Reappraisal of clinical indication regarding total pancreatectomy: can we do it for the risky gland?

BACKGROUND: Although total pancreatectomy (TP) is performed at an increasing rate at major pancreatic centers, there is still debate regarding its indications and outcomes. This study aims to analyze the indications and outcomes of TP using our retrospective data. METHODS: We conducted a retrospective study on patients who underwent TP between January 2009 and December 2019 at two academic hospitals using data collected. Preoperative data, including demographics and clinical picture, operative details, and postoperative data, were collected and analyzed. Conventional indications of TP included positive margin on the neck, lesion of the central part of the pancreas, and diffuse lesions of the whole pancreas. The classification of the risky gland included pancreas remnants, which had higher risk for pancreaticoenterostomy after pancreatic head resection. RESULTS: During the study periods, a total of 72 TP were performed for benign and malignant pancreatic diseases. After excluding six TP undergone due to trauma or complication after partial pancreatectomy, 64 patients were grouped into 47 patients with existing conventional indications and 17 patients with predicted risky anastomosis. There was no significant difference in clinical data and surgical results between the conventional indication group and the risky gland group. Thirty-day major morbidity and mortality was 9.4% and 0%, respectively. Ninety-day mortality rate was 1.4% (n=1, conventional group), with the median follow-up length of 21.5 months. Overall 5-year survival rate was 67.7% for the total participants: 87.5% for the risk gland group and 57.9% for the conventional group. There was no significant difference in between the two groups. CONCLUSIONS: Total pancreatectomy appears to be a viable option for risky glands in terms of surgical safety.