The aim of the study was to review our experience as a UK Tertiary Trauma Center in the management of blunt liver trauma. Methods: All patients who sustained blunt liver trauma presenting to a University Hospital between January 2010 and October 2015 were identified with the help of electronic patient records system.133 patients were identified. American Association for the Surgery of Trauma (AAST) liver injury grading system was used to grade the extent of injury. Grading was performed by an HPB consultant surgeon after reviewing all the scans and reports of CT-scans by a Consultant Radiologist. Patients’ management was evaluated and categorised as either conservative or surgical. Results: Mean age was 43 years; there were 80 males and 53 females (M:F 1.5:1). 77 % sustained injury through road traffic accidents; 18% suffered a fall and 5% were miscellaneous causes. According to AAST grading there were 19 grade I (14%), 58 grade II (43%), 37 grade III (27%), 12 grade IV (9%), and 7 grade V (5%) injuries respectively. Requirement for intervention increased from 7 % in grade II to 10 % in grade III, 15 % for grade IV and

42% for grade V injuries. 6 patients required angiography and embolization for active bleeding. 10 patients required laparotomy and packing for bleeding; in addition 4 patients required a splenectomy and 1 patient underwent a left hepatectomy.21 pts died from trauma related injuries (16%). Only one patient died directly from liver injury (grade V). Follow up imaging was arranged in 41 patients (37%). Mean time to follow up imaging was 3 weeks. 112 patients were discharged (84%). Average length of stay was 19 days.

cholecystectomy with or without on table cholingiogram.There were 44 (45 %) cases of LCBDE which were on both Sapphire and theatre log. 3 LCBDE were only on Sapphire system but not the theatre log. Conclusion: There was significant discrepancy in the accuracy of LCBDE documentation between theatre log and Sapphire system. Theatre log seems to be more reliable system for data collection. P27

Conclusions: The great majority of patients sustained grade 2-3 liver injuries (n=95; 71%). Nonoperative management in haemodynamically stable patients is a well established treatment strategy and in our case series 86% of patients were treated conservatively with a 100% success rates. There was no correlation shown between the severity of injury grade and the likelihood of non-operative management failure when the patient was haemodynamically stable. P26 The quality of data documentation for operative procedure: a comparison between theatre log and Sapphire system. Yousif Aawsaj, Duncan Light, Liam Horgan Northumbria healthcare NHS foundation trust, Newcastle, UK Introduction: discrepancy between different data sources for certain operative procedure will affect reputation of the institution, audit process, quality of care provided and finance. The aim of this study is to explore the discrepancy between two different documentation systems for the same surgical procedure over a period of time. Methods: The data was collected from the theatre log to identify Laparoscopic Common Bile duct exploration (LCBDE) from June 2011 to November 2014. A list of procedures which was coded as LCBDE was retrieved from sapphire system. Each procedure was checked on SIRIS system where the operative notes are saved to check if LCBDE was performed or not. Results: The total number of actual laparoscopic CBD exploration was done from June 2011 to November 2014 is 98. 95 (97%) LCBDE was documented in theatre log and there were all ‘actual’ LCBDE. 78 cases were documented as LCBDE in Sapphire system; only 47 (48%) were ‘actual’ LCBDE. The majority of the cases which was documented in Sapphire system as LCBDE and were not ‘actual’ were mainly laparoscopic

Severity of Acute Pancreatitis is in need of reclassification to reflect outcome Gaural Patel, Paul Jarvis, Ashraf Rasheed Royal Gwent Hospital, Newport, UK Background: Severe Acute Pancreatitis (SAP) can be recognised by organ failure (OF) +/- local complications and is best managed in intermediary/intensive care setting. It continues to result in high mortality despite best efforts at achieving early diagnosis and timely intervention. We sought to evaluate outcome (mortality as a primary end point) and identify determinants of survival in this cohort of patients. Methods: This is a retrospective review of all patients admitted to intensive care unit (ICU) with a diagnosis of SAP at a UK hospital over 3 years. Notes with complete data set were available for 51 patients, representing the study cohort. Standard demographics and clinico-pathological data were collected including age, sex, BMI and severity of pancreatitis score. The impact of different variables on outcome was assessed using logistic regression analysis. Overall survival was analysed using Kaplan-Meier method. Results: 37 cases were identified with SAP (Atlanta 2012 definition) and encompassed all 17 deaths. Correlation between survivors and nonsurvivors showed statistical difference for OF and infected pancreatic necrosis (IPN). The patients with organ failure on admission (early SAP) had a worse prognosis. Patients could be divided into groups in relation to survival; I (n=2) with no pancreatic necrosis (PN) or OF and II (n=3) with sterile PN or transient OF, both with 100% survival; III (n=17) with IPN or persistent OF had 6% mortality; IV (n=22) with early onset persistent organ failure had 31% mortality and V (n=7) who have a combination of IPN and persistent OF had 61% mortality. Conclusions: Pancreatic necrosis and organ failure seem to be the main determinants of severity

and outcome in acute pancreatitis. Mortality is best represented by stratifying patients into 5 groups: mild (no PN or OF), moderate (sterile PN or transient OF), severe (IPN or persistent OF), critical-a (early SAP) and critical-b (IPN and persistent OF). P28

Conclusion: Which type of incision used to perform PD has little impact on the development of postoperative complications. P29 Robotic versus Laparoscopic Distal Pancreatectomy: A single centre experience

A comparison of transverse and midline incisions for pancreaticoduodenectomy

Stuart Robinson, Rohan Thakkar, Jennifer Logue, Paul Renforth, Richard Charnley, Derek Manas, Jeremy French, Steven White

Pooja Prasad, James Hodson, Ravi Marudanayagam, John R Isaac, Robert P Sutcliffe, Paolo Muiesan, Darius F Mirza, Keith J Roberts

Freeman Hospital, Newcastle upon Tyne, UK

University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK Background: Various technical aspects of pancreaticoduodenectomy (PD) contribute towards the significant morbidity and mortality associated with this procedure. One aspect of surgical technique is the type of incision utilised. PD may be performed via a transverse subcostal or a midline incision. We sought to evaluate the clinical outcomes amongst a consecutive cohort of patients undergoing PD at our unit, stratified by incision type. Methods: Consecutive patients undergoing PD were identified from a prospectively maintained database from January 2012 to May 2015. Patient variables, intraoperative data, analgesic usage, pain scores and post-operative complications (including incisional hernia) were obtained from electronic hospital records. Pain scores were dichotomised and analysed using a binary logistic approach. Time to event variables were assessed using a Kaplan-Meier approach, with log-rank tests used to compare the two groups. Complications were graded as per the Clavien-Dindo classification. Results: Amongst 231 patients undergoing PD, 170 and 61 patients underwent PD via transverse and midline incisions respectively. There was no significant difference for any patient or perioperative variable with incision type, except for the nature of pancreaticoenteric anastomosis (which is surgeon dependant). The incision type was not found to have a significant overall effect on the likelihood of a patient experiencing pain (p=0.642), with an odds ratio for midline, relative to transverse, of 1.10 (95% CI: 0.73 – 1.66). No post-operative physiological parameter was related to the incision type. 9 patients in the midline group vs 18 patients in the transverse group developed incisional hernias (p=0.247).

Background: Robotic distal pancreatectomy offers several potential advantages to conventional laparoscopy including 3D visualisation, improved ergonomics and instrument dexterity. In this study we compare our initial experience with robotically assisted distal pancreatectomy (RDP) to our early experience with conventional laparoscopic procedures (LDP). Methods: Patients undergoing RDP (n=9) were compared to our first 10 cases of LDP (n=10). Data relating to clinical outcomes, histology and perioperative details were retrieved from a prospectively maintained database. Complications were graded according to the Dindo-Clavien classification. Statistical analysis was performed with SPSSv.22 using Fishers exact test or MannWhitney U Test as appropriate. Results: Patients in both groups were of similar age (59vs.65; p=0.356) and gender (3vs.6 males; p=0.37). The indications for surgery were similar in both groups. There was no significant difference in surgical time (RDP 339min, LDP 271min; p=0.13). There were 4 complications in the RDP group and 4 in the LDP group although one of these was of Grade 4 in the LDP group (p=0.61). There were 3 pancreatic fistula in the RDP group and 1 in the LDP group (p=0.25). There was no mortality in either group. The median length of hospital stay was 8 days in both groups (p=0.97). 2 patients in the LDP group had a R1 resection compared to 1 patient in the RDP group (p=0.5). Conclusions: RDP compares favourably to LDP and as the learning curve is passed may allow more complex cases to be performed using a minimally invasive approach.

P30

P31

Pancreas Resection and Autologous Islet Cell Transplantation (IAT) in both Adults and Children: Advancing the Indications

Laparoscopic versus open major hepatectomies for hepatocellular carcinoma: a ten-year single Institution experience.

1

2

Jennifer A Logue , William E Scott III , Minna 2 2 Honkanen-Scott , Julian De Haviland , Ahmad 1 3 1 Abou-Saleh , Hany Gabre , Derek M Manas , 1 2 James AM Shaw , Ann Dickinson , Ashley R 4 1 1 Dennison , Richard M Charnley , Steven A White 1

Institute of Transplantation, Freeman Hospital., 2 Newcastle upon Tyne, UK, Institute of Cellular Medicine, Newcastle University., Newcastle upon 3 Tyne, UK, Department of Surgery, Great North Children’s Hospital., Newcastle upon Tyne, UK, 4 Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester., Leicester, UK Background: Pancreas resection combined with IAT is a controversial procedure with limited experience in the UK and is not funded by the NHS. We present our experience of IAT in patients with chronic pancreatitis and pancreatic trauma including the UK’s first paediatric transplant. Methods: We have performed 6 pancreatic resections with IAT over 18 months. 3 patients with chronic pancreatitis (2 hereditary, 1 idiopathic) have undergone total pancreatectomy and IAT. Two patients had previous Frey procedures. 3 patients (2 adults, 1 child) sustained blunt pancreatic trauma and underwent extended left pancreatectomy combined with IAT. Complications were graded according to the Clavien-Dindo classification. Results: In the chronic pancreatitis group the islet yield was low due to severe fibrosis / previous drainage procedures (0.5). Conclusions: Neither bile nor biliary stents are routinely sent for culture in this complex group of patients. The variety of organisms and sensitivities observed may suggest the need for an individualised approach rather than a general protocol. Further prospective studies with larger cohorts of patients should guide future changes to local antibiotic prophylaxis protocols.

P34 Single centre experience of 8 consecutive Robotic pancreatectomies Rohan Thakkar, Jeremy French, Steve White Freeman Hospital, Newcastle upon Tyne, UK

group of patients and has acceptable pathological outcome and morbidity rates. P35 The role of transcription factor Nrf2 as a potential enhancer of liver regeneration 1,2

Background: When applicable, minimally invasive surgery is preferred over open surgery, especially because of the shorter length of stay and reduced blood loss. An ergonomic user interface, co-axial hand-eye alignment, stereoscopic viewer, instruments with seven degrees of freedom, and elimination of fulcrum effect are features of the da Vinci Robot that overcome the limitations of conventional laparoscopy, However, its development might be limited by 2-dimensional imaging and limited (only 4) instruments. Methods: Over a period of a year, (November 2014 – December 2015) 8 cases were retrospectively analysed with regard to, operative time, ASA status, blood loss, hospital stay and complications. The surgeons had extensive prior experience with open as well as laparoscopic distal pancreatectomies, but no substantial prior robotic experience. Results: The average age of the patients was 53.5 yrs (23-78 years), of which 5 were females. Majority of the patients were ASA II (n=6), 1 patient was ASA I and the other ASA III. The commonest indication for surgery was a NET (n=4), of which 2 were associated with MEN syndrome. The other indications were adenocarcinoma (n=1), main branch IPMN (n=1), and a serous cystadenoma (n=1). Most of the cases were distal pancreaticosplenectomies (n=5), but some patients underwent spleen preserving distal pancreatectomies (n=2) and 1 patient had an enucleation of a tumour in the pancreatic tail. The average lymph nodes retrieved were 10.4 (0-26). The mean pancreatic corpus margin was 12.1mm (3-40mm). The average time taken for surgery was 255.3 minutes (100-395 min). The blood losses in all cases were minimal (