The Clinical Outcomes after Total Pancreatectomy

Area of Science:

• Surgical Oncology
• Gastroenterology
• Endocrinology

Background:

• Total pancreatectomy (TP) historically had high morbidity and mortality for pancreatic neoplasms.
• Advances in surgical techniques, glycemic monitoring, and supportive therapies have increased TP indications.
• This review examines recent clinical outcomes following TP.

Purpose of the Study:

• To review recent literature on clinical outcomes after total pancreatectomy (TP).
• To compare TP with less aggressive pancreatic resection techniques, specifically pancreaticoduodenectomy (PD).

Main Methods:

• Systematic review of publications on TP from 2007 onwards.
• Analysis of clinicophysiological and survival data from reviewed studies.

Main Results:

• Perioperative morbidity for TP did not decrease, but mortality has declined compared to historical data.
• All patients undergoing TP required lifelong insulin and high-dose pancreatic enzyme supplementation.
• Five-year survival rates for pancreatic cancer were similar between TP and PD.

Conclusions:

• Total pancreatectomy (TP) is a feasible treatment option for pancreatic neoplasms, with reduced perioperative mortality due to improved surgical and perioperative care.
• Long-term survival outcomes following TP are comparable to those of pancreaticoduodenectomy (PD).
• Patients undergoing TP necessitate comprehensive management with synthetic insulin and pancreatic enzyme replacement therapy.