A REAPPRAISAL OF TOTAL PANCREATECTOMY FOR PANCREATIC-CANCER - RESULTS FROM US-VETERANS-AFFAIRS-HOSPITALS, 1987-1991

BACKGROUND: After enthusiasm for total pancreatectomy for pancreatic adenocarcinoma peaked in the 1970s, a failure tp improve outcomes in the 1980s led to fewer reports of this procedure. METHODS: We retrieved records from 252 Whipple and 47 total pancreatectomies for pancreatic cancer performed at U.S. Department of Veterans Affairs hospitals from 1987 to 1991. RESULTS: Thirty-day mortality was 8% with both procedures. There was no significant difference in morbidity at 30 days (Whipple 36%, total pancreatectomy 39%). The mean survival after total pancreatectomy was 526 days compared to 376 days following Whipple (P = 0.03). Staging information was retrieved from tumor registrars for 117 patients with pancreatic adenocarcinoma, 21 of whom underwent total pancreatectomy and 96 the Whipple procedure. In patients with stage I and stage II localized pancreatic adenocarcinoma, mean survival was 172 days in 11 patients after total pancreatectomy, and 446 days in 55 patients after Whipple resection (P = 0.057). CONCLUSION: The type of resection did not affect the mean survival of patients with stage III (nodal metastases) or stage IV (distant metastases) cancer.