A reappraisal of total pancreatectomy for pancreatic cancer: results from U.S. Veterans Affairs hospitals, 1987-1991.
BACKGROUND
After enthusiasm for total pancreatectomy for pancreatic adenocarcinoma peaked in the 1970s, a failure to improve outcomes in the 1980s led to fewer reports of this procedure.


METHODS
We retrieved records from 252 Whipple and 47 total pancreatectomies for pancreatic cancer performed at U.S. Department of Veterans Affairs hospitals from 1987 to 1991.


RESULTS
Thirty-day mortality was 8% with both procedures. There was no significant difference in morbidity at 30 days (Whipple 36%, total pancreatectomy 39%). The mean survival after total pancreatectomy was 526 days compared to 376 days following Whipple (P = 0.03). Staging information was retrieved from tumor registrars for 117 patients with pancreatic adenocarcinoma, 21 of whom underwent total pancreatectomy and 96 the Whipple procedure. In patients with stage I and stage II localized pancreatic adenocarcinoma, mean survival was 772 days in 11 patients after total pancreatectomy, and 446 days in 55 patients after Whipple resection (P = 0.057).


CONCLUSIONS
The type of resection did not affect the mean survival of patients with stage III (nodal metastases) or stage IV (distant metastases) cancer.
Swope
T J
TJ
Department of Surgery, John Cochran Department of Veterans Affairs Medical Center, St. Louis, Missouri.
Wade
T P
TP
Neuberger
T J
TJ
Virgo
K S
KS
Johnson
F E
FE
D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D000368:Aged; D006787:Hospitals, Veterans; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012086:Reoperation; D015996:Survival Rate; D014481:United States