Total pancreatectomy in surgery of malignant pancreatic diseases

Summary. The aims of this study were to evaluate the early and long-term outcome of the patient who underwent total pancreatectomy for malignant pancreatic disease. Patients and methods. In a prospective study conducted from 2003 to 2011 years, 14 patients undergoing a total pancreatectomy were included, and perioperative and late follow-up data, including quality of life (SF-36 questionnaire), were evaluated. Indications for total pancreatectomy were pancreatic adenocarcinoma (n =10), intraductal papillary mucinous neoplasm (n=1), renal metastatic lesions (n=2), gastric cancer with pancreatic invasion (n=1). There were 5 men and 9 women with a mean age of 45,3±7,2 years. Results. Median intraoperative blood loss was 1000 mL and median operation time was 410 minutes. Postoperative morbidity was 64,3% and mortality was 42,9%. The relaparotomy rate was 14,3%. Median postoperative hospital stay was 17 days. Total pancreatectomy results in total exocrine insufficiency with nutritional disorders, diabetes with high risk of hypoglycemia and liver steatosis. Survival for total pancreatectomy for pancreatic adenocarcinoma was comparable for pancreatoduodenectomy. After a follow-up of 6—8 months, quality of life of patients was comparable to that of Whipple patients, although a few items of SF-36 were reduced in both group of patients. Conclusion. Total pancreatectomy is the treatment option for selectively limited pancreatic cancer and other pancreatic malignant diseases, when the patient condition permits and offers a chance of cure, and careful follow-up and long-term medical care are very essential.