More is More? Total Pancreatectomy for Periampullary Cancer as an Alternative in Patients with High-Risk Pancreatic Anastomosis: A Propensity Score-Matched Analysis

• Published in: Annals of surgical oncology 2021-12, Vol.28 (13), p.8309-8317
• Main Authors: Hempel, Sebastian, Oehme, Florian, Tahirukaj, Ermal, Kolbinger, Fiona R., Müssle, Benjamin, Welsch, Thilo, Weitz, Jürgen, Distler, Marius
• Format: Article
• Language: English
• Subjects: Anastomosis; Anastomosis, Surgical; Cancer; Glucose tolerance; Humans; Medicine; Medicine & Public Health; Morbidity; Mortality; Oncology; Pancreas; Pancreatectomy; Pancreatic Neoplasms - surgery; Pancreatic Tumors; Pancreaticoduodenectomy; Patients; Propensity Score; Pylorus - surgery; Retrospective Studies; Surgery; Surgical Oncology; Survival
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-021-10292-8

Background Postpancreatectomy morbidity remains significant even in high-volume centers and frequently results in delay or suspension of indicated adjuvant oncological treatment. This study investigated the short-term and long-term outcome after primary total pancreatectomy (PTP) and pylorus-preserving pancreaticoduodenectomy (PPPD) or Whipple procedure, with a special focus on administration of adjuvant therapy and oncological survival. Methods Patients who underwent PTP or PPPD/Whipple for periampullary cancer between January 2008 and December 2017 were retrospectively analyzed. Propensity score-matched analysis was performed to compare perioperative and oncological outcomes. Correspondingly, cases of rescue completion pancreatectomy (RCP) were analyzed. Results In total, 41 PTP and 343 PPPD/Whipple procedures were performed for periampullary cancer. After propensity score matching, morbidity (Clavien-Dindo classification (CDC) ≥ IIIa, 31.7% vs. 24.4%; p  = 0.62) and mortality rates (7.3% vs. 2.4%, p  = 0.36) were similar in PTP and PPPD/Whipple. Frequency of adjuvant treatment administration (76.5% vs. 78.4%; p  = 0.87), overall survival (513 vs. 652 days; p  = 0.47), and progression-free survival (456 vs. 454 days; p  = 0.95) did not significantly differ. In turn, after RCP, morbidity (CDC ≥ IIIa, 85%) and mortality (40%) were high, and overall survival was poor (median 104 days). Indicated adjuvant therapy was not administered in 77%. Conclusions In periampullary cancers, PTP may provide surgical and oncological treatment outcomes comparable with pancreatic head resections and might save patients from RCP. Especially in selected cases with high-risk pancreatic anastomosis or preoperatively impaired glucose tolerance, PTP may provide a safe treatment alternative to pancreatic head resection.