Changing indications for a total pancreatectomy: perspectives over a quarter of a century.

Abstract

INTRODUCTION:

The indications for a total pancreatectomy (TP), its peri-operative management, provision of pancreatic surgical services and medical treatment of the inherent exo- and endocrine deficient states have all changed considerably over recent decades. The effects of these upon the incidence, indications for and outcomes of TP are unclear. Patients undergoing TP at a single institution over a quarter of a century were reviewed to try to address these issues.

METHODS:

Data on patients who underwent elective (el-) and emergency TP (em-TP) between 1987 and 2013 were reviewed. Patient demographics, indications, intra-operative details, peri-operative management and long-term outcomes were analysed. Absolute numbers of TP were reported relative to partial pancreatectomy rates.

RESULTS:

In total, 136 patients underwent TP [98 (72.1%) el-TP; 38 (27.9%) em-TP]. There was a significant change in indication for el-TP with it increasingly performed for (an intraductal papillary mucinous neoplasm (IPMN) and renal cell metastases whereas there was a decrease in the number of el-TP performed for chronic pancreatitis (P = 0.025). The relative rates of el-TP, however, did not change significantly across the study period (P = 0.225). The median length of stay after el-TP decreased from 19 days pre-1997 to 12 days post-1997 (P = 0.009). The relative use of em-TP declined by 0.28 percentage points per year [P = 0.018; 95% confidence interval (CI): 0.04-0.41].

CONCLUSIONS:

The indications for el-TP have changed; it is being performed more frequently although the proportion relative to other pancreatic resections has not changed. A decrease in the rate of em-TP is likely to reflect improved peri-operative management of a pancreatic fistula and its complications after a pancreaticoduodenectomy.

• Authors: Max Almond, Keith J Roberts, James Hodson, Robert Sutcliffe, Ravi Marudanayagam, John Isaac, Paolo Muiesan, Darius Mirza
• Journal: HPB : the official journal of the International Hepato Pancreato Biliary Association (HPB (Oxford)) Vol. 17 Issue 5 Pg. 416-21 (May 2015) ISSN: 1477-2574 [Electronic] England
• PMID: 25406456 (Publication Type: Journal Article)
• Copyright: © 2014 International Hepato-Pancreato-Biliary Association.

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Decision Making
• Female
• Humans
• Male
• Middle Aged
• Pancreatectomy (methods, trends)
• Pancreatic Diseases (surgery)
• Retrospective Studies
• Young Adult