Peri-operative mortality and long-term survival after total pancreatectomy for pancreatic adenocarcinoma: a population-based perspective.
OBJECTIVE
Many surgeons perceive total pancreatectomy (TP) for pancreatic adenocarcinoma to be associated with inferior outcomes compared to partial pancreatectomy (PP), such as pancreaticoduodenectomy (PD) and distal pancreatectomy (DP). We sought to analyze peri-operative mortality and long-term survival following TP versus PP for pancreatic adenocarcinoma.


METHODS
The Surveillance, Epidemiology, and End Results (SEER) database was used to identify patients with resected pancreatic adenocarcinoma (1998-2004). Survival after TP versus PP was compared by tumor location.


RESULTS
Of 3280 patients with resected pancreatic head tumors, 292 underwent TP, and 2988 PD. One-month mortality was 9.0% for TP and 6.5% for PD (P = 0.11). Of 315 patients with resected body/tail tumors, 32 underwent TP, and 283 DP. One-month mortality was 9.3% for TP and 3.9% for DP (P = 0.17). Of 426 patients with resected tumors in unspecified pancreatic locations, 52 underwent TP, and 374 PP. One-month mortality was 5.8% for TP and 6.5% for PP (P = 0.87). Survival analyses demonstrated no difference between TP and PP (hazard ratio (HR) 1.06, P = 0.49 for head; HR 0.84, P = 0.51 for body/tail; HR 1.06, P = 0.79 for unspecified locations).


CONCLUSIONS
Peri-operative mortality and long-term survival are similar following TP versus PP for pancreatic adenocarcinoma, supporting the use of TP when oncologically appropriate.
Nathan
Hari
H
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
Wolfgang
Christopher L
CL
Edil
Barish H
BH
Choti
Michael A
MA
Herman
Joseph M
JM
Schulick
Richard D
RD
Cameron
John L
JL
Pawlik
Timothy M
TM
D000230:Adenocarcinoma / Q000401:mortality* / Q000601:surgery*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000401:mortality; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000601:surgery*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018426:SEER Program; D016019:Survival Analysis