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279 Background: Preoperative bowel preparation (PBP) before pancreaticoduodenectomy (PD) is commonly performed; however, the effect of PBP on intraoperative fluid requirements and acute renal failure (ARF) after PD has not been reported. The goal of this study was to determine the effect of PBP on postoperative complications, intraoperative fluid requirements, and ARF after PD. Methods: In this retrospective sequential analysis, all patients undergoing PD consecutively from September 2005 to July 2012 by a single surgeon were identified. Clinical data from patients who received PBP from September 2005 to November 2008 was compared to those without PBP from December 2008 to July 2012. Results: In all, 140 consecutive patients were identified with 49 (35%) having received PBP. There was no significant difference in the frequency of chronic renal failure between groups. The PBP group received a larger total intraoperative fluid volume (9.33 vs 6.54 L, p

329 Background: Surgical therapy remains the only curative modality for pancreatic cancer, though survival remains quite poor even for patients with resected early stage disease. Better (neo) adjuvant therapies are needed to improve resectability rates for patients with borderline resectable pancreatic cancer and to prevent recurrence following resection. We undertook this pilot study to determine the safety of accelerated fraction radiotherapy (AFRT) with capecitabine in such patients. Methods: Eligible patients have histologically confirmed borderline resectable adenocarcinoma of the pancreas as defined by the MD Anderson categories of vascular involvement, indeterminate metastatic disease, borderline performance status; normal organ function; and no prior therapy for pancreatic cancer. Radiation is given as external beam radiation therapy to a dose of 50 Gy delivered in 20, 2.5 Gy fractions Mon-Fri using IMRT. If insurance denied IMRT, 3D conformal techniques with daily image guidance is permitted. Capecitabine is delivered as 825mg/m2 BID on radiation days. The primary outcome is to determine the frequency of treatment-related adverse events (AE). Planned enrollment is 40 pts. Results: 10 pts have enrolled to date. 8/10 received IMRT. This regimen has been exceedingly tolerable. Lymphopenia is the most common AE (n=10), grade 3-4 n=6. Other common toxicities were hyponatremia (n=6), fatigue (n=5). Grade 3 AE occurred in 8 pts, grade 4 in 3 patients. One pt had hemorrhage from a radiation induced gastric ulcer complicated by an MI. 5/10 pts had stable disease and were resected and 4/5 had an R0 resection. In the remaining 5/10 patients, disease progressed outside the pancreas and they are receiving palliative therapy. Conclusions: The combination of AFRT and capecitabine was well tolerated. Xenograft models derived from these patients’ tumors are being used to study molecular mechanisms of treatment resistance that could be targeted in a follow up phase II study building on this platform.

178 Background: Pancreatic neuroendocrine tumors (pNETs) are a heterogeneous group of rare malignancies in which surgical resection remains the only curative therapy. The optimal surgical approach (enucleation vs. pancreatectomy) is controversial. This study aims to determine the 1) incidence, 2) predictors, and 3) preoperative detection of lymph node (LN) metastases in resected pNETs to help guide surgical management. Methods: A retrospective review of prospectively collected data was performed for all patients with pancreatic neuroendocrine tumors who underwent surgical resection at the University of Virginia between 1991 and 2010. The electronic medical record, radiology reports and pathology reports were used to identify patient demographics, surgical procedure, tumor functional status, type, size, location, and LN status. Results: In all, 76 patients were identified. Most tumors were non-functioning (71%) with insulinomas (13%) and gastrinomas (5%) representing the largest groups of functioning pNETs. Nineteen tumors (25%) had LN metastases at the time of resection. LN-positive tumors were significantly larger than LN-negative tumors (4.0 ± 0.4 cm vs. 2.8 ± 0.2 cm, p=0.01). Five (11%) of 46 tumors ≤ 3 cm and one (14%) of 7 tumors ≤ 1 cm had LN metastases. There were no significant relationships between LN status and either tumor type or location (head/uncinate vs. body/tail). Of patients with LN-positive tumors, preoperative CT or MRI detected the LN metastases in only 19%. Conclusions: Twenty-five percent of pNETs are associated with LN metastasis. The only predictor of LN metastasis was tumor size, but even smaller tumors were associated with LN metastasis. The sensitivity of preoperative CT and MRI is quite poor in detecting LN metastasis. Thus, formal resection with lymphadenectomy should be considered the standard of care for pNETs. [Table: see text]