Background: Surgeons rarely perform elective total pancreatectomy (TP). Our study seeks to report surgical outcomes in a contemporary series of single-stage (SS) TP patients.
Methods: Between the years 2013 to 2023 we conducted a retrospective review of 60 consecutive patients who underwent SSTP. Demographics, pathology, treatment-related variables, and survival were recorded and analyzed.
Results: SSTP consisted of 3% (60/1859) of elective pancreas resections conducted. Patient median age was 68 years. Ninety percent of these patients (n = 54) underwent SSTP for pancreatic ductal adenocarcinoma (PDAC). Conversion from a planned partial pancreatectomy to TP occurred intraoperatively in 31 (52%) patients. Fifty-nine patients (98%) underwent an R0 resection. Median length of hospital stay was 6 days. The majority of morbidities were minor, with 27% patients (n = 16) developing severe complications (Clavien-Dindo ≥3). Thirty and ninety-day mortality rates were 1.67% (one patient) and 5% (three patients), respectively. Median survival for the entire cohort was 24.4 months; 22.7 months for PDAC patients, with 1-, 3-, and 5-year survival of 68%, 43%, and 16%, respectively. No mortality occurred in non-PDAC patients (n = 6).
Conclusion: Elective single-stage total pancreatectomy can be a safe and appropriate treatment option. SSTP should be in the armamentarium of surgeons performing pancreatic resection.
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http://dx.doi.org/10.1002/jso.27614 | DOI Listing |
Ann Surg Open
December 2024
From the Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Objective: The aim was to evaluate the sustainability of the pancreatic Enhanced Recovery After Surgery (ERAS) program and the effect of ERAS items on patient morbidity and hospital stay.
Background: The current ERAS guideline recommendations encompass 27 items to improve recovery after pancreatoduodenectomy (PD).
Methods: Patients who underwent pancreatic resection at the University Hospital Hamburg-Eppendorf between February 2016 and June 2023 were included.
Langenbecks Arch Surg
December 2024
Department of Surgery, TUM Universitätsklinikum Klinikum Rechts der Isar Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
Objective: Splenectomy is regularly performed in total and distal pancreatectomy due to technical reasons, lymph node dissection and radicality of the operation. However, the spleen serves as an important organ for competent immune function, and its removal is associated with an increased incidence of cancer and a worse outcome in some cancer entities (Haematologica 99:392-398, 2014; Dis Colon Rectum 51:213-217, 2008; Dis Esophagus 21:334-339, 2008). The impact of splenectomy in pancreatic cancer is not fully resolved (J Am Coll Surg 188:516-521, 1999; J Surg Oncol 119:784-793, 2019).
View Article and Find Full Text PDFWorld J Surg Oncol
December 2024
Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Background: Preoperative biliary drainage (PBD) for selected patients with severe juandice has been shown to improve clinical conditions for pancreaticoduodenectomy (PD) and reduce the risk of post-pancreatectomy hemorrhage (PPH). However, the determination of an optimal end-point for PBD remains unclear. The aim of this research is to introduce the concept of goal-oriented biliary drainage, which may serve as a reasonable target and identify the optimal surgery time window.
View Article and Find Full Text PDFPancreatology
December 2024
Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
Background: Total pancreatectomy (TP) offers a surgical option for refractory pancreatitis, yet confers substantial long-term morbidity associated with resultant diabetes. While total pancreatectomy with islet autotransplantation (TPIAT) offers an intuitive solution, data evaluating its safety have been limited to single-center studies. The aim of this study is to evaluate whether the addition of islet autotransplantation to TP confers additional post-operative morbidity within the 30-day post-operative period.
View Article and Find Full Text PDFAnn Surg
December 2024
Division of General and Transplant Surgery, University of Pisa, Pisa, Italy.
Objective: To validate the ISGPS complexity grading system for minimally invasive pancreaticoduodenectomy (MIPD).
Background: Although concerns about patient safety persist, MIPD is gaining popularity. The ISGPS recently introduced a difficulty grading system to improve patient selection by aligning procedural complexity with surgeon and center expertise.
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