Surgical Outcomes After Total Pancreatectomy: A High-Volume Center Experience

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% ton = 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% ton = 19, 23.2%;p = 0.001) and relaparotomy rate (n = 13, 20.6% ton = 5, 6.1%;p = 0.009) improved. Improvements occurred mainly after extended TP, including lower major morbidity (n = 22, 57.9% ton = 12, 25.0%;p = 0.002) and in-hospital mortality (n = 3, 7.9% ton = 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.

Automated summary

In a study at a single, high-volume center, an increase in the surgical volume of total pancreatectomy was associated with improved perioperative outcomes, especially for extended resections.