Total pancreatectomy: Short- and long-term outcomes at a high-volume pancreas center

Abstract

Aim: To identify the current indications and outcomes of total pancreatectomy at a high-volume center.

Methods: A single institutional retrospective study of patients undergoing total pancreatectomy from 1995 to 2014 was performed.

Results: One hundred and three patients underwent total pancreatectomy for indications including: Pancreatic ductal adenocarcinoma (n = 42, 40.8%), intraductal papillary mucinous neoplasms (n = 40, 38.8%), chronic pancreatitis (n = 8, 7.8%), pancreatic neuroendocrine tumors (n = 7, 6.8%), and miscellaneous (n = 6, 5.8%). The mean age was 66.2 years, and 59 (57.3%) were female. Twenty-four patients (23.3%) underwent a laparoscopic total pancreatectomy. Splenic preservation and portal vein resection and reconstruction were performed in 24 (23.3%) and 18 patients (17.5%), respectively. The 90 d major complications, readmission, and mortality rates were 32%, 17.5%, and 6.8% respectively. The 1-, 3-, 5-, and 7-year survival for patients with benign indications were 84%, 82%, 79.5%, and 75.9%, and for malignant indications were 64%, 40.4%, 34.7% and 30.9%, respectively.

Conclusion: Total pancreatectomy, including laparoscopic total pancreatectomy, appears to be an appropriate option for selected patients when treated at a high-volume pancreatic center and through a multispecialty approach.

Keywords: Intraductal papillary mucinous neoplasms; Laparoscopic total pancreatectomy; Laparoscopy; Pancreas cancer; Pancreas cyst; Pancreatic ductal adenocarcinoma.

Figure 1

Kaplan Meier curve for survival. A: Survival in patients with pancreatic ductal adenocarcinoma; B: Survival in patients with intraductal papillary mucinous neoplasms. PDAC: Pancreatic ductal adenocarcinoma; IPMN: Intraductal papillary mucinous neoplasms.