Total Pancreatectomy

Gaston, Eugene A.

doi:10.1056/nejm194803112381101

Cited by 33 publications

(8 citation statements)

References 25 publications

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“…At the beginning of the era of oncologic pancreatic surgery, total pancreatectomy (TP) was used as a “radical procedure” for the surgical treatment of pancreatic cancer [1, 2]. However, new insights on pancreatic oncology, associated with the evidence of the side effects of total pancreatectomy, have made this procedure less appealing.…”

Section: Introductionmentioning

confidence: 99%

Are there still indications for total pancreatectomy?

et al. 2016

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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.

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Section: Introductionmentioning

confidence: 99%

Are there still indications for total pancreatectomy?

et al. 2016

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“…The patient survived for 29 years before dying of cholangitis. In 1948, Gaston [6] gathered a report of 17 cases from the scientific literature and published it.…”

Section: Historical Notesmentioning

confidence: 99%

Are There Indications for Total Pancreatectomy in 2016?

2016

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An elective total pancreatectomy (TP) was first performed by Eugene Rockey of Portland, Oregon, in 1942. In the 1960s and 1970s, TP was the routine resection for pancreatic cancer in many centers because of fear of a leaking pancreatojejunostomy and multicentricity of the disease but the result used to be dreadful (in today's perspective). However, more recently, postoperative mortality and morbidity after pancreatic resections have improved due to better anastomotic technique and pre-, peri- and postoperative care. Today, TP - despite being a more extensive operation - can be offered with about the same operation risk as that of a Whipple procedure. Also, major improvements in the control of diabetes have been seen and there is actually an ongoing discussion on the actual severity of the diabetic state after TP. Also, the development of modern pancreatic enzyme preparations with sufficient control of endocrine and exocrine pancreatic insufficiency provides options for overcoming the postoperative problems following TP. Due to the improved results, there are today different - and more specific - indications than before for TP: malignant tumors growing from the pancreatic head into the left pancreas, pancreatic head cancer where it is not possible to secure a tumor-free resection margin with extended resection or with dubious changes in the pancreatic main duct at frozen section, recurrent malignancy in the pancreatic remnant, at cancer surgery with resection of the celiac trunk, rescue pancreatectomy after a leaking pancreatojejunostomy with sepsis or bleeding after a Whipple-type first resection, multifocal intraductal papillary mucinous neoplasm with potentially malignant foci present in all parts of the gland, multiple metastases of renal cell carcinoma and melanoma without any residual tumor outside the pancreatic gland (possibly also other specified but uncommon metastatic tumors with a potential for cure by pancreatectomy), multifocal neuroendocrine tumors including multiple endocrine neoplasia and hereditary pancreatic cancer with a high grade of cancer penetration risk for the bearers.

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“…'Ιστορικού μόνον ενδιαφέροντος είναι καί δύο περιπτώσεις άνευρεθεΐσαι εις τήν βιβλιογραφίαν υπό τοϋ Sauvé (68), κατά τάς οποίας έξετε-λέσθη σχεδόν ολική παγκρεατεκτομή: Ή πρώτη έγχείρησις διενηργήθη υπό του Billroth το 1894 (ώς ανεφέρθη υπό των Mayo -Robson κατά το Συνέδριον των Παρισίων του 1900) (28). Το πάγκρεας εΐχεν άφαιρεθή εξ ολοκλήρου δια κακοήθη δγκον και ό ασθενής επέζησεν άλλα τα απώτε ρα αποτελέσματα της έγχειρήσεως παρέμειναν άγνωστα.…”

Section: ιστορικονunclassified

“…Ή δευτέρα εγχείρησις ανεφέρθη υπό του Franke το 1900 (28). Επρόκειτο περί καρκίνου του παγκρέατος άλλα το δωδεκαδάκτυλον δεν εΐχεν άφαιρεθή, μικρόν δέ τμήμα παγκρέατος, μεγέθους φουντου κιού, είχε παραμείνει παρά το 12)δάκτυλον.…”

Section: ιστορικονunclassified

“…ώς αποτέλεσμα βαρείας μετεγχειρητικής επιπλοκής. Φαίνεται δτι ή παρουσία χολίνης καί άλλων λιποτρόπων παραγόντων είναι επαρκής δια τήν προστασίαν τοΰ ήπατος τοΰ άνθρωπου (28).…”

Section: ανεπαρκεια της εναοκρινους μοιρας του παγκρεατοςunclassified

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Η Ολικη Παγκρεατεκτομη Επι Το Ανθρωπου: Αι Μεταβολικαι Και Ορμονικαι Συνεπειαι Αυτης

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Total Pancreatectomy

Cited by 33 publications

References 25 publications

Are there still indications for total pancreatectomy?

Are there still indications for total pancreatectomy?

Are There Indications for Total Pancreatectomy in 2016?

Η Ολικη Παγκρεατεκτομη Επι Το Ανθρωπου: Αι Μεταβολικαι Και Ορμονικαι Συνεπειαι Αυτης

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