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Total Pancreatectomy for Pancreatic Adenocarcinoma: Evaluation of Morbidity and Long-Term Survival

Reddy, Sushanth MD; Wolfgang, Christopher L. MD, PhD; Cameron, John L. MD; Eckhauser, Frederic MD; Choti, Michael A. MD, MBA; Schulick, Richard D. MD; Edil, Barish H. MD; Pawlik, Timothy M. MD, MPH

doi: 10.1097/SLA.0b013e3181ae9f93
Original Articles

Objective: To analyze relative perioperative and long-term outcomes of patients undergoing total pancreatectomy versus pancreaticoduodenectomy.

Background: The role of total pancreatectomy has historically been limited due to concerns over increased morbidity, mortality, and perceived worse long-term outcome.

Methods: Between 1970 and 2007, patients who underwent total pancreatectomy (n = 100) or pancreaticoduodenectomy (n = 1286) for adenocarcinoma were identified. Clinicopathologic, morbidity, and survival data were collected and analyzed.

Results: Total pancreatectomy patients had larger median tumor size (4 cm vs. 3 cm; P < 0.001) but similar rates of vascular (50.0% vs. 54.7%) and perineural invasion (90.7% vs. 91.8%) (total pancreatectomy vs. pancreaticoduodenectomy, respectively, both P > 0.05). A similar proportion of total pancreatectomy (74.7%) and pancreaticoduodenectomy (78.3%) patients had N1 disease (P = 0.45). Total pancreatectomy patients had more lymph nodes harvested (27 vs. 16) and were less likely to have positive resection margins (22.2% vs. 43.7%) (total pancreatectomy vs. pancreaticoduodenectomy, respectively, both P < 0.0001). Total pancreatectomy was increasingly used over time (1970–1989, n = 10, 1990–1999, n = 37, 2000–2007, n = 53). Total pancreatectomy was associated with higher 30-day mortality compared with pancreaticoduodenectomy (8.0% vs. 1.5%, respectively; P = 0.0007). However, total pancreatectomy operative mortality decreased over time (1970–1989, 40%; 1990–1999, 8%; 2000–2007, 2%; P = 0.0002). While operative morbidity was higher following total pancreatectomy (69.0% vs. 38.6% for pancreaticoduodenectomy; P < 0.0001), most complications were minor (Clavien Grade 1–2) (59%). Total pancreatectomy and pancreaticoduodenectomy patients had comparable 5-year survival (18.9% vs. 18.5%, respectively, P = 0.32).

Conclusions: Total pancreatectomy perioperative mortality dramatically decreased over time. Long-term survival following total pancreatectomy versus pancreaticoduodenectomy was equivalent. Total pancreatectomy should be performed when oncologically appropriate.

Contemporary institutional data on perioperative and long-term survival after total pancreatectomy for pancreatic adenocarcinoma are lacking. Data from the current study demonstrate that perioperative mortality following total pancreatectomy has dramatically decreased over time. In addition, long-term survival following total pancreatectomy versus pancreaticoduodenectomy was equivalent. Total pancreatectomy should be performed when oncologically appropriate.

From the Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.

Supported from National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research by grant 1KL2RR025006-01 (to T.M.P.). The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH.

Presented at the 4th Annual Academic Surgical Congress, Fort Meyers, FL, February 6, 2009.

Reprints: Timothy M. Pawlik, MD, MPH, Department of Surgery, Johns Hopkins Hospital, 600 North Wolfe St, Blalock 665, Baltimore, MD 22187. E-mail: tpawlik1@jhmi.edu.

© 2009 Lippincott Williams & Wilkins, Inc.