Total Pancreatectomy: No Peri-Operative Mortality and Good Long Term Qol Can Be Achieve

Abstract

Introduction: Indications for total pancreatectomy (TP) can be divided in: size or localisation of tumor, troubles in the perioperative period of partial pancreatectomy, technical difficulties and therapy-refractory pain in chronic pancreatitis. Morbidity and mortality rates are reported around 38-69% and >20%, respectively. Method: Retrospective collection of data for patients that underwent TP between 2014 and 2021 at our institution. Also an original survey to investigate the quality of life (QoL) of all surviving patients was performed. Results: A total of 14 patients underwent TP. Indications for TP were size or localisation of tumor (12 cases) and technical difficulties (2 cases). Complications Clavien-Dindo ≥ III were reported in only two cases. There was no 30-days mortality. Analysis of survival demonstrated that cancer patients had a significantly worse overall survival (p=0.021). The median overall adjusted (cancer related) survival was 13 months (3-20, SD 7.2 Mo). All non-cancer patients are alive. QoL analysis revealed good glycemic control, without diarrhoea, loss of weight or malabsorption syndrome. All patients surveyed reported a good QoL. Conclusions: Our series shows that TP can be performed in selected indications with acceptable morbidity and low mortality. The overall survival was defined by the underlying diagnosis and not the TP or apancreatic state. With multidisciplinary long term care good endocrine and exocrine control can be achieved providing a good QoL.