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Is There Still a Role for Total Pancreatectomy?

Müller, Michael W. MD*; Friess, Helmut MD*; Kleeff, Jörg MD*; Dahmen, Rolf MD*; Wagner, Markus MD†; Hinz, Ulf MSc*; Breisch-Girbig, Daniela*; Ceyhan, Güralp O. MD*; Büchler, Markus W. MD*

doi: 10.1097/SLA.0b013e31815c2ca3
Original Articles

Objective: To evaluate the perioperative and long-term results of total pancreatectomy (TP), and to assess whether it provides morbidity, mortality, and quality of life (QoL) comparable to those of the pylorus-preserving (pp)-Whipple procedure in patients with benign and malignant pancreatic disease.

Summary Background Data: TP was abandoned for decades because of high peri- and postoperative morbidity and mortality. Because selected pancreatic diseases are best treated by TP, and pancreatic surgery and postoperative management of exocrine and endocrine insufficiency have significantly improved, the hesitance to perform a TP is disappearing.

Patients and Methods: In a prospective study conducted from October 2001 to November 2006, all patients undergoing a TP (n = 147; 100 primary elective TP [group A], 24 elective TP after previous pancreatic resection [group B], and 23 completion pancreatectomies for complications) were included, and perioperative and late follow-up data, including the QoL (EORTC QLQ-C30 questionnaire), were evaluated. A matched-pairs analysis with patients receiving a pp-Whipple operation was performed.

Results: Indications for an elective TP (group A + B) were pancreatic and periampullary adenocarcinoma (n = 71), other neoplastic pancreatic tumors (intraductal papillary mucinous neoplasms, neuroendocrine tumors, cystic tumors; n = 34), metastatic lesions (n = 8), and chronic pancreatitis (n = 11). There were 73 men and 51 women with a mean age of 60.9 ± 11.3 years. Median intraoperative blood loss was 1000 mL and median operation time was 380 minutes. Postoperative surgical morbidity was 24%, medical morbidity was 15%, and mortality was 4.8%. The relaparotomy rate was 12%. Median postoperative hospital stay was 11 days. After a median follow-up of 23 months, global health status of TP patients was comparable to that of pp-Whipple patients, although a few single QoL items were reduced. All patients required insulin and exocrine pancreatic enzyme replacements. The mean HbA1c value was 7.3% ± 0.9%.

Conclusion: In this cohort study, mortality and morbidity rates after elective TP are not significantly different from the pp-Whipple. Because of improvements in postoperative management, QoL is acceptable, and is almost comparable to that of pp-Whipple patients. Therefore, TP should no longer be generally avoided, because it is a viable option in selected patients.

Several pancreatic tumor entities and the extent of surgical radicality require a total pancreatectomy (TP). In the present study we report early and late outcome in 147 patients who underwent TP. Except for endocrine insufficiency, TP provides functional outcome and quality of life comparable to that of the pylorus-preserving Whipple procedure, as shown by matched-pairs analysis.

From the *Department of General Surgery, University of Heidelberg, Heidelberg, Germany; and †Department of Visceral and Transplantation Surgery, University of Bern, Inselspital, Bern, Switzerland.

Reprints: Helmut Friess, MD, Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismanger Strasse 22, 81675 Munich, Germany. E-mail: helmut.friess@chir.med.tu-muenchen.de.

© 2007 Lippincott Williams & Wilkins, Inc.