Surgical Outcomes After Total Pancreatectomy: A High-Volume Center Experience.

Published on Mar 1, 2021in Annals of Surgical Oncology5.344
· DOI :10.1245/S10434-020-08957-X
T. F. Stoop7
Estimated H-index: 7
(CU: University of Colorado Boulder),
Zeeshan Ateeb9
Estimated H-index: 9
(Karolinska University Hospital)
+ 4 AuthorsMarco Del Chiaro34
Estimated H-index: 34
(Karolinska University Hospital)
Sources
Abstract
BACKGROUND The impact of high-volume care in total pancreatectomy (TP) is barely explored since annual numbers are mostly low. This study evaluated surgical outcomes after TP over time in a high-volume center. METHODS All adult patients (age ≥ 18 years) who underwent an elective single-stage TP at Karolinska University Hospital were retrospectively analysed (2008-2017). High volume was defined as > 20 TPs/year. RESULTS Overall, 145 patients after TP were included, including 86 (59.3%) extended resections. Major morbidity was 34.5% (50/145) and 90-day mortality 5.5% (8/145). The relative use of TP within all pancreatectomies increased from 5.4% (63/1175) in 2008-2015 to 17.3% (82/473) in 2016-2017 (p   20 was associated with reduced major morbidity (odds ratio [OR] = 0.225, 95% confidence interval [CI], 0.097-0.521; p < 0.001). In the high-volume years (2016-2017), major morbidity (n = 31, 49.2% to n = 19, 23.2%; p = 0.001) and relaparotomy rate (n = 13, 20.6% to n = 5, 6.1%; p = 0.009) improved. Improvements occurred mainly after extended TP, including lower major morbidity (n = 22, 57.9% to n = 12, 25.0%; p = 0.002) and in-hospital mortality (n = 3, 7.9% to n = 0, 0%; p = 0.082). CONCLUSIONS In a single, high-volume center study, an increase in surgical volume of TP was associated with improved perioperative outcomes, especially for extended resections.
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#1Elena Rangelova (KI: Karolinska Institutet)H-Index: 15
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: MINI: The overall survival and the survival after resection of patients with borderline resectable pancreatic cancer or locally advanced pancreatic cancer after neoadjuvant therapy (NAT) are similar. Resected patients had better survival than nonresected, irrespective of the type or whether full-dose NAT was given. For all preoperative values of Ca 19-9, surgical resection had positive impact on survival. OBJECTIVE: Neoadjuvant therapy (NAT) has become part of the multimodality treatment for b...
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#1T. F. Stoop (Karolinska University Hospital)H-Index: 7
#2Zeeshan Ateeb (Karolinska University Hospital)H-Index: 9
Last. Marco Del Chiaro (Anschutz Medical Campus)H-Index: 34
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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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#1Atsushi Oba (JFCR: Japanese Foundation for Cancer Research)H-Index: 9
#2Quoc Riccardo Bao (Anschutz Medical Campus)H-Index: 4
Last. M Del Chiaro (Anschutz Medical Campus)H-Index: 15
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Background and Aims:It has become clear that vein resection and reconstruction for pancreatic ductal adenocarcinoma (PDAC) is the standard of care as supported by multiple guidelines. However, rese...
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#1Elena Rangelova (Anschutz Medical Campus)H-Index: 15
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#1Lianne Scholten (UvA: University of Amsterdam)H-Index: 10
#2Anouk E J Latenstein (UvA: University of Amsterdam)H-Index: 6
Last. Marc G. Besselink (UvA: University of Amsterdam)H-Index: 88
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Abstract Background The threshold to perform total pancreatectomy is rather high, predominantly because of concerns for long-term consequences of brittle diabetes on patients’ quality of life. Contemporary data on postoperative outcomes, diabetes management, and long-term quality of life after total pancreatectomy from large nationwide series are, however, lacking. Methods We performed a nationwide, retrospective cohort study among adults who underwent total pancreatectomy in 17 Dutch centers (2...
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#3M Del Chiaro (Anschutz Medical Campus)H-Index: 11
textabstractBackground: Surgeons have traditionally been reluctant to perform total pancreatectomy because of concerns for brittle diabetes and poor quality of life (QoL). Several recent studies have suggested that outcomes following total pancreatectomy have improved, but a systematic review is lacking. Methods: A systematic review was undertaken of studies reporting on outcomes after total pancreatectomy for all indications, except chronic pancreatitis. PubMed, EMBASE (Ovid), and Cochrane Libr...
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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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#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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#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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Importance Comparability of morbidity and mortality rates after total pancreatectomy (TP) reported by different surgical centers is limited. Procedure-specific differences, such as the extent of resection, including additional vascular or multivisceral resections, are rarely acknowledged when postoperative outcomes are reported. Objectives To evaluate postoperative outcomes after TP and categorize different types of TP based on the extent, complexity, and technical aspects of each procedure. Des...
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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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Currently, advances in surgical techniques, improvements in perioperative care, new formulations of intermediate and long-acting insulin and of modern pancreatic enzyme preparations have allowed obtaining good short and long-term results and quality of life, especially in high-volume centres in performing total pancreatectomy (TP).Thus, the surgeon's fear in performing TP is not justified and total pancreatectomy can be considered a viable option in selected patients in high-volume centres. The ...
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#1Roberto Salvia (University of Verona)H-Index: 57
#2Gabriella Lionetto (University of Verona)H-Index: 1
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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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#1Stefano Crippa (UniSR: Vita-Salute San Raffaele University)H-Index: 61
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The extension of a partial pancreatectomy up to total pancreatectomy because of positive neck margin examined at intraoperative frozen section (IFS) analysis is an accepted procedure in modern pancreatic surgery with good accuracy. The goal of this practice is to improve the rate of radical (R0) resection in malignant tumors, mainly pancreatic ductal adenocarcinoma (PDAC), and to completely resect pre-invasive neoplasms such as intraductal papillary mucinous neoplasms (IPMNs). In the setting of ...
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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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Abstract Background Total pancreatectomy has high morbidity and mortality and differences among countries are currently unknown. This study compared the use and postoperative outcomes of total pancreatectomy among 4 Western countries. Methods Patients who underwent one-stage total pancreatectomy were included from registries in the United States, Germany, the Netherlands, and Sweden (2014–2018). Use of total pancreatectomy was assessed by calculating the ratio total pancreatectomy to pancreatodu...
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