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Background <p>Partial pancreaticoduodenectomy (PD) followed by adjuvant chemotherapy (AC) is standard treatment for resectable pancreatic ductal adenocarcinoma (PDAC) of the pancreatic head. Total pancreatectomy (TP) has historically been reserved for extensive tumors or salvage procedures due to concerns about morbidity and quality of life (QoL). However, recent evidence shows comparable perioperative outcomes and QoL between TP and PD. The authors hypothesized that avoiding postoperative pancreatic fistula TP would achieve AC initiation and completion rates similar to those for PD, even in more complex patients.</p> Methods <p>This study retrospectively analysed all patients who underwent TP or PD for PDAC at the authors’ center between 2014 and 2021. Rates, timing, and completion of AC were compared. The decision for TP versus PD was based on patient and intraoperative factors at the discretion of the surgeon.</p> Results <p>Of 263 included patients, 74 underwent TP and 189 underwent PD. Total pancreatectomy was performed mainly for repetitive positive resection margins or splenic vessel involvement (59 %). The TP patients had more comorbidities (liver disease, 16.2 % vs 5.8 % <i>p</i> = 0.013; diabetes, 40.5 % vs 24.9 % <i>p</i> = 0.016), longer surgeries (7.2 vs 6 h; <i>p</i> = 0.001), more vascular reconstructions (77 % vs 50.8 %; <i>p</i> = 0.001), and greater blood loss (1200 vs 600 ml; <i>p</i> = 0.001). Despite these factors, morbidity and mortality were comparable. The two groups did not differ in rates of AC initiation (66 % vs 76 %; <i>p</i> = 0.156), completion (69.4 % vs 74.1 %; <i>p</i> = 0.578), and timing (median, 7 weeks in both groups; <i>p</i> = 0.533).</p> Conclusion <p>Despite higher surgical complexity, AC initiation and completion rates after TP were comparable with those after PD. With modern diabetes management, TP represents a valid surgical option for selected high-risk patients without compromising oncologic treatment.</p>

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Initiation and Completion of Adjuvant Chemotherapy After Total Versus Partial Pancreaticoduodenectomy for Pancreatic Cancer

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年9月23日

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  • Romy Weber,
  • Filippa Lara Maria Kuehni,
  • Pauline Aeschbacher,
  • Stéphanie Fabienne Perrodin,
  • Andreas Andreou,
  • Hanna Kaibel,
  • Nina Marie Rohrmeier,
  • Martin D. Berger,
  • Beat Gloor,
  • Anna Silvia Wenning

摘要

Background

Partial pancreaticoduodenectomy (PD) followed by adjuvant chemotherapy (AC) is standard treatment for resectable pancreatic ductal adenocarcinoma (PDAC) of the pancreatic head. Total pancreatectomy (TP) has historically been reserved for extensive tumors or salvage procedures due to concerns about morbidity and quality of life (QoL). However, recent evidence shows comparable perioperative outcomes and QoL between TP and PD. The authors hypothesized that avoiding postoperative pancreatic fistula TP would achieve AC initiation and completion rates similar to those for PD, even in more complex patients.

Methods

This study retrospectively analysed all patients who underwent TP or PD for PDAC at the authors’ center between 2014 and 2021. Rates, timing, and completion of AC were compared. The decision for TP versus PD was based on patient and intraoperative factors at the discretion of the surgeon.

Results

Of 263 included patients, 74 underwent TP and 189 underwent PD. Total pancreatectomy was performed mainly for repetitive positive resection margins or splenic vessel involvement (59 %). The TP patients had more comorbidities (liver disease, 16.2 % vs 5.8 % p = 0.013; diabetes, 40.5 % vs 24.9 % p = 0.016), longer surgeries (7.2 vs 6 h; p = 0.001), more vascular reconstructions (77 % vs 50.8 %; p = 0.001), and greater blood loss (1200 vs 600 ml; p = 0.001). Despite these factors, morbidity and mortality were comparable. The two groups did not differ in rates of AC initiation (66 % vs 76 %; p = 0.156), completion (69.4 % vs 74.1 %; p = 0.578), and timing (median, 7 weeks in both groups; p = 0.533).

Conclusion

Despite higher surgical complexity, AC initiation and completion rates after TP were comparable with those after PD. With modern diabetes management, TP represents a valid surgical option for selected high-risk patients without compromising oncologic treatment.