Total pancreatectomy: how, when and why?

Excerpt

In the 1940s and 1950s, morbidity and mortality rates after partial pancreatectomy were so high that the survival following pancreaticoduodenectomy (PD) could be considered as a Russian roulette. In this context, total pancreatectomy (TP) was introduced with a twofold goal. First, by removing the entire pancreatic gland, surgeons of those times thought that postoperative morbidity and mortality could decrease. In fact, the starting point of this belief was usually related to the action of pancreatic juice from the pancreatic remnant. Second, recurrence rate following partial pancreatectomy was very high and TP was considered a more radical procedure to treat pancreatic malignancies. Actually, the results of TP were disappointing. Oncologic outcomes remained poor and even postoperative morbidity and mortality did not significantly improve. Although, the problem of pancreatic fistula was neutralized, other issues emerged including brittle insulin-dependent diabetes, which was difficult to control in many of these patients, and severe malabsorption due to the loss of exocrine pancreatic secretion. Therefore, TP was almost completely abandoned [1]. …