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Reappraisal of clinical indication regarding total pancreatectomy: can we do it for the risky gland?

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Abstract

Background

Although total pancreatectomy (TP) is performed at an increasing rate at major pancreatic centers, there is still debate regarding its indications and outcomes. This study aims to analyze the indications and outcomes of TP using our retrospective data.

Methods

We conducted a retrospective study on patients who underwent TP between January 2009 and December 2019 at two academic hospitals using data collected. Preoperative data, including demographics and clinical picture, operative details, and postoperative data, were collected and analyzed. Conventional indications of TP included positive margin on the neck, lesion of the central part of the pancreas, and diffuse lesions of the whole pancreas. The classification of the risky gland included pancreas remnants, which had higher risk for pancreaticoenterostomy after pancreatic head resection.

Results

During the study periods, a total of 72 TP were performed for benign and malignant pancreatic diseases. After excluding six TP undergone due to trauma or complication after partial pancreatectomy, 64 patients were grouped into 47 patients with existing conventional indications and 17 patients with predicted risky anastomosis. There was no significant difference in clinical data and surgical results between the conventional indication group and the risky gland group. Thirty-day major morbidity and mortality was 9.4% and 0%, respectively. Ninety-day mortality rate was 1.4% (n=1, conventional group), with the median follow-up length of 21.5 months. Overall 5-year survival rate was 67.7% for the total participants: 87.5% for the risk gland group and 57.9% for the conventional group. There was no significant difference in between the two groups.

Conclusions

Total pancreatectomy appears to be a viable option for risky glands in terms of surgical safety.

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Authors and Affiliations

  1. Division of HBP Surgery and Liver Transplantation, Department of Surgery, Yeouido St. Mary’s Hospital, The Catholic University of Korea College of Medicine, #10,63-ro, Yeongdengpo-gu, Seoul, 07345, South Korea

    Kwang Yeol Paik

  2. Division of HBP Surgery and Liver Transplantation, Department of Surgery, Bucheon Soonchunhyang Hospital, Soonchunhyang University of Korea College of Medicine, Asan, South Korea

    Jun Chul Chung

Authors
  1. Kwang Yeol Paik
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  2. Jun Chul Chung
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Contributions

Conception or design of the work: KYP; acquisition, analysis, or interpretation of data for the work: KYP, JCC; drafting the work: KYP, JCC; revising it critically for important intellectual content: KYP; final approval: KYP, JCC

Corresponding author

Correspondence to Kwang Yeol Paik.

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Ethics approval

This study was approved by the Institutional Review Board of Soon Chun Hyang University, Bucheon Hospital and The Catholic University, Yeouido St. Mary’s Hospital, Republic of Korea. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Consent to participate

The need for informed consent was waived because this was a retrospective chart review analysis.

Conflict of interest

The authors declare no competing interests.

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Paik, K.Y., Chung, J.C. Reappraisal of clinical indication regarding total pancreatectomy: can we do it for the risky gland?. Langenbecks Arch Surg 406, 1903–1908 (2021). https://doi.org/10.1007/s00423-021-02208-7

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  • DOI: https://doi.org/10.1007/s00423-021-02208-7

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