Portal de Periódicos da CAPES

Total Pancreatectomy for Pancreatic Adenocarcinoma

2009; Lippincott Williams & Wilkins; Volume: 250; Issue: 2 Linguagem: Inglês

10.1097/sla.0b013e3181ae9f93

1528-1140

Sushanth Reddy, Christopher L. Wolfgang, John L. Cameron, Frederic E. Eckhäuser, Michael A. Choti, Richard D. Schulick, Barish H. Edil, Timothy M. Pawlik,

Cholangiocarcinoma and Gallbladder Cancer Studies

In Brief 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.