Indications and early outcomes for total pancreatectomy at a high-volume pancreas center

Abstract

Background: This study aimed to analyse the most common current indications for total pancreatectomy (TP) at a high-volume pancreas center.

Method: Prospectively collected data on indications and short-term outcome of all TP's performed from January 2004 until June 2008 were analysed.

Results: The total pancreatectomies (TP) were 63, i.e., 6.7% of all pancreatic procedures (n = 948). Indications for TP were classified into 4 groups: tumors of advanced stage, n = 23 (36.5%), technical problems due to soft pancreatic tissue, n = 18 (28.6%), troubles due to perioperative surgical complications, n = 15 (23.8%), and therapy-resistant pain due to chronic pancreatitis, n = 7 (11.1%). Surgical complications occurred in 23 patients (36.5%). The mortality in elective TP was 6.25%. Median postoperative stay was 21 days. Mortality, morbidity and the other perioperative parameters differed substantially according to the indication for pancreatectomy.

Conclusion: Total pancreatectomy is definitely indicated for a limited range of elective and emergency situations. Indications can be: size or localisation of pancreatic tumor, trouble, technical diffuculties and therapy-refractory pain in chronic pancreatitis. A TP due to perioperative complications (troubles) after pancreatic resections is doomed by extremely high morbidity and mortality and should be avoided.

Figure 1

Operation time according to indications: (1) tumor, (2) technical, (3) trouble, (4) therapy-refractory pain, *group 3 significant shorter operation time compared to all others, P = .001.

Figure 2

Intraoperative blood loss according to indications: (1) tumor, (2) technical, (3) trouble, (4) therapy-refractory pain, *group 3 significant higher blood loss compared to all others, P < .009 in all cases, **group 1 > group 2, P = .043.

Figure 3

Intraoperative transfused RBC units according to indications: (1) tumor, (2) technical, (3) trouble, (4) therapy-refractory pain, *group 3 significant more transfused RBC units than all other groups, P = .001.

Figure 4

Postoperative stay in 53 patients who survived TP is according to indications: (1) tumor, (2) technical, (3) trouble, (4) therapy-refractory pain, *group 3 significant longer hospital stay compared to 2 (P = .04) and group 4 (P = .01), **group 4 shorter stay compared to group 1, P = .04.