Short-term clinical outcomes after total pancreatectomy: a prospective multicenter pan-European snapshot study

Latenstein, A.; Scholten, Lianne; Al-Saffar, Hasan Ahmad; Björnsson, Bergþór; Butturini, Giovanni; Capretti, Giovanni; Chatzizacharias, N.; Frigerio, Isabella; Gallagher, Tom; Gasteiger, Silvia; Halimi, Asif; Labori, Knut Jørgen; Montagnini, Greta; Muñoz‐Bellvís, Luís; Nappo, Gennaro; Nikov, Andrej; Pando, Elizabeth; Pastena, Matteo De; Peña-Moral, Jesús de la; Roberts, Keith; Salvia, Roberto; Sánchez‐Bueno, Francisco; Scandavini, Chiara Maria; Serradilla-Martín, Mario; Dervenis, C.; Radenković, Dejan V; Stättner, Stefan; Tomažič, Aleš; Varga, M; Zavrtanik, Hana; Zerbi, Alessandro; Erkan, Mert; Kleeff, Jörg; Lesurtel, Mickaël; Besselink, M.; Ramia-Ángel, José Manuel

doi:10.1016/j.pan.2020.07.371

Cited by 6 publications

(10 citation statements)

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“…10,13 A multicenter snapshot study, including TP performed at both high- and low- volume centers between 2018 and 2019, showed a major morbidity of 25% and an in-hospital mortality of 5%. 30 In the present study, major morbidity rates of patients undergoing TP were confirmed to be approximately 20%, which were similar to those of patients undergoing PD. Patients who underwent TP experienced higher rates of nonsurgical complications (cardiac complications, acute kidney injury, and pleural effusion) compared to PD but reduced rates of sepsis and abdominal abscess.…”

Section: Discussionsupporting

confidence: 83%

High-risk Pancreatic Anastomosis Versus Total Pancreatectomy After Pancreatoduodenectomy

Marchegiani

Perri²,

Burelli³

et al. 2021

Annals of Surgery

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Objective: To evaluate TP as an alternative to PD in patients at high-risk for 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, whereas 86 (63%) TP patients underwent C-TP. Postoperatively, the patients in the C-TP group exhibited lower rates of postpancreatectomy 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 2 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 diabetesspecific QoL. Conclusions: C-TP may be considered rather than HR-PD only in few selected cases and after adequate counseling.

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Section: Discussionsupporting

confidence: 83%

High-risk Pancreatic Anastomosis Versus Total Pancreatectomy After Pancreatoduodenectomy

Marchegiani

Perri²,

Burelli³

et al. 2021

Annals of Surgery

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“…Stoop et al [29] defined TP as either preoperatively planned or intraoperatively decided on total pancreatectomy. Latenstein et al [31] reported patients undergoing elective primary TP, an intraoperative decision to perform TP and elective completion (after a previous partial pancreatic resection) TP. Thus, the incidence and the proper indications for upfront TP are not easy to calculate.…”

Section: Indications For Upfront Total Pancreatectomymentioning

confidence: 99%

“…Total pancreatectomy for pancreatic cancer has been performed mainly with an open approach, and rarely with mini-invasive techniques (laparoscopic or robotic). Recently, Latenstein et al [31] showed that of 277 TPs performed in one year (June 2018-June 2019) for pancreatic cancer, only 11(4%) were performed using a minimally invasive approach. However, in their systematic review, Wang et al [43] showed a very low rate of conversion (ranging from 0 to 10%), and very good postoperative mortality (0%) and morbidity (ranging from 0 to 100%).…”

Section: Pancreatic Ductal Adenocarcinomamentioning

confidence: 99%

“…On the contrary, in a study which included patients from only two high-volume centres, Pulvirenti et al [21] reported a postoperative mortality rate of 2.1%, and Stoop et al [29] reported acceptable postoperative mortality (0%) and morbidity (25%) after TP in a single high-volume centre. A pan-European prospective snapshot study [31] has recently found 5% in-hospital mortality after TP and identified predictors for mortality, including low-volume centres. Finally, a retrospective study including all the primary TPs of 4 registries (U.S., Germany, The Netherlands, and Sweden) showed that postoperative severe morbidity was 26.8% (423 cases out of 1579) and mortality ranged from 1.8% (U.S. registry, National Surgical Quality Improvement Program [NSQIP]) to 10.8% (Netherlands registry, Dutch Pancreatic Cancer Audit [DPCA]) [30].…”

Section: Introductionmentioning

confidence: 99%

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Contemporary indications for upfront total pancreatectomy

et al. 2021

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Currently, advances in surgical techniques, improvements in perioperative care, new formulations of intermediate and longacting 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 aim of this review was to define the current indications for this procedure, in particular for upfront TP, considering not only the pancreatic disease, but also the surgical approach (open, mini-invasive) and the relationship with vascular resection.

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“…Total pancreatectomy (TP) is considered a standard procedure in pancreatic surgery and is regularly performed to achieve negative resection margins in extensive pancreatic tumors . Other indications for TP include intraductal papillary mucinous neoplasms involving the main pancreatic duct of the whole pancreas, multicentric mixed-type or side-branch intraductal papillary mucinous neoplasms, chronic pancreatitis, neuroendocrine tumors with multicentric tumor growth, and, less frequently, multifocal pancreatic metastases (eg, of clear cell renal cell carcinoma) . In rare cases, surgeons may consider TP for technical reasons, such as to avoid the need for a high-risk pancreatoenteric anastomosis in soft pancreata with extremely friable tissue texture and small-caliber pancreatic ducts, or in patients with pancreatic cancer with complex vascular resections, to prevent postoperative pancreatic fistula and its potentially deleterious sequelae, especially erosional postpancreatectomy hemorrhage (PPH) …”

Section: Introductionmentioning

confidence: 99%