Are there still indications for total pancreatectomy?

Abstract

Total pancreatectomy is associated with short- and long-term high complication rate and without evidence of oncologic advantages. Several metabolic consequences are co-related with the apancreatic state. The unstable diabetes related to the total resection of the pancreas expose the patients to short- and long-term life-threatening complications. Severe hypoglycemia is a short-term dangerous complication that can also cause patients’ death. Chronic complications of severe diabetes (cardiac and vascular diseases, neuropathy, nephropathy, and retinopathy) are also cause of morbidity, mortality and worsening of quality of life. For this reasons the number of total pancreatectomies performed has certainly decreased over time. However, today there are still some indications for this kind of procedures. Chronic pancreatitis untreatable with conventional treatments, surgical treatment of precancerous pancreatic lesions, surgical treatment of locally advanced pancreatic cancer and the management of patients with extraordinary high-risk pancreatic texture after pancreaticoduodenectomy represent possible indications for total pancreatectomy and are analyzed in the present paper.

Duodenopancreatosplenectomy for pancreatic ductal adenocarcinoma in an 87-year-old patient

“…Наиболее трудными аспектами ведения пациентов после панкреатэктомии являются контроль гликемии в раннем послеоперационном периоде и внешнесекреторной недостаточности в последующем [9]. Применение современной инсулинотерапии и корректная ферментозаместительная терапия позволили успешно компенсировать состояние пациента в нашем наблюдении, обеспечив высокое качество жизни.…”

Pancreatic Enzyme Replacement Therapy in Pancreatic Cancer

“…Patients undergoing PD for PC developed PEI in 64-100% of cases, whereas this percentage decreased to 0-42% after DP [66][67][68][69]. Total pancreatectomy (TP) is a less frequent procedure, mainly performed in the presence of advanced PC (especially when requiring arterial resection) [70] or in the presence of PC associated with a intraductal papillary mucinous neoplasm. As expected, 100% of patients submitted to TP developed a severe endocrine and exocrine pancreatic insufficiency.…”

Systematic review of functional outcome and quality of life after total pancreatectomy

“…Total pancreatectomy for IPMN requires extensive counselling, as this is prophylactic surgery. Other indications for total pancreatectomy could be multifocal pancreatic disease (such as neuroendocrine tumours and renal cell cancer metastases) and technical difficulties, or patients with a very high risk of having a pancreatic anastomosis (for instance in arterial reconstruction).…”