• Charles Poiraud, Mehdi El Amrani, Louise Barbier, Laurence Chiche, Jean Yves Mabrut, Philippe Bachellier, François-René Pruvot, Jean-Robert Delpero, Jean Jacques Tuech, Mustapha Adham, Alain Sauvanet, Olivier Turrini, and Stéphanie Truant.
• Department of Digestive Surgery, Hôpital Claude Huriez, Lille, France.
• Ann. Surg. 2018 Nov 1; 268 (5): 823-830.

ObjectiveThe aim of the current study was to assess the short and long-term outcome of total pancreatectomy (TP) for IPMN based on the largest series to date.BackgroundLiterature data are scarce regarding TP for IPMN, though increasingly performed in this setting.MethodsData of 888 IPMN patients operated between 2004 and 2013 were collected in a multicentric retrospective AFC database. Ninety-three patients (10.5%) who had TP entered this study. Patient demographics, indications, intraoperative data, 3-month morbi-mortality (Clavien), and long-term outcome were analyzed.ResultsMost patients had mixed type IPMN (59%) and underwent upfront (56%) or intraoperatively-decided (33%) TP. Morbidity and mortality rates were 47.3% and 4.3%, respectively, with no lethal hypoglycemia; morbidity was higher for intraoperatively-decided TP. Misdiagnoses were frequent regarding main pancreatic duct involvement (12%), invasiveness (33%), or mural nodules (50%), resulting in 12 TPs (13%) performed for asymptomatic IPMN showing only low/moderate dysplasia (LMD). On histopathological examination, there were 54 (58%) invasive IPMN (mostly pT3/T4 (76%), N+ (60%), R0 (75%)), with a significantly worse 5-year survival (21.2%) compared to noninvasive group (85.7%; P < 0.0001). In the former, 24 (58.5%) developed recurrence showing mostly distant metastasis, within 2 years in 92%.ConclusionThis large series of TP for IPMN reported acceptable morbi-mortality rates with no long-term death from diabetes-related complication. Morphologic assessment was imperfectly reliable with 13% of TP done for LMD only. More than half of patients were operated at an invasive carcinoma stage with poor outcome. Conversely, long-term survival was excellent after TP for noninvasive IPMN.

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