Categorization of Differing Types of Total Pancreatectomy

Area of Science:

• Surgical Oncology
• Gastrointestinal Surgery
• Clinical Outcomes Research

Background:

• Comparability of total pancreatectomy (TP) outcomes is limited due to unacknowledged procedure-specific differences.
• Extent of resection, including vascular or multivisceral involvement, impacts postoperative results but is often not detailed.

Purpose of the Study:

• To evaluate postoperative outcomes following TP.
• To categorize TP procedures based on extent, complexity, and technical aspects.

Main Methods:

• Retrospective cohort study of 1451 patients undergoing TP from 2001-2020.
• Patients classified into 4 types based on increasing difficulty: standard TP (type 1), TP with venous resection (type 2), TP with multivisceral resection (type 3), and TP with arterial resection (type 4).
• Postoperative outcomes including morbidity, length of stay, and 90-day mortality were compared across types.

Main Results:

• Surgical morbidity, hospital stay, and 90-day mortality significantly increased with TP type (P < .001).
• Type 3 (multivisceral resection) and type 4 (arterial resection) TP were independently associated with increased 90-day mortality.
• Specific outcomes: Morbidity ranged from 37.7% (type 1) to 59.4% (type 4); median stay from 14 to 18 days; 90-day mortality from 3.4% to 12.1%.

Conclusions:

• Significant differences in postoperative outcomes exist based on TP procedure extent and complexity.
• A 4-category classification system for TP can improve postoperative risk stratification.
• This categorization facilitates more accurate comparisons in future research on TP outcomes.