Impact of Endocrine and Exocrine Insufficiency on Quality of Life After Total Pancreatectomy

Published on Feb 1, 2020in Annals of Surgical Oncology5.344
· DOI :10.1245/S10434-019-07853-3
T. F. Stoop7
Estimated H-index: 7
(Karolinska University Hospital),
Zeeshan Ateeb9
Estimated H-index: 9
(Karolinska University Hospital)
+ 4 AuthorsMarco Del Chiaro34
Estimated H-index: 34
(Anschutz Medical Campus)
Sources
Abstract
Background Total pancreatectomy (TP) is rarely performed due to concerns for endocrine and exocrine insufficiency and decreased quality of life (QoL). Renewed interest is seen in recent years, but large cohort studies remain scarce. This study was designed to evaluate endocrine and exocrine insufficiency after TP and its impact on QoL.
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References44
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#1Alessandra Pulvirenti (University of Verona)H-Index: 13
#2Antonio Pea (University of Verona)H-Index: 22
Last. Roberto Salvia (University of Verona)H-Index: 57
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ANTECEDENTES: La pancreatectomia total es una cirugia necesaria para tratar enfermedades que afectan a la totalidad el pancreas y se caracteriza por una alta morbilidad y una disminucion de la calidad de vida (QoL) a largo plazo. Hasta la fecha, los factores de riesgo asociados a los resultados perioperatorios y a largo plazo no han sido completamente determinados. METODOS: Los datos de los pacientes que se sometieron a una pancreatectomia total desde el ano 2000 al 2015 en dos centros de alto v...
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#1Marco Del Chiaro (Karolinska University Hospital)H-Index: 34
#2Elena Rangelova (Karolinska University Hospital)H-Index: 15
Last. Caroline S. Verbeke (University of Oslo)H-Index: 39
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Abstract Background Few studies have investigated the outcome of pancreatectomy associated with artery resection (PAR). Methods Retrospective analysis of a cohort of operated borderline or locally advanced pancreatic cancer patients with surgically confirmed arterial involvement. Short and long-term outcome were analyzed and compared in patients who underwent PAR (Group 1) and palliative surgery (Group 2). Results Of 73 patients who underwent surgical exploration with intent of resection, 34 und...
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#1Lianne ScholtenH-Index: 10
Last. Marc G. BesselinkH-Index: 88
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Abstract Background The risk of invasive cancer in resected intraductal papillary mucinous neoplasm with main pancreatic duct involvement is 33%–60%. Most guidelines, therefore, advise resection of main duct intraductal papillary mucinous neoplasm and mixed type intraductal papillary mucinous neoplasm in surgically fit patients, although advice on the surgical strategy (partial or total pancreatectomy) differs. We performed a survey amongst international experts to guide the design of future stu...
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#1Marco Del ChiaroH-Index: 34
#2Marc G. Besselink (UniSR: Vita-Salute San Raffaele University)H-Index: 88
Last. L. WustenH-Index: 1
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Evidence-based guidelines on the management of pancreatic cystic neoplasms (PCN) are lacking. This guideline is a joint initiative of the European Study Group on Cystic Tumours of the Pancreas, United European Gastroenterology, European Pancreatic Club, European-African Hepato-Pancreato-Biliary Association, European Digestive Surgery, and the European Society of Gastrointestinal Endoscopy. It replaces the 2013 European consensus statement guidelines on PCN. European and non-European experts perf...
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#1Junjie Xiong (Sichuan University)H-Index: 16
#2Ailin Wei (Sichuan University)H-Index: 6
Last. Xubao Liu (Sichuan University)H-Index: 23
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Abstract Background Total pancreatectomy (TP) is considered a viable option in some selected patients with pancreatic ductaladenocarcinoma (PDAC). The aim of this study was to compare the clinical outcomes between TP and pancreaticoduodenectomy (PD) in patients with PDAC. Materials and methods A total of 375 patients were selected from our center's database in China and classified into two groups: the PD group (n = 325) and the TP group (n = 50). A matched-pair analysis of the patients was condu...
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#1Masao TanakaH-Index: 106
#2Carlos Fernandez-del Castillo (Harvard University)H-Index: 101
Last. Christopher L. Wolfgang (Johns Hopkins University)H-Index: 105
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Abstract The management of intraductal papillary mucinous neoplasm (IPMN) continues to evolve. In particular, the indications for resection of branch duct IPMN have changed from early resection to more deliberate observation as proposed by the international consensus guidelines of 2006 and 2012. Another guideline proposed by the American Gastroenterological Association in 2015 restricted indications for surgery more stringently and recommended physicians to stop surveillance if no significant ch...
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#7John S. Werner (LMU: Ludwig Maximilian University of Munich)H-Index: 71
Background In the recent International Study Group of Pancreatic Surgery (ISGPS) consensus on extended pancreatectomy, several issues on perioperative outcome and long-term survival remained unclear. Robust data on outcomes are sparse. The present study aimed to assess the outcome of extended pancreatectomy for borderline resectable and locally advanced pancreatic cancer. Methods A consecutive series of patients with primary pancreatic adenocarcinoma undergoing extended pancreatectomies, as defi...
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#1Marco Del Chiaro (Karolinska University Hospital)H-Index: 34
#2Elena Rangelova (Karolinska University Hospital)H-Index: 15
Last. Urban Arnelo (Karolinska University Hospital)H-Index: 21
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Total pancreatectomy is associated with short- and long-term high complication rate and without evidence of oncologic advantages. Several metabolic consequences are co-related with the apancreatic state. The unstable diabetes related to the total resection of the pancreas expose the patients to short- and long-term life-threatening complications. Severe hypoglycemia is a short-term dangerous complication that can also cause patients’ death. Chronic complications of severe diabetes (cardiac and v...
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#1Sohei Satoi (Wakayama Medical University)H-Index: 33
#2Yoshiaki MurakamiH-Index: 44
Last. Masanori KwonH-Index: 3
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The aim of this study was to reappraise the clinical role of total pancreatectomy with curative intent in patients with pancreatic ductal adenocarcinoma (PDAC).In 2001 to 2011 database from 7 institutions in Japan, 45 (3.1%) of 1451 patients with PDAC underwent total pancreatectomy (TP group), and 885 patients underwent pancreaticoduodenectomy (PD group). A matched-pairs group consisted of 45 patients matched for age, sex, year, resectability status, and neoadjuvant therapy (matched-PD group). C...
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#1Shuji Suzuki (TMU: Tokyo Medical University)H-Index: 3
#2Junnosuke MiuraH-Index: 14
Last. Masakazu YamamotoH-Index: 64
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AbstractPurpose: Total pancreatectomy (TP) for pancreatic neoplasms is associated with high morbidity and mortality rates. However, with recent advances in surgical techniques and improved postoperative management, the number of cases with clinical indications for TP is increasing. Here, we evaluated the clinical outcomes post-TP.Materials and methods: Patients (n = 41) who underwent TP between 2004 and 2011 at Tokyo Women’s Medical University were retrospectively examined. Pre- and postoperativ...
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Cited By16
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A “pandemic” of incidentally discovered pancreatic cyst neoplasms (PCNs) is ongoing. Among PCNs, intraductal papillary mucinous cystic neoplasms (IPMNs) are the most common and with their complex biology could represent a precursor lesion of pancreatic cancer. Although multiple guidelines exist to guide their treatment, there are still many “gray areas” on indications for surgery for IPMNs. The current indications for surgery of IPMNs were reappraised, considering potential discrepancies between...
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#1Roberto Salvia (University of Verona)H-Index: 57
#2Gabriella Lionetto (University of Verona)H-Index: 1
Last. Giovanni Marchegiani (University of Verona)H-Index: 32
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Postoperative pancreatic fistula (POPF) still represents the major driver of surgical morbidity after pancreaticoduodenectomy. The purpose of this narrative review was to critically analyze current evidence supporting the use of total pancreatectomy (TP) to prevent the development of POPF in patients with high-risk pancreas, and to explore the role of completion total pancreatectomy (CP) in the management of severe POPF. Considering the encouraging perioperative outcomes, TP may represent a prom...
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#1Francesca Aleotti (UniSR: Vita-Salute San Raffaele University)H-Index: 9
#2Rita Nano (UniSR: Vita-Salute San Raffaele University)H-Index: 31
Last. Gianpaolo Balzano (UniSR: Vita-Salute San Raffaele University)H-Index: 45
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Total pancreatectomy (TP) is a procedure weighed down not only by postoperative morbidity and mortality but also by long-term effects as a consequence of endocrine and exocrine pancreatic insufficiency. While the latter is now managed quite effectively with pancreatic enzyme replacement therapy, the former remains a challenge. The diabetes resulting after TP, with the complete loss of endogenous insulin and contraregulatory hormones, is characterized by important glycemic variations and is, ther...
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#1Emanuele Federico Kauffmann (UniPi: University of Pisa)H-Index: 8
#2Niccolò Napoli (UniPi: University of Pisa)H-Index: 11
Last. Ugo Boggi (UniPi: University of Pisa)H-Index: 65
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This study was designed to demonstrate non-inferiority of robot-assisted total pancreatectomy (RATP) to open total pancreatectomy (OPT) based on an intention-to-treat analysis, having occurrence of severe post-operative complications (SPC) as primary study endpoint. The two groups were matched (2:1) by propensity scores. Assuming a rate of SPC of 22.5% (non-inferiority margin: 15%; α: 0.05; β: 0.20; power: 80%), a total of 25 patients were required per group. During the study period (October 200...
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#1Matteo Palmeri (UniPi: University of Pisa)H-Index: 13
#2Gregorio Di Franco (UniPi: University of Pisa)H-Index: 13
Last. Luca Morelli (UniPi: University of Pisa)H-Index: 22
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Abstract Background The extent of pancreatic resection for intraductal papillary mucinous neoplasms (IPMNs) remains an unresolved issue. The study aims at analyzing the prognostic impact of conservative surgery (CS) i.e. of pancreatoduodenectomy or distal pancreatectomy, versus total pancreatectomy (TP), for pancreatic IPMNs. Methods We retrospectively analyzed and compared data of patients who had undergone pancreatic resection for IPMNs at our center between November 2007 and April 2019. Patie...
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#1Yosuke Inoue (JFCR: Japanese Foundation for Cancer Research)H-Index: 18
#2Atushi ObaH-Index: 1
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Aggressive arterial resection (AR) or total pancreatectomy (TP) in surgical treatment for locally advanced pancreatic cancer (LAPC) had long been discouraged because of their high mortality rate and unsatisfactory long-term outcomes. Recently, new chemotherapy regimens such as FOLFIRINOX or Gemcitabine and nab-paclitaxel have provided more adequate patient selection and local tumor suppression, justifying aggressive local resection. In this review, we investigate the recent reports focusing on a...
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#1Yuki Nakagawa (Mie University)H-Index: 1
#2Hiroyuki Kato (Mie University)H-Index: 9
Last. Shugo Mizuno (Mie University)H-Index: 25
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PURPOSE To investigate whether proximal subtotal pancreatectomy (PSTP) is superior to total pancreatectomy (TP) for preserving postoperative endocrine function, and to identify the pre-operative risk factors influencing prognosis after TP and PSTP. METHODS The subjects of this retrospective study were patients who underwent TP (n = 15) or PSTP (n = 16) between 2008 and 2018 in our hospital. First, we compared the incidence of hypoglycemia within 30 days after surgery and the total daily amount o...
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#1A. GeslotH-Index: 1
#2M. VialonH-Index: 2
Last. Delphine VezzosiH-Index: 16
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Abstract In 1953, for the first time, Paul Wermer described a family presenting endocrine gland neoplasms over several generations. The transmission was autosomal dominant and the penetrance was high. Forty years later in 1997, the Multiple Endocrine Neoplasia type 1 (MEN1) gene was sequenced, thus enabling diagnosis and early optimal treatment. Patients carrying the MEN1 gene present endocrine but also non-endocrine tumors. Parathyroid, pancreatic and pituitary impairment are the three main typ...
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#1Daniel R. Quast (RUB: Ruhr University Bochum)H-Index: 2
#2Thomas G K Breuer (RUB: Ruhr University Bochum)H-Index: 9
Last. Juris J. Meier (RUB: Ruhr University Bochum)H-Index: 74
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Einleitung Pankreasresektionen werden bei schwerwiegenden Pankreaserkrankungen durchgefuhrt. Bei Komplikationen einer chronischen Pankreatitis, teilweise jedoch auch bei Raumforderungen, kann eine Pankreasteilresektion sinnvoll sein. Eine totale Pankreatektomie fuhrt zum absoluten Insulinmangel und der Notwendigkeit einer Insulintherapie. Bei Teilresektionen (partielle Pankreatektomie) werden weniger gravierende Konsequenzen fur den Glukosemetabolismus erwartet. Es ist das Ziel der vorliegenden ...
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#1Moon Young Oh (New Generation University College)H-Index: 3
#2Eun Joo Kim (New Generation University College)H-Index: 1
Last. Jin-Young Jang (New Generation University College)H-Index: 55
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Purpose Quality of life (QoL) is widely known to be poor after total pancreatectomy (TP) due to the loss of pancreatic function and poor nutritional status, but prospective studies on changes in QoL over time are lacking. The aim of this study was to prospectively evaluate the short- and long-term consequences of pancreatic exocrine insufficiency, changes in nutritional status, and their associated effects on QoL after TP. Methods Prospective data were collected from patients who underwent TP be...
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