title: Reappraisal of Total Pancreatectomy in 45 Patients With Pancreatic Ductal Adenocarcinoma in the Modern Era Using Matched-Pairs Analysis: Multicenter Study Group of Pancreatobiliary Surgery in Japan.
abstract: The aim of this study was to reappraise the clinical role of total pancreatectomy with curative intent in patients with pancreatic ductal adenocarcinoma (PDAC).
  
  
  
  In 2001 to 2011 database from 7 institutions in Japan, 45 (3.1%) of 1451 patients with PDAC underwent total pancreatectomy (TP group), and 885 patients underwent pancreaticoduodenectomy (PD group). A matched-pairs group consisted of 45 patients matched for age, sex, year, resectability status, and neoadjuvant therapy (matched-PD group). Clinicopathological data, overall survival, and disease-free survival were compared between groups.
  
  
  
  Clinical features of the TP group revealed higher-stage disease, greater surgical stress, a higher frequency of lymph node metastasis, and a lower adjuvant chemotherapy completion rate compared with the PD group (P < 0.05). Overall survival and disease-free survival in the TP group were significantly worse than those in the PD group (P < 0.05). Multivariate analysis revealed resectability status, neoadjuvant therapy, blood transfusion, lymph node metastasis, and adjuvant therapy to be significant prognostic factors. No differences in mortality and morbidity rates were observed between the 2 groups. A matched-pairs analysis revealed similar surgical outcomes and overall survival.
  
  
  
  The surgical outcome of total pancreatectomy for patients with PDAC is acceptable. When margin-negative resection is expected, total pancreatectomy should not be abandoned in the modern era.
authors.affiliation: From the *Department of Surgery, Kansai Medical University, Osaka; †Department of Surgery, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima; ‡Division of Gastroenterological Surgery, Department of Surgery, Tohoku University, Sendai; §Department of Surgery, Nara Medical University, Nara; ∥Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kinki University Faculty of Medicine, Osaka; ¶Second Department of Surgery, Wakayama Medical University, Wakayama; #Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo; and **Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Sohei
authors.initials: S
authors.lastname: Satoi
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Murakami
authors.forename: Fuyuhiko
authors.initials: F
authors.lastname: Motoi
authors.forename: Masayuki
authors.initials: M
authors.lastname: Sho
authors.forename: Ippei
authors.initials: I
authors.lastname: Matsumoto
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Uemura
authors.forename: Manabu
authors.initials: M
authors.lastname: Kawai
authors.forename: Masanao
authors.initials: M
authors.lastname: Kurata
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Yanagimoto
authors.forename: Tomohisa
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Masamichi
authors.initials: M
authors.lastname: Mizuma
authors.forename: Michiaki
authors.initials: M
authors.lastname: Unno
authors.forename: Shoichi
authors.initials: S
authors.lastname: Kinoshita
authors.forename: Takahiro
authors.initials: T
authors.lastname: Akahori
authors.forename: Makoto
authors.initials: M
authors.lastname: Shinzeki
authors.forename: Takumi
authors.initials: T
authors.lastname: Fukumoto
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Hashimoto
authors.forename: Seiko
authors.initials: S
authors.lastname: Hirono
authors.forename: Hiroki
authors.initials: H
authors.lastname: Yamaue
authors.forename: Goro
authors.initials: G
authors.lastname: Honda
authors.forename: Masanori
authors.initials: M
authors.lastname: Kwon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001662:Biliary Tract Surgical Procedures / Q000379:methods; D021441:Carcinoma, Pancreatic Ductal / Q000188:drug therapy / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007564:Japan; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D010179:Pancreas / Q000187:drug effects / Q000473:pathology / Q000601:surgery*; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods; D011379:Prognosis; D016019:Survival Analysis