Is there still a role for total pancreatectomy?

Area of Science:

• Gastroenterology
• Surgical Oncology
• Pancreatic Surgery

Background:

• Total pancreatectomy (TP) was historically associated with high morbidity and mortality.
• Advances in surgical techniques and postoperative care have led to a reevaluation of TP.
• Improved management of exocrine and endocrine insufficiency supports the resurgence of TP for specific pancreatic conditions.

Purpose of the Study:

• To compare perioperative and long-term outcomes of TP with the pylorus-preserving (pp)-Whipple procedure.
• To evaluate morbidity, mortality, and quality of life (QoL) after TP.
• To determine if TP is a viable option for selected patients with benign and malignant pancreatic disease.

Main Methods:

• A prospective study included 147 patients undergoing TP between October 2001 and November 2006.
• Data collected included perioperative outcomes, late follow-up, and QoL using the EORTC QLQ-C30 questionnaire.
• A matched-pairs analysis compared TP outcomes with those of patients who underwent a pp-Whipple operation.

Main Results:

• Elective TP indications included adenocarcinoma (n=71), other tumors (n=34), metastases (n=8), and chronic pancreatitis (n=11).
• Postoperative morbidity was 24% surgical and 15% medical, with a 4.8% mortality rate.
• Median follow-up was 23 months; QoL was comparable to pp-Whipple, though some items were reduced. All patients required insulin and enzyme replacement, with a mean HbA1c of 7.3%.

Conclusions:

• Elective TP demonstrated mortality and morbidity rates not significantly different from the pp-Whipple procedure.
• Acceptable QoL, comparable to pp-Whipple, is achievable with improved postoperative management.
• TP is a viable surgical option for selected patients with pancreatic diseases and should not be generally avoided.