International reference values for surgical outcomes of total pancreatectomy.
Abstract
Importance: Total pancreatectomy (TP) is indicated for advanced pancreatic cancer or multifocal tumors. Furthermore, TP may be performed to avoid the risk of pancreatic fistula in selected patients to improve the perioperative risk profile.
Objective: To define reference values for TP based on a low-risk cohort treated at expert centers.
Design, setting, and participants: This multicenter study analyzed outcomes from patients undergoing primary TP for malignant or benign lesions from 25 international expert centers from January 2017 to November 2023. Low-risk patients undergoing TP (LR-TP) were without vascular resections or significant comorbidities.
Exposures: TP.
Main outcomes and measures: Twenty reference values were derived from the 75th or the 25th percentile of the median values of all centers. Outcomes of LR-TP were compared with a cohort of TP with vascular resection, TP due to high-risk pancreatic anastomosis, and the benchmark values for low-risk pancreatoduodenectomy.
Results: Of 994 patients, 333 (33.5%; median [IQR] age, 66 [58-72] years; 171 male [51.4%]) qualified as the LR-TP cohort. Reference values included blood loss (≤1000 mL), major complications (≤37%), 3-month postoperative mortality (<6%), and retrieved lymph nodes (≥29). Compared with TP with vascular resections, reference cutoffs were not met for major complications (51% vs LR-TP ≤37%) and 90-day mortality (11% vs LR-TP ≤6%). For TP due to high-risk anastomosis, failure to rescue rate (38% vs ≤6%) and 90-day mortality (11% vs LR-TP ≤6%) were not met. Compared with pancreatoduodenectomy, reference values for postoperative mortality were 3 times higher for LR-TP (≤2% vs ≤6%) and less for resected lymph nodes (≥16 vs ≥29).
Conclusions and relevance: This case-control study provided global reference values for TP, indicating significantly higher postoperative morbidity and mortality compared with pancreatoduodenectomy. Perioperative morbidity of TP was especially increased in patients with vascular resections. These reference values can serve for quality control of pancreatic surgery.
Author
Müller, Philip C
Berchtold, Caroline
Kuemmerli, Christoph
Breuer, Eva
Li, Zhihao
Vallorani, Alessia
Hansen, Carsten
Guidetti, Cristiano
Eden, Janina
Campbell, Brady A
Wu, Pengfei
Cecchetto, Sara Nicole
Gudmundsdottir, Hallbera
Kendrick, Michael
Starlinger, Patrick P
Pecorelli, Nicolò
Guarneri, Giovanni
Farooqui, Waqas
Tschuor, Christoph
Burgdorf, Stefan Kobbelgaard
Mühlhäusser, Julia
Gass, Jörn-Markus
Goh, Brian K P
Koh, Ye-Xin
Rebelo, Artur
Kleeff, Jörg
Seip, Tomas
Santibanes, Martin
Todeschini, Letizia
Marchegiani, Giovanni
Belfil, Nadiya
Lesurtel, Mickaël
Machado, Marcel
Boggi, Ugo
Kauffmann, Emanuele
Cappelle, Marie
Koerkamp, Bas Groot
Di Benedetto, Fabrizio
Roberts, Keith
Nevler, Avinoam
Lavu, Harish
Dutkowski, Philipp
Nickel, Felix
Hackert, Thilo
He, Jin
Falconi, Massimo
Truty, Mark
Billeter, Adrian T
Müller, Beat P
Halle-Smith, James
Valle, Valentina
Giulianotti, Pier
Giannone, Fabio
Pessaux, Patrick
Sánchez-Velázquez, Patricia
Thapa, Prabin Bikram
Maharjan, Dhiresh
Torres, Orlando
Kuzman, Matta
Pandanaboyana, Sanjay
Berchtold, Caroline
Kuemmerli, Christoph
Breuer, Eva
Li, Zhihao
Vallorani, Alessia
Hansen, Carsten
Guidetti, Cristiano
Eden, Janina
Campbell, Brady A
Wu, Pengfei
Cecchetto, Sara Nicole
Gudmundsdottir, Hallbera
Kendrick, Michael
Starlinger, Patrick P
Pecorelli, Nicolò
Guarneri, Giovanni
Farooqui, Waqas
Tschuor, Christoph
Burgdorf, Stefan Kobbelgaard
Mühlhäusser, Julia
Gass, Jörn-Markus
Goh, Brian K P
Koh, Ye-Xin
Rebelo, Artur
Kleeff, Jörg
Seip, Tomas
Santibanes, Martin
Todeschini, Letizia
Marchegiani, Giovanni
Belfil, Nadiya
Lesurtel, Mickaël
Machado, Marcel
Boggi, Ugo
Kauffmann, Emanuele
Cappelle, Marie
Koerkamp, Bas Groot
Di Benedetto, Fabrizio
Roberts, Keith
Nevler, Avinoam
Lavu, Harish
Dutkowski, Philipp
Nickel, Felix
Hackert, Thilo
He, Jin
Falconi, Massimo
Truty, Mark
Billeter, Adrian T
Müller, Beat P
Halle-Smith, James
Valle, Valentina
Giulianotti, Pier
Giannone, Fabio
Pessaux, Patrick
Sánchez-Velázquez, Patricia
Thapa, Prabin Bikram
Maharjan, Dhiresh
Torres, Orlando
Kuzman, Matta
Pandanaboyana, Sanjay
Date
2025-11-12
Type
Article
Subject
Pancreatectomy, General Surgery, Treatment Outcome
Collections
Citation
Müller PC, Berchtold C, Kuemmerli C, Breuer E, Li Z, Vallorani A, Hansen C, Guidetti C, Eden J, Campbell BA, Wu P, Cecchetto SN, Gudmundsdottir H, Kendrick M, Starlinger PP, Pecorelli N, Guarneri G, Farooqui W, Tschuor C, Burgdorf SK, Mühlhäusser J, Gass JM, Goh BKP, Koh YX, Rebelo A, Kleeff J, Seip T, Santibanes M, Todeschini L, Marchegiani G, Belfil N, Lesurtel M, Machado M, Boggi U, Kauffmann E, Cappelle M, Koerkamp BG, Di Benedetto F, Roberts K, Nevler A, Lavu H, Dutkowski P, Nickel F, Hackert T, He J, Falconi M, Truty M, Billeter AT, Müller BP; Outcomes for Total Pancreatectomy Group; Halle-Smith J, Valle V, Giulianotti P, Giannone F, Pessaux P, Sánchez-Velázquez P, Thapa PB, Maharjan D, Torres O, Kuzman M, Pandanaboyana S. International Reference Values for Surgical Outcomes of Total Pancreatectomy. JAMA Surg. 2026 Jan 1;161(1):50-57. doi: 10.1001/jamasurg.2025.4941.
Journal / Source Title
JAMA Surgery
DOI
10.1001/jamasurg.2025.4941
PMID
41222926
Publisher
American Medical Association
Publisher’s URL
https://pubmed.ncbi.nlm.nih.gov/41222926/