Total pancreatectomy for pancreatic ductal adenocarcinoma: review of the National Cancer Data Base

Johnston, William; Hoen, Helena; Cassera, Maria A.; Newell, Pippa; Hammill, Chet W.; Hansen, Paul; Wolf, Ronald

doi:10.1016/j.hpb.2015.07.009

Cited by 64 publications

(51 citation statements)

References 25 publications

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“…The median overall survival was 12.6-17.9 months, with 3-and 5-year survival rates of 15.3-34 and 11.3-15.9%, respectively. Similarities between TP and PD for PDAC were reported by several studies, supporting the use of TP when oncologically appropriate [7,21,38,40,42] . The rates of disease recurrence after TP for PDAC or invasive IPMN ranged 4.6-26.8% [2,4,26,47] .…”

Section: Long-term Survival Rates After Tpsupporting

confidence: 69%

“…The long-term survival rates of patients who underwent TP for pancreatic cancer were similar to those for patients who underwent PD at both the 3-and 5-year time points ( table 4 ) [2,4,9,21,24,26,39,40,42,44,45,47] , which supports the use of TP for the treatment of pancreatic adenocarcinoma in appropriately selected patients [39] . As with most retrospective studies, we were unable to collect prospective data on long-term glycemic control or QOL [40] .…”

Section: Long-term Survival Rates After Tpsupporting

confidence: 53%

“…In the reports since 2007, the morbidity rates following TP were reported in the range 19-49%, often owing to different operative methods ( table 2 ) [2,4,5,9,21,22,24,26,38,[42][43][44][45][46][47] . Morbidity rates were comparable between TP and PD.…”

Section: The Results For Tp In the Recent Yearsmentioning

confidence: 99%

“…However, more recently, the interest in TP has been shifted to alternative indications for the procedure, owing to the increasing recognition of multifocal parenchymal diseases including intraductal papillary mucinous neoplasms (IPMNs), multifocal renal cell metastases, multifocal neuroendocrine tumors (NETs), chronic pancreatitis (CPs), and even pancreatic ductal adenocarcinoma (PDAC), thereby prompting clinicians to reevaluate the role of TP [19,20] . In this context, there has once again been renewed interest in TP for the treatment of neoplastic disease over the past 10 years [21] . Recently, the number of cases with clinical indications for TP has been significantly increasing (1998, n = 384 vs. 2006, n = 494; p < 0.01) [22] .…”

mentioning

confidence: 99%

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The Clinical Outcomes after Total Pancreatectomy

et al. 2016

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Background: Total pancreatectomy (TP) is not more beneficial than less aggressive resection techniques for the treatment of pancreatic neoplasms and is associated with high morbidity and mortality. However, with advances in surgical techniques and glycemic monitoring, and the development of synthetic insulin and pancreatic enzymes for postoperative treatment, TP has been increasingly indicated. This is a review of the recent literature reporting the clinical outcomes after TP. Methods: We reviewed the publications reporting the use of TP starting 2007. The clinicophysiological and survival data were analyzed. Results: Few studies evaluated the differences in clinical outcomes between TP and pancreaticoduodenectomy (PD) with inconsistent results. It was reported that while the perioperative morbidity did not decrease, the mortality decreased compared to previous literature. All patients who underwent TP required insulin and high dose of pancreatic enzyme supplements. The 5-year survival rates after TP and PD for pancreatic cancer were similar. Conclusion: The perioperative mortality decreased in patients who underwent TP with advances in the operative procedures and perioperative care. The long-term survival rates were similar for TP and PD. Therefore, treating pancreatic neoplasms using TP is feasible. Patients undergoing TP should receive adequate treatment with synthetic insulin and pancreatic enzyme supplements.

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Section: Long-term Survival Rates After Tpsupporting

confidence: 69%

Section: Long-term Survival Rates After Tpsupporting

confidence: 53%

Section: The Results For Tp In the Recent Yearsmentioning

confidence: 99%

mentioning

confidence: 99%

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The Clinical Outcomes after Total Pancreatectomy

et al. 2016

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“…This theory has anyhow not been confirmed by the literature data. A recent analysis made on the US National Cancer Data Base [10] on 2582 patients who underwent TP for pancreatic cancer showed a 30-day mortality rate of 5.5 %. The same rate of short-term mortality was observed by Billings and co-authors [11] in a series of 99 consecutive TP, with the addition of 3 % of late death related to hypoglycemic episodes.…”

Section: Outcome Of Total Pancreatectomymentioning

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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Contemporary Reappraisal of Intraoperative Neck Margin Assessment During Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma

et al. 2021

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IMPORTANCE Although margin-negative (R0) resection is the gold standard for surgical management of localized pancreatic ductal adenocarcinoma (PDAC), the question of how to manage the patient with a microscopically positive intraoperative neck margin (IONM) during pancreaticoduodenectomy remains controversial. OBSERVATIONS In the absence of randomized clinical trials, we critically evaluated high-quality retrospective studies examining the oncologic utility of re-resecting positive IONMs during pancreaticoduodenectomy for PDAC (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018)(2019). Several studies have concluded that additional pancreatic resection to achieve an R0 margin in IONM-positive cases does not influence survival. The largest is a multi-institutional study of 1399 patients undergoing pancreaticoduodenectomy, which demonstrated that in comparison with patients undergoing R0 resection (n = 1196; median survival, 21 months), those with either final R1 resections (n = 131) or undergoing margin conversion from IONM-positive to R0 resection on permanent section (n = 72) demonstrated similar median survival times (13.7 and 11.9 months, respectively). Conversely, recent reports suggest that the conversion of IONM to R0 resection with additional resection or even total pancreatectomy may be associated with improved survival. The discordance between these conflicting studies could be explained in part by the influence of biologic and physiologic selection on the association of IONM re-resection and survival. Since most studies did not include patients receiving modern combination chemotherapy regimens, the intersection between margin status, tumor biology, and chemoresponsiveness remains unclear. Furthermore, there are no dedicated data to guide surgical management in IONM-positive pancreaticoduodenectomy for patients receiving neoadjuvant chemotherapy. CONCLUSIONS AND RELEVANCEAlthough data regarding the oncologic utility of additional resection to achieve a tumor-free margin following initial IONM positivity during pancreaticoduodenectomy for PDAC are conflicting, they suggest that IONM positivity may be a surrogate for biologic aggressiveness that is unlikely to be mitigated by the extent of surgical resection. The complex relationship between margin status and chemoresponsiveness warrants exploration in studies including patients receiving increasingly effective neoadjuvant chemotherapy.

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Total pancreatectomy for pancreatic ductal adenocarcinoma: review of the National Cancer Data Base

Cited by 64 publications

References 25 publications

The Clinical Outcomes after Total Pancreatectomy

The Clinical Outcomes after Total Pancreatectomy

Are there still indications for total pancreatectomy?

Contemporary Reappraisal of Intraoperative Neck Margin Assessment During Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma

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