Perioperative outcomes and long-term quality of life after total pancreatectomy

Abstract

Background Total pancreatectomy is required to treat diseases involving the entire pancreas, and is characterized by high morbidity rates and impaired long‐term quality of life (QoL). To date, risk factors associated with perioperative and long‐term outcomes have not been determined fully. Methods Data from patients undergoing total pancreatectomy between 2000 and 2014 at two high‐volume centres were analysed retrospectively to assess risk factors for major surgical complications. Short Form (SF) 36, European Organisation for Research and Treatment of Cancer QLQ‐PAN26 and Audit of Diabetes Dependent questionnaires, as well as an original survey were used to investigate factors influencing QoL. Results A total of 329 consecutive patients underwent total pancreatectomy in the two centres. Overall, total pancreatectomy was associated with a morbidity rate of 59·3 per cent and a 30‐day mortality rate of 2·1 per cent. Age over 65 years and long duration of surgery (more than 420 min) were independently associated with major complications (at least Clavien–Dindo grade III). QoL analysis was available for 94 patients (28·6 per cent) with a median follow‐up of 63 (i.q.r. 20–109) months; the most common indication for total pancreatectomy in these patients was intraductal papillary mucinous neoplasms (46 per cent). Both physical (PCS) and mental (MCS) component summary scores of SF‐36® were lower after total pancreatectomy compared with scores for a normative population (P = 0·020 and P < 0·001 respectively). Linear regression analysis showed that young age, abdominal pain and worse perception of body image were negatively associated with the PCS, whereas diabetes, sexual satisfaction and perception of body image affected MCS. Conclusion Total pancreatectomy can be performed with acceptable morbidity and mortality rates. Older patients had a higher risk of postoperative complications but reported better QoL than younger patients.

The use and clinical outcome of total pancreatectomy in the United States, Germany, the Netherlands, and Sweden

“…7 However, in a series describing 12-year results of 2 very high-volume centers, 30-day and 90-day mortality rates were lower with 2% and 3%, respectively. 6 These results are in line with the results from the United States and Sweden, which both had an in-hospital mortality of 2%, yet are in contrast with the high mortality rates in both Germany (10%) and the Netherlands (11%). The difference in mortality rates is interesting, and, next to age 75 and vascular resection, country was identified as a predictor.…”

“…A recent study with 329 patients from 2 very high-volume centers reported a low 30-day mortality of 2.1% after TP. 6 In contrast, a recent pan-European snapshot study reported an inhospital mortality of 5% after TP. 7 The latter study also showed that high-volume centers had better outcomes after TP.…”

Prophylactic total pancreatectomy in individuals at high risk of pancreatic ductal adenocarcinoma (PROPAN): systematic review and shared decision‐making programme using decision tables

“…6,[12][13][14] However, surgical outcomes and diabetes treatment have improved in recent years. 15,16 For such a preference-sensitive treatment dilemma as total pancreatectomy both the individual and the physician need to be well informed. A shared decision-making approach with decision tables may facilitate this process as it provides a structured and easily accessible evidencebased data overview.…”

“…International guidelines currently do not consider prophylactic total pancreatectomy as a treatment option in these patients, due to the relatively high mortality and morbidity associated with this procedure and reduced quality of life due to ‘brittle’ diabetes 6 , 12–14 . However, surgical outcomes and diabetes treatment have improved in recent years 15 , 16…”

“… 6 , 12 – 14 However, surgical outcomes and diabetes treatment have improved in recent years. 15 , 16 …”