Impact of total pancreatectomy: short- and long-term assessment
Open accessAbstract
Background The aim was to assess the outcome of a total pancreatectomy (TP). Methods From 1993 to 2010, 56 patients underwent an elective TP for intraductal papillary mucinous neoplasia (n = 42), endocrine tumours (n = 6), adenocarcinoma (n = 5), metastases (n = 2) and chronic pancreatitis (n = 1). Morbidity and survival were analysed. Long-term survivors were assessed prospectively using quality-of-life (QoL) questionnaires. Results Five patients developed gastric venous congestion intra-operatively. Post-operative morbidity and mortality rates were 45% and 3.6%, respectively. An anastomotic ulcer occurred in seven patients, but none after proton pump inhibitor therapy. There were five inappropriate TPs according to definitive pathological examination. Overall 3- and 5-year survival rates were 62% and 55% respectively; five deaths were related to TP (two postoperative deaths, one hypoglycaemia, one ketoacidosis and one anastomotic ulcer). Prospective evaluation of 25 patients found that 14 had been readmitted for diabetes and that all had hypoglycaemia within the past month. The glycated haemoglobin (HbA1c) was 7.8% (6.3-10.3). Fifteen patients experienced weight loss. The QLQ-C30 questionnaire showed a decrease in QoL predominantly because of fatigue and diarrhoea, and the QLQ-PAN26 showed an impact on bowel habit, flatulence and eating-related items. Discussion Morbidity and mortality rates of TP are acceptable, although diabetes- and TP-related mortality still occurs. Endocrine and exocrine insufficiency impacts on the long-term quality of life.
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Diabetes type 3c is mainly characterized by an extraordinary insulin sensitivity, which can be explained in terms of the missing counterregulatory glucagon.
“Diabetes type 3c is mainly characterized by an extraordinary insulin sensitivity, which can be explained in terms of the missing counterregulatory glucagon [32-36].”
From An Uncommon Cause of Recurrent Presyncope, Dizziness, and Tachycardia: A Case Report of Diffuse, Adult-Onset Nesidioblastosis/Non-Insulinoma Pancreatogenous Hypoglycemia Syndrome (NIPHS) (2023) · cites this paper as [33]
The Discussion (page not available) says pancreatic diabetes involves a complete lack of endogenous insulin and glucagon, leading to frequent, severe hypoglycaemia. The Endocrine function section reports frequent hypoglycaemic episodes after total pancreatectomy. Neither passage describes extraordinary insulin sensitivity or establishes that missing counterregulatory glucagon explains such sensitivity. (LLM, conf=0.84)
Experimental — accuracy not yet measuredSurgical procedures on the pancreas, especially total pancreatectomy, are associated with a considerable risk of morbidity and mortality.
“Of note, surgical procedures on the pancreas, especially total pancreatectomy, are associated with a considerable risk of morbidity and mortality [33,66-68].”
From An Uncommon Cause of Recurrent Presyncope, Dizziness, and Tachycardia: A Case Report of Diffuse, Adult-Onset Nesidioblastosis/Non-Insulinoma Pancreatogenous Hypoglycemia Syndrome (NIPHS) (2023) · cites this paper as [33]
The Post-operative course section reports 45% morbidity and 3.6% postoperative mortality among 56 patients who underwent total pancreatectomy, supporting the claim for that procedure. The study does not establish the risk for pancreatic surgical procedures more broadly. (LLM, conf=0.84)
Experimental — accuracy not yet measured
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Research works printed but not linked: 2
- Casadei R, Monari F, Buscemi S, Laterza M, Ricci C, Rega D et al. (2010) Total pancreatectomy: indications, operative technique, and results. a single centre experience and review of literature. Updat Surg 62:41-46.
- Farnell MB, Pearson RK, Sarr MG, DiMagno EP, Burgart LJ, Dahl TR et al. (2005) A prospective randomized trial comparing standard pancrea- toduodenectomy with pancreatoduodenectomy with extended lym- phadenectomy in resectable pancreatic head adenocarcinoma. Surgery 138:628-630.
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Perioperative Nutritional Aspects in Total Pancreatectomy: A Comprehensive Review of the Literature
Furbetta, N., Comandatore, A., Gianardi, D., Palmeri, M., Di Franco, G., Guadagni, S., Caprili, G., Bianchini, M., Fatucchi, L. M., Picchi, M., et al. (2021) · Nutrients · doi:10.3390/nu13061765 · Cited by 18 · see citing works
Diabetes management in patients undergoing total pancreatectomy: A single center cohort study
Zhao, T., Fu, Y., Zhang, T., Guo, J., Liao, Q., Song, S., Duo, Y., Gao, Y., Yuan, T., & Zhao, W. (2023) · Frontiers in Endocrinology · doi:10.3389/fendo.2023.1097139 · Cited by 18 · see citing works
Dieterle, M. P., Husari, A., Prozmann, S. N., Wiethoff, H., Stenzinger, A., Röhrich, M., Pfeiffer, U., Kießling, W. R., Engel, H., Sourij, H., et al. (2023) · Biomedicines · doi:10.3390/biomedicines11061741 · Cited by 5 · see citing works
- Authors
- Barbier, L., Jamal, W., Dokmak, S., Aussilhou, B., Corcos, O., Ruszniewski, P., Belghiti, J., & Sauvanet, A.
- Affiliations
- Hôpital Beaujon (FR)
- King Abdulaziz University (SA)
- Corresponding author
- Barbier, Louise
- Venue
- HPB
- Publisher
- Elsevier BV
- Published
- 2013-11
- Volume
- 15
- Issue
- 11
- Pages
- 882-892
- ISSN
- 1365-182X (ISSN-L)
- PMC
- PMC4503286
- OpenAlex
- W2011558778
- Cited by
- 116
- References
- 0
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 6 · 2023: 10 · 2022: 11 · 2021: 14 · 2020: 14 · 2019: 14 · 2018: 4 · 2017: 10 · 2016: 11 · 2015: 4 · 2014: 5 · 2013: 2
- FWCI
- 3.93
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- HPB (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Oncology › Pancreatic and Hepatic Oncology Research
- Health Sciences › Medicine › Epidemiology › Neuroendocrine Tumor Research Advances
- Health Sciences › Medicine › Surgery › Pancreatitis Pathology and Treatment
- Keywords
- total pancreatectomy, postoperative morbidity, survival, quality of life, diabetes mellitus, hypoglycemia, exocrine insufficiency, endocrine insufficiency, anastomotic ulcer, proton pump inhibitor therapy, chronic pancreatitis, pancreatic ductal adenocarcinoma, pancreatic metastasis, postoperative mortality
- MeSH terms
- Adult, Aged, Aged, 80 and over, Female, Follow-Up Studies, France, Humans, Male, Middle Aged, Morbidity, Pancreatectomy, Pancreatic Diseases, Postoperative Complications, Quality of Life, Surveys and Questionnaires, Retrospective Studies, Time Factors, Survival Rate, Risk Assessment
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