pchi

S15Vol. 213, No. 3S, September 2011 Surgical Forum Abstracts

RESULTS: Compared to the control mice, the IL22�/� mice dis-layed significantly less severe AP, evidenced by less pancreatic ne-rosis and lower serum amylase and lipase levels (p�0.05). However,istological analysis and Elisa assays showed significantly increased

nflammatory infiltration in IL22�/� pancreata (p�0.05). Accord-ingly, the expressions of PAPs are significantly decreased in IL22�/�pancreata.

CONCLUSIONS: These results strongly support our hypothesis in-dicating a pivotal role for IL22 in mediating tissue damage andinflammatory inhibition likely via the induction of PAPs in thepathogenesis of AP.

Corticotropin-releasing factor receptor 2 (CRF2) isessential for mediation of the urocortin1anti-inflammatory response in experimental acutepancreatitisEric Kubat MD*, Eileen Grady PhD, Victoria Lyo MD,Shilpi Mahajan PhD, Min Liao MD,Kimberly S Kirkwood MD, FACS, Aditi Bhargava PhDUniversity of California-San Francisco, San Francisco, CA

INTRODUCTION: Corticotropin Releasing Factor Receptors andtheir ligand Urocortin1 (Ucn1) are emerging as potent inflammatorymediators. We hypothesize that CRF2 actions are anti-inflammatoryin experimental acute pancreatitis.

METHODS: Acute pancreatitis was induced in male C57/bl6 micewith 6 hourly subcutaneous injections of cerulein or vehicle(0.9%NaCl). To delineate the role of CRF2, mice were pre-treatedwith a CRF2-specific antagonist, Astressin-2B (A2B). RT-PCR wasused to quantify changes in mRNA expression. Ucn1 was localizedusing immunohistochemistry (IR). Histologic damage was evaluatedwith H&E staining. Fura2-AM-loaded pancreatic acinar (AR42J)cells were used to evaluate Ucn1/CRF-receptor calcium-signalingmechanisms.

RESULTS: In naïve/control mice, Ucn1-IR was expressed in islet,pancreatic duct, and endothelial cells, but undetectable in acinarcells. During acute pancreatitis, de novo Ucn1-IR was detected inacinar cells that co-localized to secretory compartments with Cathep-sin B. As expected, cerulein-treatment increased histologic damagescores, and A2B pre-treatment further worsened the damage score; itwas 2-fold higher with significantly higher necrosis and edema(p�0.05). RT-PCR confirmed increased Ucn1 expression duringpancreatitis and decreased expression following A2B-treatment.Mechanisms of Ucn1 action in acinar AR42J cells were then eluci-dated. As seen in vivo, AR42J cells did not show basal Ucn1 expres-sion, whereas cerulein-treatment resulted in a 6-fold increase inUcn1. Ucn1-stimulation of Fura2-loaded AR42J cells resulted in adose-dependent Ca2� response. Pre-treatment with A2B, but notCP15426 (CRF1-antagonist) resulted in a 62% decrease in Ucn1-stimulated Ca2� responses.

CONCLUSIONS: Our findings demonstrate a role for Ucn1 and itsreceptor CRF2 in acute pancreatitis, suggesting a novel therapeutic tar-

get.

Advanced age is an independent risk factor for increasedmorbidity and mortality following open and laparoscopiccholecystectomy: A comparative analysis of 155,365cholecystectomies from National Inpatient Sample (NIS)Database (2004-2008)Robin Lee MD, Sachin Patil MB BS,Ronald Chamberlain MD, FACSSaint Barnabas Medical Center, Livingston, NJ

INTRODUCTION: Cholecystectomy is the most common digestivesurgery performed in the US and worldwide. Various factors influ-ence selection of open versus laparoscopic cholecystectomy, howeverwhether age alone is a selection criteria is unclear. This study analyzesthe clinical outcomes of open (OC) and laparoscopic cholecystec-tomy (LC) through all decades of life.

METHODS: 155,365 patients undergoing OC or LC between 2004and 2008 were analyzed from the Nationwide Inpatient Sample,AHRQ database. Age, gender, elective nature of case, LOS, compli-cations and mortality was abstracted for all cases age 1month �105years.

RESULTS: Acute cholecystitis was the most common indication forOC (35%) and LC (31.9%) with a mean age of 60.1 (M:F ratio 1:1)and 50.9 (1:2.3) respectively. OC was most common in the 7th and8th decade (19.9%) of which 69.6% were non-elective. LC was mostcommon in the 5th decade (35.3%), 82% of which were non-elective. Mean LOS was 7.6 days � 7.8 for OC vs. 4.0 days � 4.1 forLC, and increased with age. 0.03% of patients suffered bile ductinjury after OC vs. 0.005% after LC. OC was associated with 2%mortality vs. 0.4% with LC. The highest mortality rate occured inthe oldest patients (7.6%).

CONCLUSIONS: OC was far more common in older patients andassociated with longer LOS, complications and mortality than LC atany age. Common bile duct injuries were more common with LC upto 60 but were more frequent with OC after that. Mortality ratesincreased with age, non-elective cases and open cases.

The McGill-Brisbane score is an excellent predictorof survival in patients undergoing apancreatico-duodenectomy for pancreaticadenocarcinomaMohammad Jamal MD, MED, Aboukhalil Jad MD,Sinziana Dumitra MD, Eve Simoneau MD, Suhail Doi MD, PhD,Jeffrey Barkun MD, MSC, FRCSCMcGill University, Montreal, QC and QueenlandsUniversity,Brisbane, Australia

INTRODUCTION: We have previously described and validated theMcGill-Brisbane score (MBS), which predicts survival in palliative(unresectable) pancreatic adenocarcinoma patients. It is based on 4clinical variables recorded at first clinical encounter (weight loss�10%, pain, jaundice & smoking). The purpose of this study is todetermine the ability of the MBS to predict survival of patientsundergoing pancreaticoduodenectomy (PD) for resectable pancre-

atic adenocarcinoma (rPA).