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

Abstract

Background: Enthusiasm for total pancreatectomy (TP) has varied with time. It is still a topic of controversial discussions even since surgeons realized its feasibility. The aim of this study is to identify the current indications and outcome of TP in the spectrum of pancreatic resections in this high volume center. Methods: A single institutional retrospective study of patients undergoing total pancreatectomy from 1995 to 2014 was performed. Results: One hundred 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.