High-risk Pancreatic Anastomosis vs. Total Pancreatectomy after Pancreatoduodenectomy: Postoperative Outcomes and Quality of Life Analysis

Published on Mar 4, 2021in Annals of Surgery12.969
· DOI :10.1097/SLA.0000000000004840
Giovanni Marchegiani32
Estimated H-index: 32
Giampaolo Perri8
Estimated H-index: 8
+ 6 AuthorsRoberto Salvia57
Estimated H-index: 57
OBJECTIVE To evaluate total pancreatectomy (TP) as an alternative to pancreatoduodenectomy (PD) in patients at high-risk for postoperative pancreatic fistula (POPF). BACKGROUND Outcomes of high-risk PD (HR-PD) and TP have never been compared. METHODS All patients who underwent PD or TP between July 2017 and December 2019 were identified. HR-PD was defined according to the alternative Fistula Risk Score. Postoperative outcomes (primary endpoint), pancreatic insufficiency and quality of life after 12 months of follow-up (QoL) were compared between HR-PD or planned PD intraoperatively converted to TP (C-TP). RESULTS A total of 566 patients underwent PD and 136 underwent TP during the study period. One hundred one (18%) PD patients underwent HR-PD, while 86 (63%) TP patients underwent C-TP. Postoperatively, the patients in the C-TP group exhibited lower rates of post-pancreatectomy hemorrhage (15% vs 28%), delayed gastric emptying (16% vs 34%), sepsis (10% vs 31%), and Clavien-Dindo ≥3 morbidity (19% vs 31%) and had shorter median lengths of hospital stay (10 vs 21 days) (all p<0.05). The rate of POPF in the HR-PD group was 39%. Mortality was comparable between the two groups (3% vs 4%). Although general, cancer- and pancreas-specific QoL were comparable between the HR-PD and C-TP groups, endocrine and exocrine insufficiency occurred in all the C-TP patients, compared to only 13% and 63% of the HR-PD patients respectively, and C-TP patients had worse diabetes-specific QoL. CONCLUSIONS C-TP may be considered rather than HR-PD only in few selected cases and after adequate counselling.
Cited By1
#1Martin Loos (University Hospital Heidelberg)H-Index: 3
#2Mohammed Al-Saeedi (University Hospital Heidelberg)H-Index: 10
Last. Markus W. Büchler (University Hospital Heidelberg)H-Index: 177
view all 13 authors...
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...
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...
#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
view all 5 authors...
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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