Eighty-six cases of total pancreatectomy for pancreatic neoplasms

Abstract

Background: Although frequency of total pancreatectomy (TP) indicated for pancreatic neoplasm has increased, surgical outcome and nutrition was still unclear. Objective: To clarify the outcome of TP. Methods: Patients with pancreatic neoplasms who underwent between 1990 and 2018 were analyzed. Surgical variables and outcome were compared between subjects who underwent simple TP [group A], TP followed by pancreaticoduodenectomy (PD) or distal pancreatectomy (DP) according to intraoperative pathological diagnosis of pancreatic margin [B], TP followed by past PD or DP for another disease [C]. Results: A total 86 patients, 64 [36-80] year-old 44 males and 42 females, underwent TP. Operative time and blood loss were 520 [155-1070] minutes and 1095 [85-8155] ml, respectively. Mortality rate [n=2(2%)] and morbidity rate [>=Clavien-Dindo grade IIIa; n=4(5%)] were acceptable. Sixty-one cases were indicated for ductal adenocarcinoma (PDAC), 7 for neuroendocrine tumor, 7 for metastatic tumor from renal cell carcinoma, 11 for others. Although overall survival of patients with PDAC in group A (n=25), B (n=30), C (n=5) were statistically comparable respectively, the survival (3-5 years survival/ median survival time) of group A (29-29%/15.5 months) tended to be worse than that of group B and C (53-29%/ 46.9 months and 60-30%/ 56.6 months). PDAC patients with CA19-9 level less than 500 U/ml (56-41%/ 48.6 months) survived statistically more than those with CA19-9 level more than 500 U/ml (18-0%/ 16.4 months, P=0.011). Conclusions: Because of recent advance of surgical technique and management of TP, TP for wide-spread non PDAC or less advanced PDAC provides acceptable prognosis.