Is it worthy to perform total pancreatectomy considering morbidity and mortality?: Experience from a high-volume single center

被引:3
作者
Jung, Ji Hye [1 ]
Yoon, So Jeong [1 ]
Lee, Ok Joo [1 ]
Shin, Sang Hyun [1 ]
Heo, Jin Seok [1 ]
Han, In Woong [1 ,2 ]
机构
[1] Sungkyunkwan Univ Sch Med, Div Hepatobiliary Pancreat Surg, Dept Surg, Samsung Med Ctr, Seoul, South Korea
[2] Sungkyunkwan Univ Sch Med, Div Hepatobiliary Pancreat Surg, Dept Surg, Samsung Med Ctr, 81 Irwon-Ro, Seoul, South Korea
关键词
early period; late period; 1-stage TP; postoperative outcomes; risk factors; total pancreatectomy (TP); 2-stage TP; INTERNATIONAL STUDY-GROUP; RESECTION; SURGERY; CANCER; DEFINITION; SURVIVAL; OUTCOMES;
D O I
10.1097/MD.0000000000030390
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Total pancreatectomy (TP) is performed for diseases of the entire pancreas. However, reluctance remains regarding TP because of the fear of high morbidity and mortality. Our retrospective study aimed to evaluate the postoperative outcomes of TP performed at a high-volume single center and to identify the risk factors associated with major morbidities and mortality after TP. A total of 142 patients who underwent elective TP at Samsung Medical Center between 1995 and 2015 were included. TP was usually planned before surgery or decided during surgery [one-stage TP], and there were some completion TP cases that were performed to manage tumors that had formed in the remnant pancreas after a previous partial pancreatectomy [2-stage TP]. The differences between the 1-stage and 2-stage TP groups were analyzed. Chronological comparison was also conducted by dividing cases into 2 periods [the early and late period] based on the year TP was performed, which divided the total number of patients to almost half for each period. Among all TP patients, major morbidity occurred in 25 patients (17.6%), the rate of re-admission within 90-days was 20.4%, and there was no in-hospital and 30-days mortality. Between the 1-stage and 2-stage TP groups, most clinical, operative, and pathological characteristics, and postoperative outcomes did not differ significantly. Chronological comparison showed that, although the incidence of complications was higher, hospitalization was shorter due to advanced managements in the late period. The overall survival was improved in the late period compared to the early period, but it was not significant. A low preoperative protein level and N2 were identified as independent risk factors for major morbidity in multivariable analysis. The independent risk factors for poor overall survival were R1 resection, adenocarcinoma, and high estimated blood loss (EBL). TP is a safe and feasible procedure with satisfactory postoperative outcomes when performed at a high-volume center. More research and efforts are needed to significantly improve overall survival rate in the future.
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页数:10
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  • [1] Effect of centralization on long-term survival after resection of pancreatic ductal adenocarcinoma
    Ahola, R.
    Siiki, A.
    Vasama, K.
    Vornanen, M.
    Sand, J.
    Laukkarinen, J.
    [J]. BRITISH JOURNAL OF SURGERY, 2017, 104 (11) : 1532 - 1538
  • [2] Postoperative Pancreatic Fistula Following Pancreaticoduodenectomy-Stratification of Patient Risk
    Akgul, Ozgur
    Merath, Katiuscha
    Mehta, Rittal
    Hyer, J. Madison
    Chakedis, Jeffery
    Wiemann, Brianne
    Johnson, Morgan
    Paredes, Anghela
    Dillhoff, Mary
    Cloyd, Jordan
    Pawlik, Timothy M.
    [J]. JOURNAL OF GASTROINTESTINAL SURGERY, 2019, 23 (09) : 1817 - 1824
  • [3] Are There Indications for Total Pancreatectomy in 2016?
    Andren-Sandberg, Ake
    Ansorge, Christoph
    Yadav, Thakur Deen
    [J]. DIGESTIVE SURGERY, 2016, 33 (04) : 329 - 334
  • [4] The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After
    Bassi, Claudio
    Marchegiani, Giovanni
    Dervenis, Christos
    Sarr, Micheal
    Abu Hilal, Mohammad
    Adham, Mustapha
    Allen, Peter
    Andersson, Roland
    Asbun, Horacio J.
    Besselink, Marc G.
    Conlon, Kevin
    Del Chiaro, Marco
    Falconi, Massimo
    Fernandez-Cruz, Laureano
    Fernandez-Del Castillo, Carlos
    Fingerhut, Abe
    Friess, Helmut
    Gouma, Dirk J.
    Hackert, Thilo
    Izbicki, Jakob
    Lillemoe, Keith D.
    Neoptolemos, John P.
    Olah, Attila
    Schulick, Richard
    Shrikhande, Shailesh V.
    Takada, Tadahiro
    Takaori, Kyoichi
    Traverso, William
    Vollmer, Charles
    Wolfgang, Christopher L.
    Yeo, Charles J.
    Salvia, Roberto
    Buehler, Marcus
    [J]. SURGERY, 2017, 161 (03) : 584 - 591
  • [5] Experiences with the standardized classification of surgical complications (Clavien-Dindo) in general surgery patients
    Bolliger, M.
    Kroehnert, J. -A.
    Molineus, F.
    Kandioler, D.
    Schindl, M.
    Riss, P.
    [J]. EUROPEAN SURGERY-ACTA CHIRURGICA AUSTRIACA, 2018, 50 (06): : 256 - 261
  • [6] Is total pancreatectomy as feasible, safe, efficacious, and cost-effective as pancreaticoduodenectomy? A single center, prospective, observational study
    Casadei, Riccardo
    Ricci, Claudio
    Taffurelli, Giovanni
    Guariniello, Anna
    Di Gioia, Anthony
    Di Marco, Mariacristina
    Pagano, Nico
    Serra, Carla
    Calculli, Lucia
    Santini, Donatella
    Minni, Francesco
    [J]. JOURNAL OF GASTROINTESTINAL SURGERY, 2016, 20 (09) : 1595 - 1607
  • [7] Total pancreatectomy: Indications, operative technique, and results: A single centre experience and review of literature
    Casadei R.
    Monari F.
    Buscemi S.
    Laterza M.
    Ricci C.
    Rega D.
    D'Ambra M.
    Pezzilli R.
    Calculli L.
    Santini D.
    Minni F.
    [J]. Updates in Surgery, 2010, 62 (1) : 41 - 46
  • [8] Total pancreatectomy: Indications, different timing, and perioperative and long-term outcomes
    Crippa, Stefano
    Tamburrino, Domenico
    Partelli, Stefano
    Salvia, Roberto
    Germenia, Silvia
    Bassi, Claudio
    Pederzoli, Paolo
    Falconi, Massimo
    [J]. SURGERY, 2011, 149 (01) : 79 - 86
  • [9] Mesenchymal Plasticity Regulated by Prrx1 Drives Aggressive Pancreatic Cancer Biology
    Feldmann, Karin
    Maurer, Carlo
    Peschke, Katja
    Teller, Steffen
    Schuck, Kathleen
    Steiger, Katja
    Engleitner, Thomas
    Ollinger, Rupert
    Nomura, Alice
    Wirges, Nils
    Papargyriou, Aristeidis
    Sarker, Rim Sabrina Jahan
    Ranjan, Raphela Aranie
    Dantes, Zahra
    Weichert, Wilko
    Rustgi, Anil K.
    Schmid, Roland M.
    Rad, Roland
    Schneider, Gunter
    Saur, Dieter
    Reichert, Maximilian
    [J]. GASTROENTEROLOGY, 2021, 160 (01) : 346 - +
  • [10] Risk Factors for Anastomotic Leak After Colon Resection for Cancer Multivariate Analysis and Nomogram From a Multicentric, Prospective, National Study With 3193 Patients
    Frasson, Matteo
    Flor-Lorente, Blas
    Ramos Rodriguez, Jose Luis
    Granero-Castro, Pablo
    Hervas, David
    Alvarez Rico, Miguel Angel
    Garcia Brao, Maria Jesus
    Sanchez Gonzalez, Juan Manuel
    Garcia-Granero, Eduardo
    [J]. ANNALS OF SURGERY, 2015, 262 (02) : 321 - 330