title: Patient outcomes after total pancreatectomy: a single centre contemporary experience.
abstract: BACKGROUND
  Total pancreatectomy (TP) is associated with significant metabolic abnormalities leading to considerable morbidity. With the availability of modern pancreatic enzyme formulations and improvements in control of diabetes mellitus, the metabolic drawbacks of TP have diminished. As indications for TP have expanded, we examine our results in patients undergoing TP.
  
  
  METHODS
  Retrospective study of 47 patients undergoing TP from January 2002 to January 2008 was performed. Patient data and clinical outcomes were collected and entered into a database. Disease-free survival and overall survival were estimated using the Kaplan-Meier method.
  
  
  RESULTS
  Fifteen males and 32 females with a median age of 70 years underwent TP for non-invasive intraductal papillary mucinous neoplasms (IPMN) (21), pancreatic adenocarcinoma (20), other neoplasm (3), chronic pancreatitis (2) and trauma (1). Median hospital stay and intensive care stay were 11 days and 1 day, respectively. Thirty-day major morbidity and mortality was 19% and 2%, respectively. With a median follow-up length of 23 months, 33 patients were alive at last follow-up. Estimated overall survival at 1, 2 and 3 years for the entire cohort was 80%, 72% and 65%, and for those with pancreatic adenocarcinoma was 63%, 43% and 34%, respectively. Median weight loss at 3, 6 and 12 months after surgery was 6.8 kg, 8.5 kg and 8.8 kg, respectively. Median HbA1c values at 6, 12 and 24 months after surgery were 7.3, 7.5 and 7.7, respectively. Over one-half of the patients required re-hospitalization within 12 months post-operatively.
  
  
  CONCLUSIONS
  TP results in significant metabolic derangements and exocrine insufficiency, diabetic control and weight maintenance remain a challenge and readmission rates are high. Survival in those with malignant disease remains poor. However, the mortality appears to be decreasing and the morbidities associated with TP appear acceptable compared with the benefits of resection in selected patients.
authors.affiliation: Department of Surgery, Mayo Clinic, Jacksonville, FL 32224, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Stauffer
authors.forename: Justin H
authors.initials: JH
authors.lastname: Nguyen
authors.forename: Michael G
authors.initials: MG
authors.lastname: Heckman
authors.forename: Manpreet S
authors.initials: MS
authors.lastname: Grewal
authors.forename: Marjorie
authors.initials: M
authors.lastname: Dougherty
authors.forename: Kanwar R S
authors.initials: KR
authors.lastname: Gill
authors.forename: Laith H
authors.initials: LH
authors.lastname: Jamil
authors.forename: Daniela
authors.initials: D
authors.lastname: Scimeca
authors.forename: Massimo
authors.initials: M
authors.lastname: Raimondo
authors.forename: C Daniel
authors.initials: CD
authors.lastname: Smith
authors.forename: J Kirk
authors.initials: JK
authors.lastname: Martin
authors.forename: Horacio J
authors.initials: HJ
authors.lastname: Asbun