Total pancreatectomy: Short- and long-term outcomes at a high-volume pancreas center

Table 1 Demographics for 103 patients undergoing total pancreatectomy with subgroup analysis

Variable	Overall (n = 103)	PDAC (n = 42)	IPMN (n = 40)	LTP (n = 24)
Age, yr1	70.2 (32-84.5)	70.3 (33.3-84.5)	71.3 (42.9-81.1)	70.3 (37.3-84.5)
Body mass index1	25.1 (17.7-42.1)	24.2 (17.7-39.8)	25.8 (18.5-42.1)	26.7 (17.7-36.3)
Male	44 (42.7%)	18 (42.9%)	19 (47.5%)	13 (54.2%)
Hypertension	70 (68%)	29 (69%)	31 (77.5%)	14 (58.3%)
Diabetes	46 (44.7%)	19 (45.2%)	16 (40%)	13 (54.2%)
Cardiac disease	31 (30.1%)	8 (19%)	14 (35%)	7 (29.2%)
Pulmonary disease	19 (18.4%)	7 (16.7%)	7 (17.5%)	5 (20.8%)
ASA
II	24 (23.3%)	11 (26.2%)	9 (22.5%)	2 (8.3%)
III	72 (69.9%)	26 (61.9%)	29 (72.5%)	22 (91.7%)
IV	7 (6.8%)	5 (11.9%)	2 (5%)	0
Type of resection
Standard	35 (34%)	17 (40.5%)	10 (25%)	5 (20.8%)
Pylorus preserving	56 (54.4%)	20 (47.6%)	27 (67.5%)	16 (66.7%)
Completion	12 (11.6%)	5 (11.9%)	3 (7.5%)	3 (12.5%)

¹Values are median (range), values in parenthesis are percentages unless otherwise indicated. ASA: American Society of Anesthesiologists score; IPMN: Intraductal papillary mucinous neoplasm; LTP: Laparoscopic total pancreatectomy; PDAC: Pancreatic ductal adenocarcinoma.

Table 2 Operative variables for 103 patients undergoing total pancreatectomy with subgroup analysis

Variable	Overall (n = 103)	PDAC (n = 42)	IPMN (n = 40)	LTP (n = 24)
Operative time (min)1	426 (165-930)	390 (165-636)	435 (240-930)	534 (234-770)
Estimated blood loss (mL)1	500 (50-18000)	500 (50-7800)	525 (50-18000)	200 (50-600)
Intraoperative pRBC transfusion (unit)1	1 (0%-40%)	2 (0%-30%)	1 (0%-40%)	0 (0%-2%)
Vein resection	18 (17.5%)	13 (40%)	4 (10%)	1 (4.2%)

¹Values are median (range), values in parenthesis are percentages unless otherwise indicated. IPMN: Intraductal papillary mucinous neoplasm; LTP: Laparoscopic total pancreatectomy; PDAC: Pancreatic ductal adenocarcinoma; pRBC: Intraoperative packed red blood cell.

Table 3 Postoperative outcomes and complications (90 d) for 103 patients undergoing total pancreatectomy

Variable	Overall (n = 103)	PDAC (n = 42)	IPMN (n = 40)	LTP (n = 24)
Cardiac	10 (9.7%)	5 (11.9%)	3 (7.5%)	1 (4.2%)
Pulmonary	15 (14.6%)	7 (16.7%)	6 (15%)	5 (20.8%)
Renal insufficiency	8 (7.8%)	3 (7.1%)	6 (15%)	4 (16.7%)
Hepatic insufficiency	3 (2.4%)	1 (2.4%)	3 (7.5%)	2 (8.3%)
Major glycemic event	6 (5.8%)	3 (7.1%)	2 (5%)	1 (4.2%)
Post-pancreatectomy hemorrhage	5 (4.9%)	0 (0.0%)	4 (10%)	4 (16.7%)
A	2 (1.9%)	0	2 (5%)	2 (8.3%)
B	1 (0.8%)	0	0	1 (4.2%)
C	2 (1.9%)	0	2 (5%)	1 (4.2%)
Delayed gastric emptying	14 (13.6%)	5 (11.9%)	5 (12.5%)	2 (8.3%)
A	4 (4.9%)	2 (4.8%)	2 (5%)	0
B	5 (4.9%)	2 (4.8%)	1 (2.5%)	1 (4.2%)
C	5 (4.9%)	1 (2.4%)	2 (5%)	1 (4.2%)
Wound infection	11 (10.7%)	5 (11.9%)	2 (5%)	2 (8.3%)
Intra-abdominal abscess	14 (13.6%)	2 (4.8%)	8 (20%)	4 (16.7%)
Biliary fistula	2 (1.9%)	0	1 (2.5%)	0
Mesenteric/portal vein thrombosis	5 (4.9%)	2 (4.8%)	2 (5%)	1 (4.2%)
Reoperation	7 (6.8%)	2 (4.8%)	2 (5%)	2 (8.3%)
Patients intensive care stay	64 (62.1%)	24 (57.1%)	30 (75%)	10 (41.7%)
Median intensive care stay, d1 (range)	2 (1-59)	2 (1-12)	2 (1-59)	2 (1-33)
Overall morbidity	66 (64.1%)	27 (64.3%)	25 (62.5%)	10 (41.7%)
Major (III-V)	33 (32%)	13 (31%)	13 (32.5%)	5 (20.8%)
IIIa	14 (13.6%)	5 (11.9%)	6 (15%)	0
IIIb	3 (2.9%)	2 (4.8%)	0	0
IVa	4 (4.9%)	1 (2.4%)	2 (5%)	2 (8.3%)
IVb	5 (4.9%)	2 (4.8%)	1 (2.5%)	2 (8.3%)
V	7 (6.8%)	3 (7.1%)	4 (10%)	1 (4.2%)
Length of stay, d1 (range)	9 (3%-71%)	9 (3%-71%)	10 (4%-67%)	8 (4%-52%)
Readmission	26 (25.2%)	12 (28.6%)	8 (20%)	3 (12.5%)

¹Values are median (range), values in parenthesis are percentages unless otherwise indicated. IPMN: Intraductal papillary mucinous neoplasm; LTP: Laparoscopic total pancreatectomy; PDAC: Pancreatic ductal adenocarcinoma.

Table 4 Pathologic findings for 103 patients undergoing total pancreatectomy

Variable	Overall (n = 103)	LTP (n = 24)
Malignant	n = 53	n = 12
Pancreatic ductal adenocarcinoma	42 (40.8%)	5 (20.8%)
De novo	23 (22.3%)	3 (12.5%)
Arising from IPMN	19 (18.5%)	2 (8.3%)
Neuroendocrine	7 (6.8%)	6 (25%)
Cholangiocarcinoma with IPMN	1 (0.97%)	0
Ampullary adenocarcinoma with IPMN	1 (0.97%)	1 (4.2%)
Renal cell carcinoma	1 (0.97%)	0
Sarcoma	1 (0.97%)	0
Tumor size, cm1	3.5 ± 2.4 (0.5%-14%)	3.2 ± 2.5 (1.3%-10%)
Margin negative (R0)	41 (77.4%)	11 (91.7%)
Number of lymph nodes harvested1	23 ± 14 (1%-61%)	28 ± 11 (11%-41%)
Non malignant	n = 50	n = 12
IPMN	40 (38.8%)	11 (45.8%)
Chronic pancreatitis	8 (7.8%)	1 (4.2%)
Ampullary adenoma with IPMN	1 (0.97%)	0
Trauma	1 (0.97%)	0

¹Values are mean (range), values in parenthesis are percentages unless otherwise indicated. IPMN: Intraductal papillary mucinous neoplasm; LTP: Laparoscopic total pancreatectomy.