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Total Pancreatectomy: Indications, Operative Technique, and Postoperative Sequelae

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Total pancreatectomy has been used to treat both benign and malignant disease of the pancreas, but its use has been limited by concerns about management of the apancreatic state with its attendant total endocrine and exocrine insufficiency. Here, we review the indications for total pancreatectomy, operative technique, and improvements in the postoperative management of patients. Total pancreatectomy remains a viable option in the treatment of intractable pain associated with chronic pancreatitis, multicentric or extensive neuroendocrine tumors, patients with familial pancreatic cancer with premalignant lesions, and in patients with intraductal papillary mucinous neoplasia with diffuse ductal involvement or invasive disease. Improvements in postoperative management include auto-islet cell transplantation, advances in insulin formulations, and the use of glucagon rescue therapy which allow much tighter control of blood glucose than previously possible. This markedly lessens the risk of life-threatening hypoglycemia and decreases the risk of long-term complications, resulting in improved quality of life for these patients.

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Abbreviations

IPMN:

intraductal papillary mucinous neoplasia

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Authors and Affiliations

  1. Department of Surgery, University of Michigan, Ann Arbor, MI, 48109, USA

    David G. Heidt & Diane M. Simeone

  2. Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, 48109, USA

    Charles Burant & Diane M. Simeone

  3. Department of Internal Medicine, University of Michigan, Ann Arbor, MI, 48109, USA

    Charles Burant

  4. University of Michigan Medical Center, TC 2922D, Box 0331, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA

    Diane M. Simeone

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  1. David G. Heidt
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Heidt, D.G., Burant, C. & Simeone, D.M. Total Pancreatectomy: Indications, Operative Technique, and Postoperative Sequelae. J Gastrointest Surg 11, 209–216 (2007). https://doi.org/10.1007/s11605-006-0025-7

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