title: Impact of total pancreatectomy: short- and long-term assessment.
abstract: BACKGROUND
  The aim was to assess the outcome of a total pancreatectomy (TP).
  
  
  METHODS
  From 1993 to 2010, 56 patients underwent an elective TP for intraductal papillary mucinous neoplasia (n = 42), endocrine tumours (n = 6), adenocarcinoma (n = 5), metastases (n = 2) and chronic pancreatitis (n = 1). Morbidity and survival were analysed. Long-term survivors were assessed prospectively using quality-of-life (QoL) questionnaires.
  
  
  RESULTS
  Five patients developed gastric venous congestion intra-operatively. Post-operative morbidity and mortality rates were 45% and 3.6%, respectively. An anastomotic ulcer occurred in seven patients, but none after proton pump inhibitor therapy. There were five inappropriate TPs according to definitive pathological examination. Overall 3- and 5-year survival rates were 62% and 55% respectively; five deaths were related to TP (two postoperative deaths, one hypoglycaemia, one ketoacidosis and one anastomotic ulcer). Prospective evaluation of 25 patients found that 14 had been readmitted for diabetes and that all had hypoglycaemia within the past month. The glycated haemoglobin (HbA1c) was 7.8% (6.3-10.3). Fifteen patients experienced weight loss. The QLQ-C30 questionnaire showed a decrease in QoL predominantly because of fatigue and diarrhoea, and the QLQ-PAN26 showed an impact on bowel habit, flatulence and eating-related items.
  
  
  CONCLUSIONS
  Morbidity and mortality rates of TP are acceptable, although diabetes- and TP-related mortality still occurs. Endocrine and exocrine insufficiency impacts on the long-term quality of life.
authors: Department of HPB Surgery, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, University Denis-Diderot Paris VII, Clichy, France.
authors: Louise
authors: L
authors: Barbier
authors: Department of HPB Surgery, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, University Denis-Diderot Paris VII, Clichy, France.|Department of General Surgery, King Abdulaziz University, University Hospital, Jeddah, Saudi Arabia.
authors: Wisam
authors: W
authors: Jamal
authors: Department of HPB Surgery, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, University Denis-Diderot Paris VII, Clichy, France.
authors: Safi
authors: S
authors: Dokmak
authors: Department of HPB Surgery, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, University Denis-Diderot Paris VII, Clichy, France.
authors: Béatrice
authors: B
authors: Aussilhou
authors: Department of Gastroenterology-Nutrition, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, University Denis-Diderot Paris VII, Clichy, France.
authors: Olivier
authors: O
authors: Corcos
authors: Department of Pancreatology, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, University Denis-Diderot Paris VII, Clichy, France.
authors: Philippe
authors: P
authors: Ruszniewski
authors: Department of HPB Surgery, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, University Denis-Diderot Paris VII, Clichy, France.
authors: Jacques
authors: J
authors: Belghiti
authors: Department of HPB Surgery, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, University Denis-Diderot Paris VII, Clichy, France.
authors: Alain
authors: A
authors: Sauvanet
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D010180:Pancreatectomy; D010182:Pancreatic Diseases / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D011795:Surveys and Questionnaires; D015996:Survival Rate / Q000639:trends; D013997:Time Factors