Surgical Outcomes After Total Pancreatectomy: A High-Volume Center Experience

Stoop, Thomas F.; Ateeb, Zeeshan; Ghorbani, Poya; Scholten, Lianne; Arnelo, Urban; Besselink, Marc G.; Chiaro, Marco Del

doi:10.1245/s10434-020-08957-x

Cited by 33 publications

(42 citation statements)

References 40 publications

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“…Therefore, in terms of the results of this study, the median CSS for determining prognosis is valuable and reasonable. In addition, Stoop et al (31) reported that Total PT could be a better treatment option for elderly patients with pancreatic cancer. However, Johnston et al (32) studied the clinical data of 2,582 patients and found that the mortality rate of Total PT was higher than those in previous reports, and the survival time after surgery was limited.…”

Section: Discussionmentioning

confidence: 99%

Can Elderly Patients With Pancreatic Cancer Gain Survival Advantages Through More Radical Surgeries? A SEER-Based Analysis

et al. 2020

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Section: Discussionmentioning

confidence: 99%

Can Elderly Patients With Pancreatic Cancer Gain Survival Advantages Through More Radical Surgeries? A SEER-Based Analysis

et al. 2020

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“…TP is indicated in cases of diffuse MPD involvement, multifocal disease in patients with family history positive for PDAC, and persistent HGD at the resection margin because the established risk for recurrence and/or cancer in these patients makes the morbidity of TP more acceptable [52]. Moreover, recent studies have reported improved perioperative outcomes and postoperative quality of life (QoL) after TP, presumably due to centralization at high-volume centers and development of long-acting insulin and modern pancreatic enzyme preparations [53][54][55][56][57].…”

Section: Surgery For Ipmns: Intra-and Postoperative Implicationsmentioning

confidence: 99%

State-of-the-art surgical treatment of IPMNs

Salvia

Burelli

Perri

et al. 2021

Langenbecks Arch Surg

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Background A “pandemic” of incidentally discovered pancreatic cyst neoplasms (PCNs) is ongoing. Among PCNs, intraductal papillary mucinous cystic neoplasms (IPMNs) are the most common and with their complex biology could represent a precursor lesion of pancreatic cancer. Although multiple guidelines exist to guide their treatment, there are still many “gray areas” on indications for surgery for IPMNs. Methods The current indications for surgery of IPMNs were reappraised, considering potential discrepancies between available evidence and guidelines policies. The practice at a high-volume center for the diagnosis and treatment of PCN was presented and discussed. Results Most IPMNs do not and will never require surgery, as they won’t progress to malignancy. The current literature is solid in identifying high-grade dysplasia (HGD) as the right and timely target for IPMN resection, but how to precisely assess its presence remains controversial and guidelines lack of accuracy in this regard. Multiple tumorigenic pathways of progression of IPMNs exist, and their knowledge will likely lead to more accurate tests for malignancy prediction in the future. Conclusions The surgical management of IPMNs still is a matter of debate. Indication for resection should be considered only in highly selected cases with the ideal target of HGD. Clinicians should critically interpret the guidelines’ indications, refer to a multidisciplinary team discussion, and always consider the outcome of an adequate counselling with the patient.

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“…As mentioned above, recent studies have reported improved perioperative outcomes and postoperative quality of life after TP, presumably due to centralization at high-volume centers and development of long-acting insulin and modern pancreatic enzyme preparations [ 6 , 7 , 14 , 15 ].…”

Section: Total Pancreatectomy To Avoid Pancreatic Fistula In High-risk Patients: a Promising New Friend?mentioning

confidence: 99%

“…In this perspective, the encouraging postoperative outcomes of total pancreatectomy (TP) reported at high-volume centers in recent years [ 6 , 7 ] have led the authors questioning whether the burden of complications related to a high-risk pancreatic anastomosis could justify the use of TP as an alternative strategy in selected patients to avoid the occurrence of POPF [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Total pancreatectomy and pancreatic fistula: friend or foe?

et al. 2021

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Postoperative pancreatic fistula (POPF) still represents the major driver of surgical morbidity after pancreaticoduodenectomy. The purpose of this narrative review was to critically analyze current evidence supporting the use of total pancreatectomy (TP) to prevent the development of POPF in patients with high-risk pancreas, and to explore the role of completion total pancreatectomy (CP) in the management of severe POPF. Considering the encouraging perioperative outcomes, TP may represent a promising tool to avoid the morbidity related to an extremely high-risk pancreatic anastomosis in selected patients. Surgical management of severe POPF is only required in few critical scenarios. In this context, even if anecdotal, CP might play a role as last resort in expert hands.

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Surgical Outcomes After Total Pancreatectomy: A High-Volume Center Experience

Cited by 33 publications

References 40 publications

Can Elderly Patients With Pancreatic Cancer Gain Survival Advantages Through More Radical Surgeries? A SEER-Based Analysis

Can Elderly Patients With Pancreatic Cancer Gain Survival Advantages Through More Radical Surgeries? A SEER-Based Analysis

State-of-the-art surgical treatment of IPMNs

Total pancreatectomy and pancreatic fistula: friend or foe?

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