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• W2069761010 abstract "Introduction: Many surgeons perceive total pancreatectomy (TP) for pancreatic adenocarcinoma to be associated with an increased peri-operative morbidity and a worse long-term outcome compared with pancreaticoduodenectomy (PD). Specifically, there is a concern that complete endocrine and exocrine insufficiency following TP leads to inferior survival following surgery. National data on the relative survival of patients (pts) undergoing TP vs PD have not been previously reported. The purpose of the current study was to analyze the peri-operative and long-term outcomes of pts undergoing TP vs PD using a large, population-based data set. Methods: The Surveillance, Epidemiology, and End Results (SEER) database was used to identify 6449 pts who underwent surgical resection of pancreatic adenocarcinoma between 1988-2004 (TP, n=619 vs PD, n=5830). Descriptive statistics were compared using the rank-sum test, chi-squared test or a non-parametric test for trend, as appropriate. Mortality rates at 30 days after diagnosis were calculated. Long-term mortality risks were compared using Kaplan-Meier curves and Cox proportional hazards models. Short- and long-term outcomes were stratified by procedure type (TP vs PD). To identify possible temporal trends in survival, the data were also stratified into 2 consecutive time periods (1988-1996 vs 1997-2004). Results: Median age (TP, 66 years vs PD, 66 years; P=0.17) and gender (TP, male=50% vs. PD, male=51%; P=0.61) were similar in the two cohorts. TP pts had a larger median tumor size (TP, 3.5 cm versus PD, 3.0 cm; P<0.001); however, TP and PD pts had comparable overall AJCC T-stage distributions: T1-6% vs 7%, T2-22% vs 16%, T3-67% vs 73%, and T4-5% vs 4% (TP vs PD, respectively; P=0.07). Most tumors were classified as low-grade in both TP (66%) and PD (63%) pts (P=0.20). A similar proportion of TP (54%) vs PD (56%) pts had metastatic nodal disease (N1). Fewer TP pts (37%) received peri-operative radiation therapy compared with PD pts (41%) (P=0.02). Overall, there was no difference in 30-day mortality following TP (7.9%) vs PD (7.3%) (P=0.57). However, further analyses revealed a relative 37% decrease in 30-day mortality following PD over the time periods examined (1988-1996, 10.0% vs 1997-2004, 6.3%; P<0.001); a similar improvement in peri-operative survival was not seen following TP (1988-1996, 6.5% vs 1997-2004, 8.2%; P=0.59). Median and 5-year survival was similar in TP and PD pts (TP, 14 mon and 18% vs PD, 14 mon and 13%, respectively; both P>0.05) (Figure). After adjusting for competing risk factors such as pt age, sociodemographic factors, year of diagnosis, T-stage, tumor grade, presence of N1 disease, and receipt of radiation therapy, the overall long-term outcome of pts undergoing TP vs PD remained similar (HR 1.01, P=0.84). Conclusions: In aggregate, 30-day mortality following TP vs PD is comparable. While peri-operative mortality following PD has improved over time, there has not been a similar relative decrease in peri-operative mortality following TP. Long-term survival following TP vs PD is equivalent. TP should be performed in pts when oncologically appropriate, as it is not associated with an increased peri-operative mortality nor a worse long-term prognosis." @default.
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• W2069761010 date "2008-02-01" @default.
• W2069761010 modified "2023-09-27" @default.
• W2069761010 title "QS116. Survival After Total Pancreatectomy Versus Pancreaticoduodenectomy for Pancreatic Adenocarinoma" @default.
• W2069761010 doi "https://doi.org/10.1016/j.jss.2007.12.356" @default.
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