Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, South Korea.
Medicine (Baltimore). 2022 Sep 9;101(36):e30390. doi: 10.1097/MD.0000000000030390.
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.
全胰切除术（TP）用于治疗整个胰腺的疾病。然而，由于担心高发病率和死亡率，人们对 TP 仍持保留态度。我们的回顾性研究旨在评估在高容量单一中心进行的 TP 的术后结果，并确定与 TP 后主要并发症和死亡率相关的危险因素。共有 142 名患者于 1995 年至 2015 年在三星医疗中心接受择期 TP。TP 通常在术前计划或术中决定（一期 TP），并且有一些完成的 TP 病例是为了处理在前次部分胰切除术后残胰中形成的肿瘤而进行的（二期 TP）。分析了一期和二期 TP 组之间的差异。还通过根据 TP 实施的年份将病例分为两个时期[早期和晚期]进行了时间序列比较，每个时期将总患者数几乎减半。在所有 TP 患者中，25 名患者（17.6%）发生主要并发症，90 天内再入院率为 20.4%，无院内和 30 天死亡率。在一期和二期 TP 组之间，大多数临床、手术和病理特征以及术后结果没有显著差异。时间序列比较显示，尽管并发症发生率较高，但由于晚期的先进管理，住院时间缩短。与早期相比，晚期的总体生存率有所提高，但差异无统计学意义。多变量分析显示，术前低蛋白水平和 N2 是主要并发症的独立危险因素。R1 切除、腺癌和高估计出血量（EBL）是总生存率差的独立危险因素。在高容量中心进行 TP 是一种安全可行的手术，具有令人满意的术后结果。未来需要更多的研究和努力来显著提高总体生存率。
