Long‐Term Outcomes After Total Pancreatectomy: Special Reference to Survivors’ Living Conditions and Quality of Life

Watanabe, Yusuke; Ohtsuka, Takao; Matsunaga, Taketo; Kimura, Hideyo; Tamura, Koji; Ideno, Noboru; Aso, Teijiro; Miyasaka, Yoshihiro; Ueda, Junji; Takahata, Shunichi; Igarashi, Hisato; Inoguchi, Toyoshi; Ito, Tetsuhide; Tanaka, Masao

doi:10.1007/s00268-015-2948-1

Cited by 55 publications

(60 citation statements)

References 28 publications

(51 reference statements)

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“…The long-term survival rates of patients who underwent TP for pancreatic cancer were similar to those for patients who underwent PD at both the 3-and 5-year time points ( table 4 ) [2,4,9,21,24,26,39,40,42,44,45,47] , which supports the use of TP for the treatment of pancreatic adenocarcinoma in appropriately selected patients [39] . As with most retrospective studies, we were unable to collect prospective data on long-term glycemic control or QOL [40] .…”

Section: Long-term Survival Rates After Tpmentioning

confidence: 54%

“…In the reports since 2007, the morbidity rates following TP were reported in the range 19-49%, often owing to different operative methods ( table 2 ) [2,4,5,9,21,22,24,26,38,[42][43][44][45][46][47] . Morbidity rates were comparable between TP and PD.…”

Section: The Results For Tp In the Recent Yearsmentioning

confidence: 99%

“…The endocrine abnormalities associated with TP included glucagon and pancreatic polypeptide deficiency in addition to insulin abnormalities and thus were different from the conventional types 1 and 2 DM [47] . TP patients are thought to have been more vulnerable to severe hypoglycemic episodes, tend to be resistant to ketosis, and have higher plasma levels of gluconeogenic precursors, which include lactate and alanine, owing to the absence of glucagon [55,56] .…”

Section: Endocrine and Exocrine Replacement After Tpmentioning

confidence: 99%

“…We reviewed the endocrine and exocrine replacement therapies and clinicophysiological parameters after TP ( table 3 ) [2,9,26,43,[45][46][47][48] . All patients required insulin and exocrine pancreatic enzyme replacement.…”

Section: Endocrine and Exocrine Replacement After Tpmentioning

confidence: 99%

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The Clinical Outcomes after Total Pancreatectomy

et al. 2016

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Background: Total pancreatectomy (TP) is not more beneficial than less aggressive resection techniques for the treatment of pancreatic neoplasms and is associated with high morbidity and mortality. However, with advances in surgical techniques and glycemic monitoring, and the development of synthetic insulin and pancreatic enzymes for postoperative treatment, TP has been increasingly indicated. This is a review of the recent literature reporting the clinical outcomes after TP. Methods: We reviewed the publications reporting the use of TP starting 2007. The clinicophysiological and survival data were analyzed. Results: Few studies evaluated the differences in clinical outcomes between TP and pancreaticoduodenectomy (PD) with inconsistent results. It was reported that while the perioperative morbidity did not decrease, the mortality decreased compared to previous literature. All patients who underwent TP required insulin and high dose of pancreatic enzyme supplements. The 5-year survival rates after TP and PD for pancreatic cancer were similar. Conclusion: The perioperative mortality decreased in patients who underwent TP with advances in the operative procedures and perioperative care. The long-term survival rates were similar for TP and PD. Therefore, treating pancreatic neoplasms using TP is feasible. Patients undergoing TP should receive adequate treatment with synthetic insulin and pancreatic enzyme supplements.

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Section: Long-term Survival Rates After Tpmentioning

confidence: 54%

Section: The Results For Tp In the Recent Yearsmentioning

confidence: 99%

Section: Endocrine and Exocrine Replacement After Tpmentioning

confidence: 99%

Section: Endocrine and Exocrine Replacement After Tpmentioning

confidence: 99%

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The Clinical Outcomes after Total Pancreatectomy

et al. 2016

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“…Moreover, pancreatic enzyme replacement therapy has improved GI symptoms and largely resolved nutritional deficiency in appropriately managed patients [38,45] . As a result, post-TP QoL is now reported to be comparable to that of regular type 1 diabetics, post-PD patients and even the age-matched general population [44,[46][47][48][49] .…”

Section: Discussion: Who Should Undergo Tp For Ipmn?mentioning

confidence: 69%

Is It Time to Expand the Role of Total Pancreatectomy for IPMN?

Griffin

Poruk

Wolfgang³

2016

Dig Surg

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Intraductal papillary mucinous neoplasms (IPMN) are cystic precursors to pancreatic cancer believed to arise within a widespread neoplastic field defect. The tendency for some patients to present with multifocal disease and/or develop additional lesions over time argues in favor of a field defect and complicates surgical management decisions. Surgery usually consists of partial pancreatic resection, which leaves behind a pancreatic remnant at risk for recurrent disease and progression to cancer. As an alternative, total pancreatectomy (TP) provides the most complete oncologic resection, but postoperative morbidity and quality of life (QoL) issues have generally limited its use to only the highest risk patients. Significant progress has been made in the management of the post-TP apancreatic state and studies now show less morbidity with acceptable QoL comparable to type 1 diabetic and post-pancreaticoduodenectomy patients. These improvements do not yet justify the routine use of TP, but they have opened the door for expansion to additional subsets of non-invasive IPMN. Here, we have identified several groups of patients that we believe would benefit from TP over partial resection based on the most current literature.

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