Is There Still a Role for Total Pancreatectomy?

• DOI: 10.1097/sla.0b013e31815c2ca3
• Publication Date: 2009-03-05T02:51:00Z
• Authors: Michael W. Müller; Helmut Friess; Jörg Kleeff; Rolf Dahmen; Markus Wagner; Ulf Hinz; Daniela Breisch-G...; Güralp O. Ceyhan; Markus W. Büchler
• Keywords: Whipple Procedure

In Brief Objective: To evaluate the perioperative and long-term results of total pancreatectomy (TP), to assess whether it provides morbidity, mortality, quality life (QoL) comparable those pylorus-preserving (pp)-Whipple procedure in patients with benign malignant pancreatic disease. Summary Background Data: TP was abandoned for decades because high peri- postoperative morbidity mortality. Because selected diseases are best treated by TP, surgery management exocrine endocrine insufficiency have significantly improved, hesitance perform a is disappearing. Patients Methods: prospective study conducted from October 2001 November 2006, all undergoing (n = 147; 100 primary elective [group A], 24 after previous resection B], 23 completion pancreatectomies complications) were included, late follow-up data, including QoL (EORTC QLQ-C30 questionnaire), evaluated. A matched-pairs analysis receiving pp-Whipple operation performed. Results: Indications an (group + B) periampullary adenocarcinoma 71), other neoplastic tumors (intraductal papillary mucinous neoplasms, neuroendocrine tumors, cystic tumors; n 34), metastatic lesions 8), chronic pancreatitis 11). There 73 men 51 women mean age 60.9 ± 11.3 years. Median intraoperative blood loss 1000 mL median time 380 minutes. Postoperative surgical 24%, medical 15%, mortality 4.8%. The relaparotomy rate 12%. hospital stay 11 days. After months, global health status that patients, although few single items reduced. All required insulin enzyme replacements. HbA1c value 7.3% 0.9%. Conclusion: this cohort study, rates not different pp-Whipple. improvements management, acceptable, almost patients. Therefore, should no longer be generally avoided, viable option Several tumor entities extent radicality require (TP). present we report early outcome 147 who underwent TP. Except insufficiency, functional Whipple procedure, as shown analysis.