Elena Vrabie, Mara Mardare, Mihai Eftimie, Octav Ginghina, Traian Dumitrascu
{"title":"全胰切除术-指征,早期发病率和围手术期策略。36例连续患者的亲身体会及文献复习。","authors":"Elena Vrabie, Mara Mardare, Mihai Eftimie, Octav Ginghina, Traian Dumitrascu","doi":"10.21614/chirurgia.3171","DOIUrl":null,"url":null,"abstract":"<p><p>Background/ Aim: Total pancreatectomy (TP) is an uncommon type of pancreatic resection, even at high-volume centers. The indications of a TP are not fully defined, and the outcomes are controversial. The study aims to assess the frequency of use, indications, and early outcomes of TP in a contemporary consecutive series of 36 patients. Patients and <b>Methods:</b> The data of all consecutive elective TP performed by three experienced pancreatic surgeons between February 1, 2017, and December 31, 2024, were retrospectively extracted from a prospectively maintained electronic database of pancreatic resections. The data of patients requiring TP were analyzed for indications, surgical technique, and early outcomes. <b>Results:</b> The patients were predominantly males (20 patients, 56%) with a median age of 67 years (range 44-76 years). Pancreatic ductal adenocarcinoma was the main indication (24 patients, 67%). The main reasons for a TP were multicentric lesions (14 patients, 39%), distal pancreas hypoplasia/ hypotrophy (8 patients, 22%), highrisk anastomoses (7 patients, 19%), and positive pancreatic margins (6 patients, 17%) following pancreaticoduodenectomy. Splenectomy was performed in 23 patients (64%), while venous and arterial resections were performed in 4 patients (11%) and two patients (6%), respectively. Overall and severe (i.e., grade 3 Dindo) morbidity rates were 83% and 25%, respectively, with a 90-day mortality of 6%. The primary sources of surgical morbidity were clinically relevant delayed gastric emptying (5 patients, 14%) and bile leak (4 patients, 11%). <b>Conclusions:</b> TP has rare and specific indications, including multicentric tumors, distal pancreas hypotrophy, positive pancreatic neck margins, and high-risk anastomosis after pancreaticoduodenectomy. In experienced hands, severe morbidity and mortality rates are acceptable for such a complex surgical procedure.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"120 4","pages":"384-395"},"PeriodicalIF":0.8000,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Total Pancreatectomy - Indications, Early Morbidity and Perioperative Strategy. Own Experience of 36 Consecutive Patients and Literature Review.\",\"authors\":\"Elena Vrabie, Mara Mardare, Mihai Eftimie, Octav Ginghina, Traian Dumitrascu\",\"doi\":\"10.21614/chirurgia.3171\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>Background/ Aim: Total pancreatectomy (TP) is an uncommon type of pancreatic resection, even at high-volume centers. The indications of a TP are not fully defined, and the outcomes are controversial. The study aims to assess the frequency of use, indications, and early outcomes of TP in a contemporary consecutive series of 36 patients. Patients and <b>Methods:</b> The data of all consecutive elective TP performed by three experienced pancreatic surgeons between February 1, 2017, and December 31, 2024, were retrospectively extracted from a prospectively maintained electronic database of pancreatic resections. The data of patients requiring TP were analyzed for indications, surgical technique, and early outcomes. <b>Results:</b> The patients were predominantly males (20 patients, 56%) with a median age of 67 years (range 44-76 years). Pancreatic ductal adenocarcinoma was the main indication (24 patients, 67%). The main reasons for a TP were multicentric lesions (14 patients, 39%), distal pancreas hypoplasia/ hypotrophy (8 patients, 22%), highrisk anastomoses (7 patients, 19%), and positive pancreatic margins (6 patients, 17%) following pancreaticoduodenectomy. Splenectomy was performed in 23 patients (64%), while venous and arterial resections were performed in 4 patients (11%) and two patients (6%), respectively. Overall and severe (i.e., grade 3 Dindo) morbidity rates were 83% and 25%, respectively, with a 90-day mortality of 6%. The primary sources of surgical morbidity were clinically relevant delayed gastric emptying (5 patients, 14%) and bile leak (4 patients, 11%). <b>Conclusions:</b> TP has rare and specific indications, including multicentric tumors, distal pancreas hypotrophy, positive pancreatic neck margins, and high-risk anastomosis after pancreaticoduodenectomy. 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Total Pancreatectomy - Indications, Early Morbidity and Perioperative Strategy. Own Experience of 36 Consecutive Patients and Literature Review.
Background/ Aim: Total pancreatectomy (TP) is an uncommon type of pancreatic resection, even at high-volume centers. The indications of a TP are not fully defined, and the outcomes are controversial. The study aims to assess the frequency of use, indications, and early outcomes of TP in a contemporary consecutive series of 36 patients. Patients and Methods: The data of all consecutive elective TP performed by three experienced pancreatic surgeons between February 1, 2017, and December 31, 2024, were retrospectively extracted from a prospectively maintained electronic database of pancreatic resections. The data of patients requiring TP were analyzed for indications, surgical technique, and early outcomes. Results: The patients were predominantly males (20 patients, 56%) with a median age of 67 years (range 44-76 years). Pancreatic ductal adenocarcinoma was the main indication (24 patients, 67%). The main reasons for a TP were multicentric lesions (14 patients, 39%), distal pancreas hypoplasia/ hypotrophy (8 patients, 22%), highrisk anastomoses (7 patients, 19%), and positive pancreatic margins (6 patients, 17%) following pancreaticoduodenectomy. Splenectomy was performed in 23 patients (64%), while venous and arterial resections were performed in 4 patients (11%) and two patients (6%), respectively. Overall and severe (i.e., grade 3 Dindo) morbidity rates were 83% and 25%, respectively, with a 90-day mortality of 6%. The primary sources of surgical morbidity were clinically relevant delayed gastric emptying (5 patients, 14%) and bile leak (4 patients, 11%). Conclusions: TP has rare and specific indications, including multicentric tumors, distal pancreas hypotrophy, positive pancreatic neck margins, and high-risk anastomosis after pancreaticoduodenectomy. In experienced hands, severe morbidity and mortality rates are acceptable for such a complex surgical procedure.
期刊介绍:
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