P-P33 Quality of Life Assessment in Patients undergoing Robot Assisted Pancreaticoduodenectomy Qazi Rahim Muhammad 1 , Alexia Farrugia 2 , Hope Poole 1 , Majid Ali 1 , Gabriele Marangoni 3 , Jawad Ahmad 1 1 UHCW, Coventry, United Kingdom, 2 Walsall Manor Hospital, Walsall, United Kingdom, 3 uhcw, coventry, United Kingdom Background: Robot-assisted pancreaticoduodenectomy has recently gained attention as there is evidence from high volume centres sug- gests better outcomes and quick recovery. This study aimed to evaluate the quality of life after robotic-assisted pancreaticoduodenectomy Methods: The study included the first 12 consecutive patients who underwent robotic pancreaticoduodenectomy. The RAND SF 36-Item health survey form was used to assess the quality of life through a one- hour face-to-face interview carried out by a junior doctor from a differ- ent team with no prior involvement in patient care. The interview was carried out at least three months postoperative period. Each item in the subscale was recorded with a pre-coded numeric value. The compari- son was made between preoperative periods’ scores defined by the on- set of disease symptoms to surgery and the postoperative follow-up score. The SF-36 survey questions were supplemented with additional items such as postoperative pain, emotional wellbeing, and fatigue sta- tus. Results: Analysis of SF-36 domains showed better quality of life post- operatively than the baseline, as evidenced by the mean physical func- tioning score from 82.91 to 90 and mean general health score from 37.9 to 69.5 postoperatively. 91.66% of the patients reported that they felt better at the time of study and were happy overall. Conclusions: Robotic-assisted pancreaticoduodenectomy shows a bet- ter quality of life than in the preoperative period, which can be attained in a brief postoperative period. P-P34 Impact of an Enhanced Recovery After Surgery Protocol on Short-Term Outcomes in Elderly Patients Undergoing Pancreaticoduodenectomy Syed Soulat Raza, Anisa Nutu, Sarah Powell-Brett, Amanda Carvalheiro Boteon, James Hodson, Manuel Abradelo, Bobby Dasari, John Isaac, Nikolaos Chatzizacharias, Ravi Marudanayagam, Darius Mirza, Keith Roberts, Robert Sutcliffe Queen Elizabeth Hospital, Birmingham, United Kingdom Background: In an effort to improve postoperative recovery and reduce complications, enhanced recovery after surgery (ERAS) pathways have been introduced across a range of surgical disciplines. The demo- graphics of patients being considered for PD have evolved over recent decades, with older patients undergoing increasingly more complex procedures. The feasibility and benefits of an ERAS protocol for elderly patients undergoing PD is debated, a recent study suggesting that age over 70 years is an independent risk factor for protocol failure . Existing studies on ERAS after PD in elderly patients are limited by small sample sizes and failure to include a pre-ERAS control. Methods: 830 consecutive patients who underwent PD between January 2009 and March 2019 were divided according to age: elderly (75 years) vs. non-elderly patients (<75 years). Within each age group, cohort characteristics and outcomes were compared between patients treated pre- and post-ERAS (ERAS was systematically introduced in December 2012). Univariable and multivariable analysis were then per- formed, to assess whether ERAS was independently associated with length of hospital stay (LOS). Results: Of the entire cohort, 577 of 830 patients (69.5%) were managed according to an ERAS protocol, and 170 patients (20.5%) were aged  75 years old. Patients treated post-ERAS were significantly more comorbid than those pre-ERAS, with a mean Charlson Comorbidity Index of 4.6 vs. 4.1 (p < 0.001) and 6.0 vs. 5.7 (p ¼ 0.039) for the non-elderly and elderly subgroups, respectively. There were significantly fewer medical compli- cations in non-elderly patients treated post-ERAS compared to pre-ERAS (12.4% vs. 22.4%; p ¼ 0.002), but not in elderly patients (23.6% vs. 14.0%; p ¼ 0.203). On multivariable analysis, ERAS was independently associated with reduced LOS in both elderly (14.8% reduction, 95% CI: 0.7-27.0%, p ¼ 0.041) and non-elderly patients (15.6% reduction, 95%CI: 9.2-21.6%, p < 0.001), with the effect size being similar in each group. Conclusions: ERAS protocol can be safely applied to patients undergo- ing pancreaticoduodenectomy irrespective of age. ERAS is associated with a significant reduction in postoperative LOS in elderly and non- elderly patients, despite higher comorbidity in the post-ERAS period. P-P35 Textbook outcomes after pancreaticoduodenectomy in high risk patients: results from a high volume UK centre Syed Soulat Raza, Anisa Nutu, Sarah Powell-Brett, Nikolaos Chatzizacharias, Bobby Dasari, John Isaac, Manuel Abradelo, Ravi Marudanayagam, Darius Mirza, Keith Roberts, Robert Sutcliffe Queen Elizabeth Hospital, Birmingham, United Kingdom Background: Textbook Outcome (TO) after pancreaticoduodenectomy (PD) is a quality metric that may be used to compare outcomes between centres, but the effect of casemix on TO is unknown. The aim of this study was to determine if TO after PD is affected by casemix. Methods: TO was evaluated in a prospectively maintained database of 830 consecutive patients who underwent PD between 2009-2019 in a high volume centre. TO was defined as an absence of POPF, bile leak, haemorrhage, Clavien IIIþ complications, readmission and hospital mortality. Frequency of TO was compared between high and low risk cases. High risk was defined as any of the following: age  75 years, sig- nificant comorbidity (Charlson index 5), vascular resection or addi- tional procedures. Multivariable analysis using binary logistic regression analysis was performed to assess factors associated with TO. Results: Overall, 599/830 patients (72%) had TO after PD. There has been no change during the study period (2009-2013 v 2014-2018: 70% v 75%; p ¼ 0.148). There was no difference in TO in elderly patients (p ¼ 0.774), severe comorbidity (p ¼ 0.483), vascular resection (p ¼ 0.187) or additional procedures (p ¼ 0.189). On multivariable analysis, cardiac disease (OR 0.47, 95%CI 0.28-0.81; p ¼ 0.006), pancreatic adenocarci- noma (OR 1.55 95%CI 1.02-2.35; p ¼ 0.039) and hard gland (OR 3.12, 95%CI 2.06-4.736; p < 0.001) were independently associated with TO. Conclusions: Acceptable Textbook Outcomes can be achieved in high risk patients and those undergoing complex surgery, when performed in high volume specialist centres with appropriate patient selection. P-P36 AXIOS TM stents in the management of pancreatic fluid collections: case series from a single healthcare trust Joseph Doyle, Nadiah Latip, Stephen McCain, Ryan Scott, Mark Love, Mark Taylor, David Vass, Claire Jones, Gareth Kirk, Lloyd McKie, Thomas Diamond Belfast Health and Social Care Trust, Belfast, United Kingdom Background: This was a consecutive case-series of all pancreatic fluid collections (PFCs) managed with AXIOS TM stents in a 3 year period from a single healthcare trust, retrospectively analysed to determine the rate of technical success, clinical success and adverse events related to the procedure. Methods: All patients in who underwent AXIOS stenting for PFCs in the Belfast Health and Social Care Trust between May 2016 and July 2019 were included, with a follow-up period of 1 year. Electronic care records (ECR) and Radiology reports were reviewed for each patient. PFCs were categorised into walled-of pancreatic necrosis (WOPN) and pseudocysts as per the revised Atlanta classification. The number of re- peat procedures, endoscopic lavage þ/- necrosectomy, the need for de- finitive surgery or any adverse events post-procedure were recorded. Results: 45 patients were included in the study (21 male, 24 female). 17 patients (37.8 %) had WOPN and 28 (62.2 %) pancreatic pseudocysts. Median collection diameter on CT imaging was 12 cm (range 6.2 – 22 cm). The procedure was technically successful in 43 patients (95.6%), with stent mal-deployment in the remaining 2. Median duration for stenting was 29.5 days (Range 13 – 92). The procedure was clinically successful for 33 patients (73.3%). n ¼ 8 (17.8%) of patients were re-admitted with sepsis following stent inser- tion requiring intravenous antibiotics. n ¼ 16 (35.6%) patients required repeated endoscopic lavage þ/- necrosectomy following stent blockage Abstracts | ix105