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Comparison of oncologic outcomes between pancreaticoduodenectomy and total pancreatectomy for pancreatic adenocarcinoma

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Abstract

Background

Pancreatoduodenectomy (PD) and total pancreatectomy (TP) are two surgical methods to treat patients with pancreatic head adenocarcinoma (PHAC). However, the oncologic outcomes of TP for PHAC remain controversial. In this study, we compared early mortality and long-term survival patients undergoing TP and those with PD.

Methods

All patients diagnosed with non-metastatic PHAC who underwent PD or TP from 1988 to 2016 were retrieved from the Surveillance, Epidemiology, and End Results database. Propensity score matching (PSM) was used to balance the inter-group covariates. Cancer-specific survival (CSS) was the primary endpoint.

Results

A total of 4748 patients (743 TP and 4005 PD) were included in the study. Some 740 patients who underwent TP were matched with 1479 who had PD. After PSM, there was no difference between TP and PD groups regarding 30-day mortality (3.5% vs. 2.7%, p = 0.290) and 90-day mortality (9.9% vs. 8%, p = 0.135). More importantly, TP showed comparable survival in comparison to PD, prior or after excluding patients who died within 30 and 90 days. Besides, multivariate analysis revealed that tumor size, tumor stage, N stage, chemotherapy, and radiation were significant prognostic factors.

Conclusion

PD and TP have similar early mortality and long-term survival for patients with PHAC. In selected patients, TP can be used when oncologically appropriate.

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References

  1. Siegel RL, Miller KD, Fuchs HE et al (2021) Cancer statistics, 2021. CA Cancer J Clin 71:7–33

    Article  Google Scholar 

  2. Sener SF, Fremgen A, Menck HR et al (1999) Pancreatic cancer: a report of treatment and survival trends for 100,313 patients diagnosed from 1985–1995, using the National Cancer Database. J Am Coll Surg 189:1–7

    Article  CAS  Google Scholar 

  3. Conlon KC, Klimstra DS, Brennan MF (1996) Long-term survival after curative resection for pancreatic ductal adenocarcinoma. clinicopathologic analysis of 5-year survivors. Ann Surg 223:273–279

    Article  CAS  Google Scholar 

  4. Mayo SC, Nathan H, Cameron JL et al (2012) Conditional survival in patients with pancreatic ductal adenocarcinoma resected with curative intent. Cancer 118:2674–2681

    Article  Google Scholar 

  5. Satoi S, Murakami Y, Motoi F et al (2016) Reappraisal of total pancreatectomy in 45 patients with pancreatic ductal adenocarcinoma in the modern era using matched-pairs analysis: multicenter study group of pancreatobiliary surgery in Japan. Pancreas 45:1003–1009

    Article  Google Scholar 

  6. Reddy S, Wolfgang CL, Cameron JL et al (2009) Total pancreatectomy for pancreatic adenocarcinoma: evaluation of morbidity and long-term survival. Ann Surg 250:282–287

    Article  Google Scholar 

  7. Stoop TF, Ateeb Z, Ghorbani P et al (2021) Surgical outcomes after total pancreatectomy: a high-volume center experience. Ann Surg Oncol 28:1543–1551

    Article  Google Scholar 

  8. Schmidt CM, Glant J, Winter JM et al (2007) Total pancreatectomy (R0 resection) improves survival over subtotal pancreatectomy in isolated neck margin positive pancreatic adenocarcinoma. Surgery 142:572–578

    Article  Google Scholar 

  9. Simons JP, Shah SA, Ng SC et al (2009) National complication rates after pancreatectomy: beyond mere mortality. J Gastrointest Surg 13:1798–1805

    Article  Google Scholar 

  10. Bhayani NH, Miller JL, Ortenzi G et al (2014) Perioperative outcomes of pancreaticoduodenectomy compared to total pancreatectomy for neoplasia. J Gastrointest Surg 18:549–554

    Article  Google Scholar 

  11. Karpoff HM, Klimstra DS, Brennan MF et al (2001) Results of total pancreatectomy for adenocarcinoma of the pancreas. Arch Surg 136:44–47

    Article  CAS  Google Scholar 

  12. Müller MW, Friess H, Kleeff J et al (2007) Is there still a role for total pancreatectomy? Ann Surg 246:966–974

    Article  Google Scholar 

  13. Scholten L, Latenstein AEJ, van Eijck C et al (2019) Outcome and long-term quality of life after total pancreatectomy (PANORAMA): a nationwide cohort study. Surgery 166:1017–1026

    Article  Google Scholar 

  14. Stoop TF, Ateeb Z, Ghorbani P et al (2020) Impact of endocrine and exocrine insufficiency on quality of life after total pancreatectomy. Ann Surg Oncol 27:587–596

    Article  Google Scholar 

  15. Hartwig W, Gluth A, Hinz U et al (2015) Total pancreatectomy for primary pancreatic neoplasms: renaissance of an unpopular operation. Ann Surg 261:537–546

    Article  Google Scholar 

  16. Pulvirenti A, Pea A, Rezaee N et al (2019) Perioperative outcomes and long-term quality of life after total pancreatectomy. Br J Surg 106:1819–1828

    Article  CAS  Google Scholar 

  17. Billings BJ, Christein JD, Harmsen WS et al (2005) Quality-of-life after total pancreatectomy: is it really that bad on long-term follow-up? J Gastrointest Surg 9:1059–1066

    Article  Google Scholar 

  18. Epelboym I, Winner M, DiNorcia J et al (2014) Quality of life in patients after total pancreatectomy is comparable with quality of life in patients who undergo a partial pancreatic resection. J Surg Res 187:189–196

    Article  Google Scholar 

  19. Xiong J, Wei A, Ke N et al (2017) A case-matched comparison study of total pancreatectomy versus pancreaticoduodenectomy for patients with pancreatic ductal adenocarcinoma. Int J Surg 48:134–141

    Article  Google Scholar 

  20. Govindarajan A, Tan JC, Baxter NN et al (2008) Variations in surgical treatment and outcomes of patients with pancreatic cancer: a population-based study. Ann Surg Oncol 15:175–185

    Article  Google Scholar 

  21. Nathan H, Wolfgang CL, Edil BH et al (2009) Peri-operative mortality and long-term survival after total pancreatectomy for pancreatic adenocarcinoma: a population-based perspective. J Surg Oncol 99:87–92

    Article  Google Scholar 

  22. Little RJ, Rubin DB (2000) Causal effects in clinical and epidemiological studies via potential outcomes: concepts and analytical approaches. Annu Rev Public Health 21:121–145

    Article  CAS  Google Scholar 

  23. Austin PC (2008) A critical appraisal of propensity-score matching in the medical literature between 1996 and 2003. Stat Med 27:2037–2049

    Article  Google Scholar 

  24. Rockey EW (1943) Total pancreatectomy for carcinoma: case report. Ann Surg 118:603–611

    Article  CAS  Google Scholar 

  25. Tattersall RB (1997) Brittle diabetes revisited: the Third Arnold Bloom Memorial Lecture. Diabet Med 14:99–110

    Article  CAS  Google Scholar 

  26. Coco D, Leanza S, Guerra F (2019) Total pancreatectomy: indications, advantages and disadvantages-a review. Maedica (Bucur) 14:391–396

    Google Scholar 

  27. Capretti G, Donisi G, Gavazzi F et al (2021) Total pancreatectomy as alternative to pancreatico-jejunal anastomosis in patients with high fistula risk score: the choice of the fearful or of the wise? Langenbecks Arch Surg 406:713–719

    Article  Google Scholar 

  28. Marchegiani G, Perri G, Burelli A et al (2021) High-risk pancreatic anastomosis vs. total pancreatectomy after pancreatoduodenectomy: postoperative outcomes and quality of life analysis. Ann Surg. https://doi.org/10.1097/SLA.0000000000004840

    Article  Google Scholar 

  29. Paik KY, Chung JC (2021) Reappraisal of clinical indication regarding total pancreatectomy: can we do it for the risky gland? Langenbecks Arch Surg. https://doi.org/10.1007/s00423-021-02208-7

    Article  Google Scholar 

  30. Almond M, Roberts KJ, Hodson J et al (2015) Changing indications for a total pancreatectomy: perspectives over a quarter of a century. HPB (Oxford) 17:416–421

    Article  Google Scholar 

  31. Johnston WC, Hoen HM, Cassera MA et al (2016) Total pancreatectomy for pancreatic ductal adenocarcinoma: review of the National Cancer Data Base. HPB (Oxford) 18:21–28

    Article  Google Scholar 

  32. Schnelldorfer T, Ware AL, Sarr MG et al (2008) Long-term survival after pancreatoduodenectomy for pancreatic adenocarcinoma: is cure possible? Ann Surg 247:456–462

    Article  Google Scholar 

  33. Hashimoto D, Mizuma M, Kumamaru H et al (2020) Risk model for severe postoperative complications after total pancreatectomy based on a nationwide clinical database. Br J Surg 107:734–742

    Article  CAS  Google Scholar 

  34. Latenstein AEJ, Mackay TM, Beane JD et al (2021) The use and clinical outcome of total pancreatectomy in the United States, Germany, the Netherlands, and Sweden. Surgery 170:563–570

    Article  Google Scholar 

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Author notes

  1. Jisheng Zhu and Zhengying Jiang have contributed equally to this work.

Authors and Affiliations

  1. Department of General Surgery, The First Affiliated Hospital of Nanchang University, No.17 Yongwai Zhengjie, Nanchang, 330006, Jiangxi, China

    Jisheng Zhu, Bin Xie, Chengchao Fu, Weidong Xiao & Yong Li

  2. Department of Bun, The First Affiliated Hospital of Nanchang University, No.17 Yongwai Zhengjie, Nanchang, 330006, Jiangxi, China

    Zhengying Jiang

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  1. Jisheng Zhu
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Correspondence to Yong Li.

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Drs. Jisheng Zhu, Zhengying Jiang, Bin Xie, Chengchao Fu, Weidong Xiao, and Yong Li have no conflicts of interest or financial ties to disclose.

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Zhu, J., Jiang, Z., Xie, B. et al. Comparison of oncologic outcomes between pancreaticoduodenectomy and total pancreatectomy for pancreatic adenocarcinoma. Surg Endosc 37, 109–119 (2023). https://doi.org/10.1007/s00464-022-09441-1

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  • DOI: https://doi.org/10.1007/s00464-022-09441-1

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