Abstract
Background
The impact of high-volume care in total pancreatectomy (TP) is barely explored since annual numbers are mostly low. This study evaluated surgical outcomes after TP over time in a high-volume center.
Methods
All adult patients (age ≥ 18 years) who underwent an elective single-stage TP at Karolinska University Hospital were retrospectively analysed (2008–2017). High volume was defined as > 20 TPs/year.
Results
Overall, 145 patients after TP were included, including 86 (59.3%) extended resections. Major morbidity was 34.5% (50/145) and 90-day mortality 5.5% (8/145). The relative use of TP within all pancreatectomies increased from 5.4% (63/1175) in 2008–2015 to 17.3% (82/473) in 2016–2017 (p < 0.001). Over time, TP was more often performed to achieve radicality (n = 11, 17.5% to n = 31, 37.8%; p = 0.007). In multivariable logistic regression analysis, an annual TP-volume of > 20 was associated with reduced major morbidity (odds ratio [OR] = 0.225, 95% confidence interval [CI], 0.097–0.521; p < 0.001). In the high-volume years (2016–2017), major morbidity (n = 31, 49.2% to n = 19, 23.2%; p = 0.001) and relaparotomy rate (n = 13, 20.6% to n = 5, 6.1%; p = 0.009) improved. Improvements occurred mainly after extended TP, including lower major morbidity (n = 22, 57.9% to n = 12, 25.0%; p = 0.002) and in-hospital mortality (n = 3, 7.9% to n = 0, 0%; p = 0.082).
Conclusions
In a single, high-volume center study, an increase in surgical volume of TP was associated with improved perioperative outcomes, especially for extended resections.
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Funding
Marco Del Chiaro-We have been awarded an industry grant (Haemonetics, Inc) to conduct a multicenter study to evaluate the prognostic implications of TEG in pancreas cancer. This grant was applied for and awarded after the data were collected and analyzed. To reiterate plainly, Haemonetics had no involvement with the data analysis in this report.
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The results of this article have previously been presented at the annual Surgical Society meeting in Helsingborg (Sweden, August 2018) and at the E-AHPBA meeting in Amsterdam (The Netherlands, June 2019). From this cohort, the impact of endocrine and exocrine insufficiency on quality of life is published in Annals of Surgical Oncology previously.
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Stoop, T.F., Ateeb, Z., Ghorbani, P. et al. Surgical Outcomes After Total Pancreatectomy: A High-Volume Center Experience. Ann Surg Oncol 28, 1543–1551 (2021). https://doi.org/10.1245/s10434-020-08957-x
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DOI: https://doi.org/10.1245/s10434-020-08957-x