Limited data is describing the comparability of morbidity and mortality rates after total pancreatectomy (TP). Procedure-specific differences, like the extent of resection, including additional vascular or multi visceral resections, are seldom acknowledged while reporting postoperative outcomes.

A recent study evaluated postoperative outcomes after TP and categorized different types of TP based on the extent, complexity, and technical aspects of each procedure.

A total of 1451 patients who had undergone TP were included in the study. Each patient was assigned to the categories that mirrored increasing levels of procedure-related difficulty: standard TP (type 1), TP with venous resection (type 2), TP with multi-visceral resection (type 3), and TP with arterial resection (type 4) and the Postoperative outcomes among the groups were compared.

The results were as follows-

• 57.9% of the subjects were male; the median age of the participants was 64.9 years. 
• 46.6% of the patients were assigned to type 1, 20.4% to type 2, 21.6% to type 3, and 11.4% to type 4 TP. 
• A gradual increase in surgical morbidity was observed by TP type (type 1: 37.7%, type 2: 46.3%, type 3: 56.7%, and type 4: 59.4%) 
• A gradual increase in median length of hospital stay was observed by TP type (type 1: 14 days, type 2: 16 days, type 3: 17 days, and type 4: 18 days)
• 90-day mortality was also seen to increase with TP type (type 1:3.4%, type 2: 5.7%, type 3: 9.2%, and type 4: 12.1%). 
• The multivariable analysis showed an independent association of type 3 (TP with multi-visceral resection) and type 4 (TP with arterial resection) with an increased 90-day mortality rate.

Thus there exist significant differences in postoperative outcomes when the extent, complexity, and technical aspects of the procedure are considered. Classifying TP into 4 different categories will allow for better postoperative risk stratification and more accurate comparisons in future studies. 

Source: JAMA Surg. 2022;157(2):120–128. doi:10.1001/jamasurg.2021.5834