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Erschienen in: Journal of Gastrointestinal Surgery 3/2014

01.03.2014 | Original Article

Perioperative Outcomes of Pancreaticoduodenectomy Compared to Total Pancreatectomy for Neoplasia

verfasst von: Neil H. Bhayani, Jennifer L. Miller, Gail Ortenzi, Jussuf T. Kaifi, Eric T. Kimchi, Kevin F. Staveley-O’Carroll, Niraj J. Gusani

Erschienen in: Journal of Gastrointestinal Surgery | Ausgabe 3/2014

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Abstract

Purpose

Total pancreatectomy (TP) eliminates the risk and morbidity of pancreatic leak after pancreaticoduodenectomy (PD). However, TP is a more extensive procedure with guaranteed endocrine and exocrine insufficiency. Previous studies conflict on the net benefit of TP.

Methodology

A comparison of patients undergoing non-emergent, curative-intent TP or PD for pancreatic neoplasia using the National Surgical Quality Improvement Project data from 2005–2011 was done. Main outcome measures were mortality and major and minor morbidities.

Results

Of the 6,314 (97 %) who underwent PD and the 198 (3 %) who underwent TP, malignancy was present in 84 % of patients. The two groups were comparable at baseline. Mortality was higher after TP (6.1 %) than DP (3.1 %), p = 0.02. Adjusting for differences on multivariable analysis, TP carried increased mortality (OR 2.64, 95 % CI 1.3–5.2, p = 0.005). TP was also associated with increased rates of major morbidity (38 vs. 30 %, p = 0.02) and blood transfusion (16 vs. 10 %, p = 0.01). Infectious and septic complications occurred equally in both groups.

Conclusion

The morbidity of a pancreatic fistula can be eliminated by TP. However, based on our findings, TP is associated with increased major morbidity and mortality. TP cannot be routinely recommended for to reduce perioperative morbidity when pancreaticoduodenectomy is an appropriate surgical option.
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Metadaten
Titel
Perioperative Outcomes of Pancreaticoduodenectomy Compared to Total Pancreatectomy for Neoplasia
verfasst von
Neil H. Bhayani
Jennifer L. Miller
Gail Ortenzi
Jussuf T. Kaifi
Eric T. Kimchi
Kevin F. Staveley-O’Carroll
Niraj J. Gusani
Publikationsdatum
01.03.2014
Verlag
Springer US
Erschienen in
Journal of Gastrointestinal Surgery / Ausgabe 3/2014
Print ISSN: 1091-255X
Elektronische ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-013-2393-0

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