Surgical Outcomes After Total Pancreatectomy: A High-Volume Center Experience

• Published in: Annals of surgical oncology Vol. 28; no. 3; pp. 1543 - 1551
• Main Authors: Stoop, Thomas F., Ateeb, Zeeshan, Ghorbani, Poya, Scholten, Lianne, Arnelo, Urban, Besselink, Marc G., Del Chiaro, Marco
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.03.2021; Springer Nature B.V
• Subjects: Adolescent; Adult; Elective Surgical Procedures; Hospital Mortality; Humans; Medicin och hälsovetenskap; Medicine; Medicine & Public Health; Morbidity; Mortality; Oncology; Pancreatectomy; Pancreatic Neoplasms - surgery; Pancreatic Tumors; Retrospective Studies; Surgery; Surgical Oncology; Surgical outcomes; Treatment Outcome
• ISSN: 1068-9265; 1534-4681; 1534-4681
• DOI: 10.1245/s10434-020-08957-x

Background The impact of high-volume care in total pancreatectomy (TP) is barely explored since annual numbers are mostly low. This study evaluated surgical outcomes after TP over time in a high-volume center. Methods All adult patients (age ≥ 18 years) who underwent an elective single-stage TP at Karolinska University Hospital were retrospectively analysed (2008–2017). High volume was defined as > 20 TPs/year. Results Overall, 145 patients after TP were included, including 86 (59.3%) extended resections. Major morbidity was 34.5% (50/145) and 90-day mortality 5.5% (8/145). The relative use of TP within all pancreatectomies increased from 5.4% (63/1175) in 2008–2015 to 17.3% (82/473) in 2016–2017 ( p  < 0.001). Over time, TP was more often performed to achieve radicality ( n  = 11, 17.5% to n  = 31, 37.8%; p  = 0.007). In multivariable logistic regression analysis, an annual TP-volume of > 20 was associated with reduced major morbidity (odds ratio [OR] = 0.225, 95% confidence interval [CI], 0.097–0.521; p  < 0.001). In the high-volume years (2016–2017), major morbidity ( n  = 31, 49.2% to n  = 19, 23.2%; p  = 0.001) and relaparotomy rate ( n  = 13, 20.6% to n  = 5, 6.1%; p  = 0.009) improved. Improvements occurred mainly after extended TP, including lower major morbidity ( n  = 22, 57.9% to n  = 12, 25.0%; p  = 0.002) and in-hospital mortality ( n  = 3, 7.9% to n  = 0, 0%; p  = 0.082). Conclusions In a single, high-volume center study, an increase in surgical volume of TP was associated with improved perioperative outcomes, especially for extended resections.