Clinical outcomes after total pancreatectomy for malignant neoplasms; a single center retrospective study of 26 cases

Abstract

Background: Total pancreatectomy (TP) used to be applied for pancreatic cancer to obtain better oncological clearance or to avoid pancreatic fistulae, but indications have changed. The aim of this study was to clarify recent disease indications and outcomes for this procedure. Methods: A total of 26 patients who underwent one-stage surgery (n=11) or two-stage surgery (n=15) were analyzed retrospectively. Results: The postoperative morbidity rate was 26.9%, but no postoperative mortality was encountered. Twenty-two patients had multiple diseases, including intraductal papillary mucinous neoplasm (IPMN) -associated tumors in 12 and de novo pancreatic ductal carcinoma (PDAC) in 5. Significantly more T3/T4 and stage III/IV tumors were included in the de novo PDAC group than in the IPMN-associated tumor group (T3/T4: 70% vs. 16.7%, p=0.002; stage III/IV: 100% vs. 33.3%, p=0.012). Two-year survival rates were lower in the de novo PDAC group (20%) than in the IPMN-associated tumor group (68.8%, p=0.041). Conclusions: TP can be performed safely with low mortality and acceptable morbidity. Our study revealed that the most frequent indication for TP was multiple diseases, and the two main cohorts involved different malignancies: IPMN-associated tumors; and de novo PDAC.

Is it worthy to perform total pancreatectomy considering morbidity and mortality?: Experience from a high-volume single center

“…This number did not appear to be small compared to other studies presented in Table 6. [10][11][12][13][15][16][17]25,26,29] Centers participating in all the above studies appeared to be high-volume centers that performed more than 20 cases of PD per year. [30] In our study, short-term postoperative outcomes such as overall morbidity (38.0%), major morbidity (17.6%), 30-days mortality (0.0%), 90-days mortality (2.1%), and rate of re-admission within 90-days (20.4%) were relatively favorable and tolerable.…”

“…TP is required when tumors with malignant potential such as intraductal papillary mucinous neoplasm (IPMN) or neuroendocrine tumor (NET) are present multifocally throughout pancreas. [10–12,14] There are also many cases of TP performed for unresolvable problems such as uncontrolled pain due to severe chronic pancreatitis. [14–17]…”

“…In operating room during partial pancreatectomy such as pancreaticoduodenectomy (PD) or distal pancreatectomy (DP), if tumor invasion of resection margin is confirmed several times through frozen biopsy, surgical decision can be converted to TP. [10][11][12] And for patients who have undergone previous partial pancreatectomy, completion TP is performed to remove recurrent malignancy in remnant pancreas. [12,13] There are indications for benign tumors.…”

“…[10][11][12] And for patients who have undergone previous partial pancreatectomy, completion TP is performed to remove recurrent malignancy in remnant pancreas. [12,13] There are indications for benign tumors. TP is required when tumors with malignant potential such as intraductal papillary mucinous neoplasm (IPMN) or neuroendocrine tumor (NET) are present multifocally throughout pancreas.…”

Intraoperative Positive Pancreatic Parenchymal Resection Margin: Is It a True Indication of Completion Total Pancreatectomy after Partial Pancreatectomy for Pancreatic Ductal Adenocarcinoma?

“…This is the main reason for conversion of partial pancreatectomy, such as pancreaticoduodenectomy (PD) or distal pancreatectomy (DP), to total pancreatectomy (TP) due to a positive pancreatic parenchymal resection margin during the operation. Despite the major disadvantages of TP, including life-long endocrine and exocrine insufficiency, TP has been steadily performed since favorable long-term outcomes were obtained by radical resection and short-term outcomes were deemed tolerable [ 11 , 12 , 13 , 14 , 15 ]. Moreover, postoperative outcomes after TP have been reported to be relatively equivalent to those after PD [ 16 , 17 , 18 , 19 ].…”