Prognostic Impact of Unplanned Total Pancreatectomy in Pancreatic Ductal Adenocarcinoma: A Retrospective Analysis

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BACKGROUND: This study evaluated the clinical significance of an unplanned total pancreatectomy (TP) by comparing surgical outcomes of planned and unplanned TP for pancreatic ductal adenocarcinoma (PDAC). METHODS: Forty-two patients who underwent TP for PDAC between 2009 and 2020 at the Kindai University Hospital were retrospectively analyzed. We evaluated the differences in the prognosis and related factors between planned and unplanned TP, and independent prognostic factors of TP for PDAC. RESULTS: Twenty-three patients underwent planned TP, and 19 underwent unplanned TP. There were no significant differences in clinicopathological data between the two groups, except for microscopic vascular invasion. However, the unplanned TP group had significantly better overall survival (OS) and recurrence-free survival (RFS) times than the planned TP group. In the multivariate analysis of the prognostic factors of TP for PDAC, a planned TP and not receiving or completing postoperative adjuvant chemotherapy (AC) were independent poor prognostic factors. CONCLUSION: This study supports a rigorous approach to margin clearance in TP for PDAC to achieve curative negative margins in cancer-positive pancreatic resection stumps. However, the prognosis of a planned TP for PDAC is extremely poor, and adequate preoperative and multidisciplinary treatment may be necessary to prolong the prognosis.

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