title: Perioperative outcomes of pancreaticoduodenectomy compared to total pancreatectomy for neoplasia.
abstract: OBJECTIVE
  Total pancreatectomy (TP) eliminates the risk and morbidity of pancreatic leak after pancreaticoduodenectomy (PD). However, TP is a more extensive procedure with guaranteed endocrine and exocrine insufficiency. Previous studies conflict on the net benefit of TP.
  
  
  METHODS
  A comparison of patients undergoing non-emergent, curative-intent TP or PD for pancreatic neoplasia using the National Surgical Quality Improvement Project data from 2005-2011 was done. Main outcome measures were mortality and major and minor morbidities.
  
  
  RESULTS
  Of the 6,314 (97%) who underwent PD and the 198 (3%) who underwent TP, malignancy was present in 84% of patients. The two groups were comparable at baseline. Mortality was higher after TP (6.1%) than DP (3.1%), p = 0.02. Adjusting for differences on multivariable analysis, TP carried increased mortality (OR 2.64, 95% CI 1.3-5.2, p = 0.005). TP was also associated with increased rates of major morbidity (38 vs. 30%, p = 0.02) and blood transfusion (16 vs. 10%, p = 0.01). Infectious and septic complications occurred equally in both groups.
  
  
  CONCLUSIONS
  The morbidity of a pancreatic fistula can be eliminated by TP. However, based on our findings, TP is associated with increased major morbidity and mortality. TP cannot be routinely recommended for to reduce perioperative morbidity when pancreaticoduodenectomy is an appropriate surgical option.
authors.affiliation: Department of Surgery, College of Medicine; Program for Liver, Pancreas, & Foregut Tumors, Penn State Cancer Institute, The Pennsylvania State University, 500 University Drive, H070, Hershey, PA, 17033-0850, USA.
authors.forename: Neil H
authors.initials: NH
authors.lastname: Bhayani
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Miller
authors.forename: Gail
authors.initials: G
authors.lastname: Ortenzi
authors.forename: Jussuf T
authors.initials: JT
authors.lastname: Kaifi
authors.forename: Eric T
authors.initials: ET
authors.lastname: Kimchi
authors.forename: Kevin F
authors.initials: KF
authors.lastname: Staveley-O'Carroll
authors.forename: Niraj J
authors.initials: NJ
authors.lastname: Gusani
mesh_terms: D018784:Abdominal Abscess / Q000209:etiology; D000368:Aged; D001803:Blood Transfusion / Q000706:statistics & numerical data; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D010180:Pancreatectomy / Q000009:adverse effects* / Q000401:mortality*; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000401:mortality*; D012769:Shock / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology