Are There Indications for Total Pancreatectomy in 2016?

Area of Science:

• Surgical Oncology
• Gastroenterology
• Endocrinology

Background:

• Total pancreatectomy (TP) was historically associated with high mortality and morbidity.
• Improvements in surgical techniques and perioperative care have significantly reduced risks.
• Advances in diabetes management and pancreatic enzyme replacement have mitigated postoperative complications.

Purpose of the Study:

• To review the evolution and current indications for total pancreatectomy (TP).
• To highlight the improved safety and outcomes of TP in contemporary surgical practice.
• To discuss the management of endocrine and exocrine insufficiency after TP.

Main Methods:

• Review of historical and current surgical practices for TP.
• Analysis of advancements in anastomotic techniques and postoperative care.
• Evaluation of modern strategies for managing diabetes and pancreatic insufficiency.

Main Results:

• Postoperative mortality and morbidity after TP are now comparable to the Whipple procedure.
• Significant improvements in controlling diabetes and managing exocrine insufficiency post-TP.
• Expanded and more specific indications for TP have emerged due to improved safety and outcomes.

Conclusions:

• Total pancreatectomy (TP) is a safe and effective option for select complex pancreatic pathologies.
• Careful patient selection and management of postoperative complications are crucial for successful TP.
• TP offers a potentially curative option for specific malignant and premalignant pancreatic conditions.