The Application Of Total Pancreatectomy In The Surgical Therapy For Pancreatic Adenocarcinoma

Objective:The role of total pancreatectomy to treat pancreatic adenocarcinoma is still debated.The aims of this study were to identify the indications to perform a total pancreatectomy and to evaluate the outcome of the patient who underwent this procedure at a single centerMethods:The clinical characteristics of patients who underwent total pancreatectomy in the department of hepatobiliary&pancreas surgery,The First Hospital of Jilin University,were reviewed from January 2015 through January 2020 retrospectively.Relevant data:patient baseline characteristics(age,sex);preoperative ASA grade,CA 19-9,comorbidity;indication for surgery;type of procedure;operative parameters(operative time,blood loss,blood transfusion);tumor characteristics(histology,size,differentiation,lymph node);postoperative morbidity&hospital stay,postoperative mortality;phone calls were made to the patients or their relatives to retrieve the parameters(blood glucose level,HbA1c,episode of hypoglycemia and total insulin dose;diarrhea and enzyme dose;weight loss;adjuvant therapy)prospectively.Data analyses were performed with IBM SPSS for Mac version 26(IBM Corp.,Orchard Road Armonk,NY)Results:during the period,7 total pancreatectomy were performed,all for pancreatic adenocarcinoma.3 patients were male,4 female with a average of 58.1 years(standard deviation 7.6).Preoperatively,their AS A grade were all ?,comorbidity was reported in 7 patients(100%)with a median CA 19-9 of 170 U/mL(range 124-286),which included 7 patients with jaundice and 1 patient with diabetes mellitus of which is insulin-dependent.Median operation time was 610 minutes(range 536.5-727.5),intraoperative blood loss was 800(525-1000)mL,blood transfusion was 2(1.5-4)U.the greatest dimension of tumor was 5.5(4.8-6.8)cm,all patients' tumor were moderate differentiation,they all had positive lymph node Postoperatively,postoperative morbidity was 85.7%,of which delay gastric emptying was the most prevalent,postoperative mortality rate was 0.postoperative hospital stay was a median of 15 days.During the follow-up period of which median was 20 months,all of the patients did not receive any adjuvant therapy and experience weight lose.The median blood glucose level was 8.7±2.0mmol/L,and HbAlc was 7.4±0.5%,their median dose of insulin was 30U.5 patients(71.4%)reported diarrhea during a median of 2 days in the past week,Exocrine replacement via the daily intake of pancreatic enzyme supplements was median 120,000 UConclusion:Total pancreatectomy for pancreatic adenocarcinoma is safe,feasible and efficacious in selected patients.The outcome of apanreatic status is under control with dynamic glycemic management with synthetic insulin and adequate pancreatic enzyme supplements.