• Laparoscopic total pancreatectomy (LTP)
• National cancer database (NCDB)
• Pancreatic adenocarcinoma
• Robotic total pancreatectomy (RTP)

• Humans
• Pancreatectomy/methods
• Pancreatectomy/statistics & numerical data
• Robotic Surgical Procedures/methods
• Robotic Surgical Procedures/statistics & numerical data
• Laparoscopy/methods
• Laparoscopy/statistics & numerical data
• Pancreatic Neoplasms/surgery
• Pancreatic Neoplasms/mortality
• Male
• Female
• Aged
• Middle Aged
• Databases, Factual
• Treatment Outcome
• Adenocarcinoma/surgery
• Adenocarcinoma/mortality
• Length of Stay/statistics & numerical data

• meta-analysis
• overall survival
• pancreatic ductal adenocarcinoma
• pancreaticoduodenectomy
• total pancreatectomy

• Humans
• Pancreatectomy/methods
• Pancreaticoduodenectomy/methods
• Pancreatic Neoplasms/pathology
• Carcinoma, Pancreatic Ductal/surgery
• Prognosis

• Humans
• Pancreatectomy/adverse effects
• Pancreatectomy/methods
• Pancreaticoduodenectomy/methods
• Postoperative Complications/etiology
• Postoperative Complications/therapy
• Prospective Studies
• Minimally Invasive Surgical Procedures/methods
• Laparoscopy/methods

Background: Total pancreatectomy (TP) seems to be experiencing a renaissance in recent years. In this study, we aimed to determine the long-term survival of pancreatic ductal adenocarcinoma (PDAC) patients who underwent TP by comparing with pancreaticoduodenectomy (PD), and formulate a nomogram to predict overall survival (OS) for PDAC individuals following TP.

Methods: Patients who were diagnosed with PDAC and received PD (n = 5,619) or TP (n = 1,248) between 2004 and 2015 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. OS and cancer-specific survival (CSS) of the PD and TP groups were compared using Kaplan-Meier method and log-rank test. Furthermore, Patients receiving TP were randomly divided into the training and validation cohorts. Univariate and multivariate Cox regression were applied to identify the independent factors affecting OS to construct the nomogram. The performance of the nomogram was measured according to concordance index (C-index), calibration plots, and decision curve analysis (DCA).

Results: There were no significant differences in OS and CSS between TP and PD groups. Age, differentiation, AJCC T stage, radiotherapy, chemotherapy, and lymph node ratio (LNR) were identified as independent prognostic indicators to construct the nomogram. The C-indexes were 0.67 and 0.69 in the training and validation cohorts, while 0.59 and 0.60 of the American Joint Committee on Cancer (AJCC) tumor-node-metastasis (TNM) staging system. The calibration curves showed good uniformity between the nomogram prediction and actual observation. DCA curves indicated the nomogram was preferable to the AJCC staging system in terms of the clinical utility. A new risk stratification system was constructed which could distinguish patients with different survival risks.

Conclusions: For PDAC patients following TP, the OS and CSS are similar to those who following PD. We developed a practical nomogram to predict the prognosis of PDAC patients treated with TP, which showed superiority over the conventional AJCC staging system.

• SEER
• nomogram
• pancreatic ductal adenocarcinoma
• prognosis
• propensity score matching
• total pancreatectomy

• Body composition
• Fat tissue
• Insulin
• Skeletal muscle
• Total pancreatectomy

Aggressive arterial resection or total pancreatectomy in surgical treatment for locally advanced pancreatic cancer (LAPC) has gradually been encouraged thanks to new chemotherapy regimens such as FOLFIRINOX or Gemcitabine and nab-paclitaxel, which have provided more adequate patient selection and local tumor suppression, justifying aggressive local resection. The development of surgical techniques provides the safety of arterial resection (AR) for even major visceral arteries, such as the celiac axis or superior mesenteric artery. Total pancreatectomy has been re-evaluated as an effective option to balance both the local control and postoperative safety. In this review, we investigate the recent reports focusing on arterial resection and total pancreatectomy for locally advanced pancreatic cancer (LAPC) and discuss the rationale of such an aggressive approach in the treatment of PC.

Aggressive arterial resection (AR) or total pancreatectomy (TP) in surgical treatment for locally advanced pancreatic cancer (LAPC) had long been discouraged because of their high mortality rate and unsatisfactory long-term outcomes. Recently, new chemotherapy regimens such as FOLFIRINOX or Gemcitabine and nab-paclitaxel have provided more adequate patient selection and local tumor suppression, justifying aggressive local resection. In this review, we investigate the recent reports focusing on arterial resection and total pancreatectomy for LAPC and discuss the rationale of such an aggressive approach in the treatment of PC. AR for LAPCs is divided into three, according to the target vessel. The hepatic artery resection is the simplest one, and the reconstruction methods comprise end-to-end, graft or transposition, and no reconstruction. Celiac axis resection is mainly done with distal pancreatectomy, which allows collateral arterial supply to the liver via the pancreas head. Resection of the superior mesenteric artery is increasingly reported, though its rationale is still controversial. Total pancreatectomy has been re-evaluated as an effective option to balance both the local control and postoperative safety. In conclusion, more and more aggressive pancreatectomy has become justified by the principle of total neoadjuvant therapy. Further technical standardization and optimal neoadjuvant strategy are mandatory for the global dissemination of aggressive pancreatectomies.

• arterial resection
• neoadjuvant therapy
• pancreatic cancer
• total pancreatectomy

Total pancreatectomy (TP) is usually considered a therapeutic option for pancreatic cancer in which Whipple surgery and distal pancreatectomy are undesirable, but brittle diabetes and poor quality of life (QoL) remain major concerns. A subset of patients who underwent TP even died due to severe hypoglycemia. For pancreatic cancer involving the pancreatic head and proximal body but without invasion to the pancreatic tail, we performed partial pancreatic tail preserving subtotal pancreatectomy (PPTP-SP) in selected patients, in order to improve postoperative glycemic control and QoL without compromising oncological outcomes.

To evaluate the efficacy of PPTP-SP for patients with pancreatic cancer.

We retrospectively reviewed 56 patients with pancreatic ductal adenocarcinoma who underwent PPTP-SP (n = 18) or TP (n = 38) at our institution from May 2014 to January 2019. Clinical outcomes were compared between the two groups, with an emphasis on oncological outcomes, postoperative glycemic control, and QoL. QoL was evaluated using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30 and EORTC PAN26). All patients were followed until May 2019 or until death.

A total of 56 consecutive patients were enrolled in this study. Perioperative outcomes, recurrence-free survival, and overall survival were comparable between the two groups. No patients in the PPTP-SP group developed cancer recurrence in the pancreatic tail stump or splenic hilum, or a clinical pancreatic fistula. Patients who underwent PPTP-SP had significantly better glycemic control, based on their higher rate of insulin-independence (P = 0.014), lower hemoglobin A1c (HbA1c) level (P = 0.046), lower daily insulin dosage (P < 0.001), and less frequent hypoglycemic episodes (P < 0.001). Global health was similar in the two groups, but patients who underwent PPTP-SP had better functional status (P = 0.036), milder symptoms (P = 0.013), less severe diet restriction (P = 0.011), and higher confidence regarding future life (P = 0.035).

For pancreatic cancer involving the pancreatic head and proximal body, PPTP-SP achieves perioperative and oncological outcomes comparable to TP in selected patients while significantly improving long-term glycemic control and QoL.

• Partial pancreatic tail preserving subtotal pancreatectomy
• Total pancreatectomy
• Pancreatic cancer
• Treatment outcome
• Diabetes mellitus
• Quality of life

Individuals with a very high lifetime risk of developing pancreatic ductal adenocarcinoma; for example, hereditary pancreatitis and main-duct or mixed-type intraductal papillary mucinous neoplasm, may wish to discuss prophylactic total pancreatectomy but strategies to do so are lacking.

To develop a shared decision-making programme for prophylactic total pancreatectomy using decision tables.

Focus group meetings with patients were used to identify relevant questions. Systematic reviews were performed to answer these questions.

The first tables included hereditary pancreatitis and main-duct or mixed-type intraductal papillary mucinous neoplasm. No studies focused on prophylactic total pancreatectomy in these groups. In 52 studies (3570 patients), major morbidity after total pancreatectomy was 25% and 30-day mortality was 6%. After minimally invasive total pancreatectomy (seven studies, 35 patients) this was, respectively, 13% and 0%. Exocrine insufficiency-related symptoms occurred in 33%. Quality of life after total pancreatectomy was slightly lower compared with the general population.

The decision tables can be helpful for discussing prophylactic total pancreatectomy with individuals at high risk of pancreatic ductal adenocarcinoma.

• Pancreatic ductal adenocarcinoma
• cancer risk
• diabetes mellitus
• hereditary pancreatitis
• intraductal papillary mucinous neoplasm
• mutation
• prophylactic total pancreatectomy

• Antineoplastic Combined Chemotherapy Protocols/therapeutic use
• Chemotherapy, Adjuvant
• Combined Modality Therapy
• Outcome Assessment, Health Care/methods
• Outcome Assessment, Health Care/statistics & numerical data
• Pancreatectomy/adverse effects
• Pancreatectomy/methods
• Pancreatic Neoplasms/therapy
• Postoperative Complications/diagnosis
• Postoperative Complications/etiology
• Postoperative Complications/mortality
• Survival Analysis
• Survival Rate
• Time Factors
• Pancreatic Neoplasms

• Pancreatic cancer
• Peritoneal washing cytology
• Prognostic factor
• Total pancreatectomy

• Aged
• CA-19-9 Antigen
• Cytodiagnosis/methods
• Female
• Humans
• Male
• Pancreatectomy/methods
• Pancreatic Neoplasms/mortality
• Pancreatic Neoplasms/pathology
• Pancreatic Neoplasms/surgery
• Peritoneum/cytology
• Peritoneum/pathology
• Prognosis
• Proportional Hazards Models
• Retrospective Studies
• Survival Rate

• pancreatic ductal adenocarcinoma
• total gastrectomy
• total pancreatectomy

• Carcinoma, Pancreatic Ductal/surgery
• Combined Modality Therapy
• Gastrectomy/methods
• Humans
• Male
• Middle Aged
• Pancreatectomy/methods
• Pancreatic Neoplasms/surgery

• Pancreatectomy
• databases
• morbidity
• mortality
• pancreatic neoplasms
• pancreaticoduodenectomy
• postoperative care

• meta-analysis
• morbidity
• mortality
• pancreaticoduodenectomy
• total pancreatectomy

• Matched-pairanalysis
• Pancreatic ductal adenocarcinoma
• Pancreaticoduodenectomy
• Survival
• Total pancreatectomy

• Total pancreatectomy
• glycemic control
• pancreatic enzyme
• pancreatic neoplasms
• synthetic insulin

• Duodenopancreatectomy
• Pancreas
• Pancreatic fistula

• Intraductal papillary mucinous neoplasm
• Main-duct-involved IPMN
• Mixed-type IPMN
• Pancreatic cyst
• Pancreatic mucinous cystic lesion

• Adenocarcinoma, Mucinous/classification
• Adenocarcinoma, Mucinous/diagnosis
• Adenocarcinoma, Mucinous/therapy
• Carcinoma, Pancreatic Ductal/classification
• Carcinoma, Pancreatic Ductal/diagnosis
• Carcinoma, Pancreatic Ductal/therapy
• Humans
• Pancreatic Neoplasms/classification
• Pancreatic Neoplasms/diagnosis
• Pancreatic Neoplasms/therapy

• porcine islets of Langerhans
• problematic hypoglycemia
• renal failure
• type 1 diabetes
• type 2 diabetes
• xenotransplantation

• Animals
• Clinical Trials as Topic
• Diabetes Mellitus, Type 1/surgery
• Humans
• Islets of Langerhans Transplantation/methods
• Patient Selection
• Swine
• Transplantation, Heterologous

• U01 AI065193 NIAID NIH HHS
• U01 AI120130 NIAID NIH HHS

• Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB)
• laparoscopic middle-segment-preserving pancreatectomy
• pancreatic neuroendocrine tumor (PNET)

For pancreatic ductal adenocarcinoma (PDAC) of the head and/or body invading the splenic artery (SA), we developed a new surgical technique of proximal subtotal pancreatectomy with splenic artery and vein resection, so-called pancreaticoduodenectomy with splenic artery resection (PD-SAR). We retrospectively reviewed a total of 84 patients with curative intent pancreaticoduodenectomy (PD) for PDAC of the head and/or body. These 84 patients were classified into the two groups: conventional PD (n = 66) and PD-SAR (n = 18). Most patients were treated by preoperative chemoradiotherapy (CRT). Postoperative MDCT clearly demonstrated enhancement of the remnant pancreas at 1 and 6 months in all patients examined. Overall survival rates were very similar between PD and PD-SAR (3-year OS: 23.7% versus 23.1%, P = 0.538), despite the fact that the tumor size and the percentages of UICC-T4 determined before treatment were higher in PD-SAR. Total daily insulin dose was significantly higher in PD-SAR than in PD at 1 month, while showing no significant differences between the two groups thereafter. PD-SAR with preoperative CRT seems to be promising surgical strategy for PDAC of head and/or body with invasion of the splenic artery, in regard to the balance between operative radicality and postoperative QOL.

• Duct to mucosa
• Layer to layer
• Pancreaticoduodenectomy
• Pancreaticojejunostomy
• Resection of jejunal serosa

• Abdominal Abscess/diagnosis
• Abdominal Abscess/etiology
• Abdominal Abscess/therapy
• Anastomosis, Surgical/adverse effects
• Anastomosis, Surgical/methods
• Biliary Tract Diseases/etiology
• Biliary Tract Diseases/therapy
• Drainage
• Erythromycin/therapeutic use
• Gastric Emptying
• Gastrointestinal Agents/therapeutic use
• Humans
• Ischemia/prevention & control
• Pancreatectomy/adverse effects
• Pancreatectomy/mortality
• Pancreatic Fistula/diagnosis
• Pancreatic Fistula/etiology
• Pancreatic Fistula/prevention & control
• Pancreaticoduodenectomy/adverse effects
• Pancreaticoduodenectomy/mortality
• Pancreatitis/diagnosis
• Pancreatitis/etiology
• Postoperative Hemorrhage/diagnosis
• Postoperative Hemorrhage/etiology
• Postoperative Hemorrhage/prevention & control
• Reoperation
• Risk Factors

• pancreatic neoplasm
• pancreatic resection
• pancreatic anastomotic fistula
• postoperative haemorrhage
• postoperative peritonitis

• Aged
• Catheterization
• Digestive System Neoplasms/pathology
• Digestive System Neoplasms/surgery
• Female
• Humans
• Length of Stay
• Male
• Middle Aged
• Pancreatic Ducts/surgery
• Pancreatic Fistula/etiology
• Pancreatic Fistula/mortality
• Pancreatic Fistula/surgery
• Pancreaticoduodenectomy/adverse effects
• Pancreaticoduodenectomy/mortality
• Peritonitis/etiology
• Peritonitis/mortality
• Peritonitis/surgery
• Postoperative Hemorrhage/etiology
• Postoperative Hemorrhage/mortality
• Postoperative Hemorrhage/surgery
• Reoperation
• Retrospective Studies
• Salvage Therapy/adverse effects
• Time Factors
• Treatment Outcome

Pancreatic cancer is still associated with a poor prognosis and remains—as the fourth leading cause of cancer related mortality—a therapeutic challenge. Overall long-term survival is about 1–5%, and in only 10–20% of pancreatic cancer patients is potentially curative surgery possible, increasing five-year survival rates to approximately 20–25%. Pancreatic surgery is a technically challenging procedure and has significantly changed during the past decades with regard to technical aspects as well as perioperative care. Standardized resections can be carried out with low morbidity and mortality below 5% in high volume institutions. Furthermore, there is growing evidence that also more extended resections including multivisceral approaches, vessel reconstructions or surgery for tumor recurrence can be carried out safely with favorable outcomes. The impact of adjuvant treatment, especially chemotherapy, has increased dramatically within recent years, leading to significantly improved postoperative survival, making pancreatic cancer therapy an interdisciplinary approach to achieve best results.

• Colon cancer
• Middle-preserving pancreatectomy
• Non-functioning endocrine tumor

Intraductal papillary mucinous neoplasms (IPMN) of the pancreas include a spectrum of dysplasia ranging from minimal mucinous hyperplasia to invasive carcinoma and are extensive tumors that often spread along the ductal tree. Several studies have demonstrated that preoperative imaging is not accurate enough to adapt the extent of pancreatectomy and have suggested routinely using frozen sectioning (FS) to evaluate the completeness of resection and also to check if ductal dilatation is active or passive, in order to avoid an excessive pancreatic resection. Separate main duct and branch duct analysis is needed due to the difference in the natural history of the disease. FS accuracy averages 95%. Eroded epithelium on the main duct, severe ductal inflammation mimicking dysplasia and reactive epithelial changes secondary to obstruction can lead to inappropriate FS results. FS results change the planned extent of resection in up to 30% of cases. The optimal cut-off leading to extend pancreatectomy is not consensual and our standard option is to extend pancreatectomy if FS reveals: (1) at least IPMN adenoma on the main duct; or (2) at least borderline IPMN on branch ducts; or (3) invasive carcinoma. However, the decision to extend resection must be taken after a multidisciplinary discussion since it does not exclusively depend on the FS result but also on age, general condition and expected prognosis after resection. The main limitation of using FS is the existence of discontinuous (“skip”) lesions which account for approximately 10% of IPMN in surgical series and can lead to reoperation in up to 8% of cases.

• Intraductal papillary and mucinous tumor
• Pancreas
• Frozen section
• Branch duct
• Dysplasia
• Main duct

Background. This study aimed to analyse the most common current indications for total pancreatectomy (TP) at a high-volume pancreas center. Method. Prospectively collected data on indications and short-term outcome of all TP's performed from January 2004 until June 2008 were analysed. Results. The total pancreatectomies (TP) were 63, i.e., 6.7% of all pancreatic procedures (n = 948). Indications for TP were classified into 4 groups: tumors of advanced stage, n = 23 (36.5%), technical problems due to soft pancreatic tissue, n = 18 (28.6%), troubles due to perioperative surgical complications, n = 15 (23.8%), and therapy-resistant pain due to chronic pancreatitis, n = 7 (11.1%). Surgical complications occurred in 23 patients (36.5%). The mortality in elective TP was 6.25%. Median postoperative stay was 21 days. Mortality, morbidity and the other perioperative parameters differed substantially according to the indication for pancreatectomy. Conclusion. Total pancreatectomy is definitely indicated for a limited range of elective and emergency situations. Indications can be: size or localisation of pancreatic tumor, trouble, technical diffuculties and therapy-refractory pain in chronic pancreatitis. A TP due to perioperative complications (troubles) after pancreatic resections is doomed by extremely high morbidity and mortality and should be avoided.

• Total pancreatectomy
• diabetes mellitus
• pancreatic cancer
• survival

• Celiac Artery/surgery
• Hepatic Artery/surgery
• Humans
• Laparoscopy/methods
• Lymph Node Excision/methods
• Mesenteric Artery, Superior/surgery
• Mesenteric Veins/surgery
• Pancreatectomy/methods
• Pancreatic Neoplasms/surgery
• Pancreaticoduodenectomy/methods
• Portal Vein/surgery