Results of total pancreatectomy for adenocarcinoma of the pancreas

Hypothesis: Total pancreatectomy for infiltrating ductal adenocarcinoma is not superior to pancreaticoduodenectomy or distal pancreatectomy. Design: A retrospective analysis of a prospective database of patients. Setting: Memorial Sloan-Kettering Cancer Center, New York, Ny. Patients: All patients (n=488) undergoing pancreatic resection. Main Outcome Measures: Duration of operation, estimated blood loss, complic ations, length of stay, number of positive lymph nodes, presence of a posit ive margin, and survival times were analyzed. Results: Thirty-five patients were identified who underwent total pancreate ctomy, 28 of whom had adenocarcinoma. Median length of stay was 32 days; 19 (54%) developed postoperative complications, of which 63% were infectious. Thirty-day mortality was 3% (1 patient). Median survival was 9.3 months (r ange, 0.6-172 months). There was no significant difference between patients with and without adenocarcinoma in terms of duration of operation, estimat ed blood loss, complications, length of stay, or number of readmissions. In patients with adenocarcinoma, margin or nodal status were not significant survival variables. Patients undergoing total pancreatectomy for adenocarci noma had a significantly worse overall survival than those undergoing total pancreatectomy for other reasons (P<.001), or compared with a contemporane ous cohort with adenocarcinoma undergoing pancreaticoduodenectomy (n=409) a nd distal pancreatectomy (n=51) (7.9 vs 17.2 months; P<002). Conclusions: Total pancreatectomy can be performed safely with low mortalit y; survival is predicted by the underlying pathologic findings: patients un dergoing total pancreatectomy for adenocarcinoma have a uniformly poor outc ome. Those undergoing total pancreatectomy for benign disease or nonadenoca rcinoma variants can have longterm survival. In patients who require total pancreatectomy for ductal adenocarcinoma, the survival is so poor as to bri ng into question the value of the operation.