Key result
Low-risk total pancreatectomy established reference values of ≤37% for major complications and ≤6% for 90-day mortality, showing higher postoperative mortality than pancreatoduodenectomy.
Why the study?
Reference values for total pancreatectomy based on low-risk cohorts treated at expert centers were lacking.
What are the international reference values for surgical outcomes of total pancreatectomy in low-risk patients?
Case-Control (n=994)
Yes
What are the international reference values for surgical outcomes of total pancreatectomy in low-risk patients?
Answers are grounded in this paper and cite their sources.
Total pancreatectomy carries significantly higher postoperative morbidity and mortality compared with pancreatoduodenectomy, and these newly defined reference values can serve for quality control in pancreatic surgery.
Importance: Total pancreatectomy (TP) is indicated for advanced pancreatic cancer or multifocal tumors. Furthermore, TP may be performed to avoid the risk of pancreatic fistula in selected patients to improve the perioperative risk profile. Objective: To define reference values for TP based on a low-risk cohort treated at expert centers. Design, Setting, and Participants: This multicenter study analyzed outcomes from patients undergoing primary TP for malignant or benign lesions from 25 international expert centers from January 2017 to November 2023. Low-risk patients undergoing TP (LR-TP) were without vascular resections or significant comorbidities. Exposures: TP. Main Outcomes and Measures: Twenty reference values were derived from the 75th or the 25th percentile of the median values of all centers. Outcomes of LR-TP were compared with a cohort of TP with vascular resection, TP due to high-risk pancreatic anastomosis, and the benchmark values for low-risk pancreatoduodenectomy. Results: Of 994 patients, 333 (33.5%; median [IQR] age, 66 [58-72] years; 171 male [51.4%]) qualified as the LR-TP cohort. Reference values included blood loss (≤1000 mL), major complications (≤37%), 3-month postoperative mortality (<6%), and retrieved lymph nodes (≥29). Compared with TP with vascular resections, reference cutoffs were not met for major complications (51% vs LR-TP ≤37%) and 90-day mortality (11% vs LR-TP ≤6%). For TP due to high-risk anastomosis, failure to rescue rate (38% vs ≤6%) and 90-day mortality (11% vs LR-TP ≤6%) were not met. Compared with pancreatoduodenectomy, reference values for postoperative mortality were 3 times higher for LR-TP (≤2% vs ≤6%) and less for resected lymph nodes (≥16 vs ≥29). Conclusions and Relevance: This case-control study provided global reference values for TP, indicating significantly higher postoperative morbidity and mortality compared with pancreatoduodenectomy. Perioperative morbidity of TP was especially increased in patients with vascular resections. These reference values can serve for quality control of pancreatic surgery.
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Müller et al. (2025) conducted a case-control in Pancreatic cancer or multifocal tumors (n=994). Total pancreatectomy vs. Pancreatoduodenectomy and high-risk total pancreatectomy was evaluated on Reference values for surgical outcomes including blood loss, major complications, 90-day mortality, and retrieved lymph nodes. Low-risk total pancreatectomy established reference values of ≤37% for major complications and ≤6% for 90-day mortality, showing higher postoperative mortality than pancreatoduodenectomy.
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