• Sohei Satoi, Yoshiaki Murakami, Fuyuhiko Motoi, Masayuki Sho, Ippei Matsumoto, Kenichiro Uemura, Manabu Kawai, Masanao Kurata, Hiroaki Yanagimoto, Tomohisa Yamamoto, Masamichi Mizuma, Michiaki Unno, Shoichi Kinoshita, Takahiro Akahori, Makoto Shinzeki, Takumi Fukumoto, Yasushi Hashimoto, Seiko Hirono, Hiroki Yamaue, Goro Honda, and Masanori Kwon.
• From the *Department of Surgery, Kansai Medical University, Osaka; †Department of Surgery, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima; ‡Division of Gastroenterological Surgery, Department of Surgery, Tohoku University, Sendai; §Department of Surgery, Nara Medical University, Nara; ∥Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kinki University Faculty of Medicine, Osaka; ¶Second Department of Surgery, Wakayama Medical University, Wakayama; #Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo; and **Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
• Pancreas. 2016 Aug 1; 45 (7): 1003-9.

ObjectiveThe aim of this study was to reappraise the clinical role of total pancreatectomy with curative intent in patients with pancreatic ductal adenocarcinoma (PDAC).MethodsIn 2001 to 2011 database from 7 institutions in Japan, 45 (3.1%) of 1451 patients with PDAC underwent total pancreatectomy (TP group), and 885 patients underwent pancreaticoduodenectomy (PD group). A matched-pairs group consisted of 45 patients matched for age, sex, year, resectability status, and neoadjuvant therapy (matched-PD group). Clinicopathological data, overall survival, and disease-free survival were compared between groups.ResultsClinical features of the TP group revealed higher-stage disease, greater surgical stress, a higher frequency of lymph node metastasis, and a lower adjuvant chemotherapy completion rate compared with the PD group (P < 0.05). Overall survival and disease-free survival in the TP group were significantly worse than those in the PD group (P < 0.05). Multivariate analysis revealed resectability status, neoadjuvant therapy, blood transfusion, lymph node metastasis, and adjuvant therapy to be significant prognostic factors. No differences in mortality and morbidity rates were observed between the 2 groups. A matched-pairs analysis revealed similar surgical outcomes and overall survival.ConclusionsThe surgical outcome of total pancreatectomy for patients with PDAC is acceptable. When margin-negative resection is expected, total pancreatectomy should not be abandoned in the modern era.

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