Total Pancreatectomy and Subtotal Duodenopancreatectomy for the Management of Carcinoma of the Head of the Pancreas: An Institutional Experience and Evolving Trends

Abstract

This retrospective study includes 88 consecutive patients treated by surgical resection for adenocarcinoma of the head of the pancreas between January 1973 and December 1992. Initially in 1973 total pancreatectomy was the treatment of choice. Our policy changed after a review of 47 consecutive total pancreatectomies in 1986 which showed no benefit. From 1986 the Whipple procedure became our standard operation. In the following 41 patients, a Whipple procedure was performed in 19 patients, and a total pancreatectomy was still performed in 22 patients because of positive resection margins or a friable pancreatic remnant. After total pancreatectomy, the 5-year survival rate was 7.8%. For lymph-node-negative patients, the 1-, 3-, and 5-year survival rates were 54, 24, and 15%, respectively. For node-positive patients, the 1-and 3-year survival rates were 46 and 4%, respectively, and there were no survivors at 54 months. This difference was statistically not significant. After the Whipple procedure, the 5-year survival rate was 12.5%. For node-negative patients, the 1-, 3- and 5-year survival rates were 50, 59, and 25%, respectively. For node-positive patients, the 1-year survival rate was 21%. This difference was significant (p = 0.007). This study highlights the fact that extended radical surgery does not improve overall survival, but stage II and III disease (Hermreck classification) was associated with a prolonged survival.

Surgery for Ductal Adenocarcinoma of the Pancreatic Head: Staging, Complications, and Survival after Regional versus Extended Lymphadenectomy

“…Reasons for such controversies lie mainly in the many differences between the various studies published during recent years. The most important differences concern standardization of the surgical approach, the extent of lymph node dissection, the decision to resect portal vein segments for suspected or proven tumor infiltration, the percentage of R0 resections and the application of additional adjuvant treatment modalities [8,9,18,[25][26][27][28][29]. Consequently, the first aim of our study was to standardize as many aspects as possible.…”

<p>Total pancreatectomy compared with pancreaticoduodenectomy: a systematic review and meta-analysis</p>

“…The TP group with higher 5-OS than the PD group (14% vs 0%) 9. In contrast, two studies reported that 5-OS was higher in the PD group than in the TP group 45,46. Nevertheless, several studies suggested that long-term survival after TP was comparable to that of PD.…”

“…In total, 45 studies were included in the systematic review that reported the morbidity or mortality for TP ( Appendix Table ) 5,9,12,13,18,28–66. A total of 15 studies focused on pancreatic cancer,9,12,13,19,28,29,34,35,43,45–47,49,51,53 16 studies focused on malignant and benign pancreatic disease,18,32,36,48,50,52,54–61,63,64 10 studies reported on PDAC,30–33,40–42,62,65,66 and 4 studies37–39,44 focused on benign disease. In studies focusing on pancreatic cancer, the morbidity of TP ranged from 36.2% to 75.0% and mortality ranged from 4.0% to 26.9%.…”

“…A total of 23 comparative studies were included,9,18,19,30–32,34,36,39,42,43,45,46,48–50,53,58–60,62,64,65 however, two studies9,19 came from Johns Hopkins Hospital. One study was excluded because it included less relevant outcomes 9.…”

“…Two studies were excluded because of the absence of a primary outcome 49,53. Twelve studies were excluded because of the study duration before 2000 19,30,31,34,36,39,42,43,45,46,48,59. Finally, 5 studies were included in the meta-analysis 18,60,62,64,65.…”