Yes, we had to performed unplanned total pancreatectomy in three planned PD for adenocarcinoma and in one for chronic pancreatitis, due to inability to obtain clear resection margins or "scarred" distal pancreas in the latter case. Spleen was preserved in all procedures, and post-op course was pretty much uneventful. Three out of four were already diabetic pre-operatively.
We have also done several cases and I dont think you need to be too worried. In my mind total pancreatectomies are doing fine postoperativeley with acceptable outcome figures as described by Buchler et al this year in Annals of Surgery. In one case we even performed a resuce total pancreatectomy sinde the margins to the pancreatic remnant were changed from the freeze specimen to the formalin-prepared PAD. All to obtain oncologicallu free margins.
I had to perform several unplanned total panmcreatectomies to obtain free margins. or in patients with multicentric neuroendocrine tumors( MEN 1) or multicentric pancreatic metastasis from renal cell carcinomas.Patients had uneventful post-operative course..
We had to perform a unplanned total pancreatoduodenectomy (preserving the spleen) in 1 patient with pancreatic multifocal adenocarcinoma in an elderly patient (78 years). After discharge from the hospital at POD #18, she had 2 major episodes of hypoglicemia in the first to months due to non-compliance with the designed nutritional and insulin regimen. After that, she performed quite well, with a good QOL. The DFS was 13 months and, ultimately, she died 15 months after the operation due to overwhelming progression of the disease.
My question was performaing unplanned total pancreatectomy due to 'soft pancreas' where every suture cuts through. I know Dr. Machado might have published soemthing on this topic.
We have had to perform several of these for pathology unable to state no tumor at the margin. Patients have done well postoperatively
For soft pancreas I never performed a total pancreatectomy.In these cases I always use an isolated jejunal loop for pancreatic anastomosis and an external pancreatic duct drainage.and of course abdominal cavity drainage. We may have pancreatic fistula but most of them category A .Our original publication was in Surg Gyn Obs 1976;143:271-272.Recently this techique was reevaluated by chinese surgeons and confirm our results Surgery 2013;153(6) 743-752.
I do not performed a total pancreatectomy ,unless there is a suspicious of margin involwement .
I performed only once the total pancreatectomy in a patient in whom the whole pancreas showed a multinodular appearance and had a hard consistency
I personally did not, but it was done in our department. But there is rarely an indication! Leaving behind a small remnant of the pancreatic tail with/without anastomosis or even blocking the pancreatic duct seems favorable to me to avoid or ameliorate the postoperative diabetes. I know some patients without pancreas and their life is not very comfortable or secure even with modern therapies.
I have performed 44 total dudenopancreatectomies personally. The main indications for the procedure were 1.the repeated positive frozen-section hystology (after Whipple and resection of the body) in ductak adenocarcinoma;; 2. intraductal tubulo-papillary tumor or carcinoma after frozen-section confirmation and total involvement
In case of combined arterial resection I personally prefer to perform a total pancreatectomy in order to prevent pancreas fistula and potential complications (pseudoaneurysms) on the arterial anastomosis
Has anyone done a total pancreatectomy as a salvage procedure due to uncontrolable postoperative pancreatic fistula?
In my dpt this is the main option. We have done not less than ten such procedures in this situation
I have never done this type of procedure Since i start performing pancretoduodenectomies using double loop technique as I described before this situataion never happened in my service
Unfortunatelly i haven't found that post from you, did you mean separate Roux loop for hepaticojejunoanastomosis?
Yes for pancreatojejunostomy We hav published this tecnique in Surg Gyn Obs 1976;143:271-272.Recently this techique was reevaluated by chinese surgeons and confirm our results Surgery 2013;153(6) 743-752. Recently we published a review of our recent cases
Eur J Surg Oncol. 2016 Oct;42(10):1584-90. doi: 10.1016/j.ejso.2016.05.023. Epub 2016 May 29
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