Total pancreatectomy and its current place in the treatment of pancreatic diseases

Authors: M. Ryska
Authors‘ workplace: Chirurgická klinika 2. LF UK a ÚVN – VFN v Praze
Published in: Gastroent Hepatol 2016; 70(5): 408-412
Category: Gastrointestinal Oncology: Review Article
doi: 10.14735/amgh2016408


Total pancreatectomy (TP) is a surgical procedure indicated selectively for patients with benign and malignant disease. In the case of malignancy, TP is indicated electively for multifocal or advanced disease, mostly for chronic pancreatitis after a non-effective primary operation. TP is indicated as “salvage surgery” in cases of acute postoperative pancreatitis or in situations where it is not possible to complete the elective partial resection. With respect to survival and quality of life, the outcomes of TP patients are comparable to those of patients who have undergone partial resection. The exclusion of patients who have a high probability of not profiting from TP is still a problem. The aim of this review is to inform gastroenterologists about the current place of TP in the treatment of malignant and benign pancreatic diseases. A multidisciplinary team and a surgeon played key roles in all cases.

Key words:
pancreatic cancer – chronic pancreatitis – total pancreatectomy – multidisciplinary team

The author declares he has no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

6. 9. 2016

18. 9. 2016


1. Watanabe Y, Ohtsuka T, Matsunage T et al. Long-term outcomes after total pancreatectomy: special reference to survivors’ living conditions and quality of life. World J Surg 2015; 39 (5): 1231–1239. doi: 10.1007/s00268-015-2948-1.

2. Almond M, Roberts KJ, Hodson J et al. Changing indications for a total pancreatectomy: perspectives over a quarter of a century. HPB (Oxford) 2015; 17 (5): 416–421. doi: 10.1111/hpb.12365.

3. Hartwig W, Gluth A, Hinz U et al. Total pancreatectomy for primary pancreatic neoplasms. Ann Surg 2015; 261 (3): 537–546. doi: 10.1097/SLA.0000000000000791.

4. Epelboym I, Winner M, DiNorcia J et al. Quality of life in patiens after total pancreatectomy is comparable with quality of life in patiens who undergo a partial pancreatic resection. J Surg Res 2014; 187 (1): 189–196. doi: 10.1016/j.jss.2013.10.004.

5. Nentwich MF, El Gammal AT, Lemcke T et al. Salvage completion pancreatectomies as damage control for post-pancreatic surgery complications: a single-center retrospective analysis. World J Surg 2015; 39 (6): 1550–1556. doi: 10.1007/ s00268-015-2969-9.

6. Johnston WC, Hoen HM, Cassera MA et al. Total pancreatectomy for pancreatic ductal adenocarcinoma: review of the National Cancer Data Base. HPB (Oxford) 2016; 18 (1): 21–28. doi: 10.1016/j.hpb.2015.07.009.

7. Fazlalizadeh R, Moghadamyeghaneh Z, Demirjian AN et al. Total pancreatectomy and islet autotransplantation: a decade nationwide analysis. World J Transplant 2016; 6 (1): 233–238. doi: 10.5500/wjt.v6.i1. 233.

8. Whipple AO, Parsons WB, Mullins CR. Treatment of carcinoma of ampulla of vater. Ann Surg 1935; 102 (4): 763–779.

9. Rockey EW. Total pancreatectomy for carcinoma: case report. Ann Surg 1943; 118 (4): 603–611.

10. Ihse I, Lilja P, Arnesjö B et al. Total pancreatectomy for cancer. An appraisal of 65 cases. Ann Surg 1977; 186 (6): 675–680.

11. Trede M, Schwall G. The complications of pancreatectomy. Ann Surg 1988; 207 (1): 39–47.

12. Martin RF, Rossi RL. Pancreatoduodenectomy with or without pylorus preservation. In: Beger HG, Warshaw AL, Buchler ME et al. The Pancreas. Oxford: Blackwell Science 1998: 863–869.

13. Andrén-Sanberg A, Ihse I. Factors influencing survival after total pancreatectomy in patients with pancreatic cancer. Ann Surg 1983; 198 (5): 605–610.

14. Willet CG, Lewandrowski K, Warshaw AL et al. Resection margins in carcinoma of the head of the pancreas. Implications for radiation therapy. Ann Surg 1993; 217 (2): 144–148.

15. Verbeke CS, Leitch D, Menon KV et al. Redefining the R1 resection in pancreatic cancer. Br J Surg 2006; 93 (10): 1232–1237.

16. Verbeke CS, Menon KV. Redefining resection margin status in pancreatic cancer. HPB (Oxford) 2009; 11 (4): 282–289. doi: 10.1111/j.1477-2574.2009.00055.x.

17. Ducreux M, Cuhna AS, Caramella C et al. Cancer of the pancreas: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 2015; 26 (Suppl 5): v56–v68. doi: 10.1093/annonc/ mdv295.

18. Ryska M, Dušek L, Pohnán R et al. Kvalita života je důležitým faktorem indikační rozvahy u nemocných s karcinomem pankreatu. Multicentrická prospektivní studie. Rozhl Chir 2012; 91 (4): 199–208.

19. Ryska M, Rudis J. Pancreatic fistula and postoperative pancreatitis after pancreatoduodenectomy for pancreatic cancer. Hepatobiliary Surg Nutr 2014; 3: 268–275.

20. Ryska M. Předoperační staging u nemocného s karcinomem pankreatu. Gastroent Hepatol 2015; 69 (6): 525–529. doi: 10.14735/amgh2015525.

21. Ryska M, Rudiš J, Bělina F et al. Totální pankreatektomie. Retrospektivní klinická studie. RvCH 2016. In press.

22. Russell RC. Surgical failures – total pancreatectomy. In: Beger HG, Warren RS, Büchler MW et al. The Pancreas. Oxford: Blackwell Science 1998; 877–885.

23. Kocik M, Lipar K, Saudek F et al. Pancreatic islet autotransplantation after com- pletion pancreatectomy for pancreatic fistula after hemipancreatoduodenectomy for carcinoma. Transplant Proc 2014; 46 (6): 1996–1998. doi: 10.1016/j.trans- proceed.2014.06.009.

24. Kulu Y, Schmied BM, Werner J et al. Total pancreatectomy for pancreatic cancer: indications and operative technique. HPB (Oxford) 2009; 11 (6): 469–475. doi: 10.1111/j.1477-2574.2009.00085.x.

25. Tol JAMG, Gouma DJ, Bassi C et al. Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma: a consensus statement by the International Study Group on Pancreatic Surgery (ISGPS). Surgery 2014; 156 (3): 591–600. doi: 10.1016/j.surg.2014.06. 016.

26. Müller MW, Friess H, Kleeff J et al. Is there still a role for total pancreatectomy? Ann Surg 2007; 246 (6): 966–974.

27. Behrman SW, Mulloy M. Total pancreatectomy for the treatment of chronic pancreatitis: indications, otcomes, and recommendations. Am Surg 2006; 72 (4): 297–302.

28. Wu JM, Ho TW, Kuo TC et al. Glycemic change after pancreaticoduodenectomy: a population-based study. Medicine (Baltimore) 2015; 94 (27): e1109. doi: 10.1097/MD.0000000000001109.

29. Jethwa P, Sodergren M, Lala A et al. Diabetic control after total pancreatectomy. Dig Liver Dis 2006; 38 (6): 415–419.

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