Completion Pancreatectomy. Indications and Outcomes: A Systematic Review

Area of Science:

• Gastroenterology and Hepatology
• Surgical Oncology
• Pancreatic Surgery

Background:

• Completion pancreatectomy (CP) is an important surgical procedure for managing specific pancreatic conditions.
• Indications for CP include post-pancreatectomy complications and recurrence in the pancreatic remnant.
• Limited studies focus on CP as a distinct operation, necessitating analysis of its indications and outcomes.

Approach:

• A systematic literature search was conducted using PubMed and Scopus databases up to February 2020.
• The search adhered to the PRISMA protocol, focusing on studies reporting CP indications and postoperative morbidity/mortality.
• Data from 32 studies involving 561 completion pancreatectomies were analyzed.

Key Points:

• CP for post-pancreatectomy complications (249 cases) had a high mortality (44.5%) and morbidity (72.6%).
• CP for isolated local recurrence (225 cases) showed significantly lower rates: 0% mortality and 21.5% morbidity.
• CP for recurrent neuroendocrine neoplasms (12 cases) had 8% mortality and 58.3% morbidity; for refractory chronic pancreatitis (1 study), it was 0% mortality and 19% morbidity.

Conclusions:

• Completion pancreatectomy is a recognized treatment for diverse pathologies.
• The success and risks of CP are strongly influenced by the specific indication, patient status, and surgical timing (elective vs. urgent).
• Further research is warranted to refine patient selection and optimize outcomes for completion pancreatectomy.