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Total Pancreatectomy for Treatment of Pancreatic Adenocarcinoma

  • Thomas Schnelldorfer
  • Kaye M. Reid Lombardo
  • Michael B. Farnell
  • Michael G. Sarr
Part of the M. D. Anderson Solid Tumor Oncology Series book series (MDA)

Successful total pancreatectomy was first performed in 1942 by Priestley at the Mayo Clinic in Rochester, Minnesota for an insulinoma (1). In 1944, Fallis at the Henry Ford Hospital in Detroit, Michigan undertook the first successful total pancreatectomy for pancreatic carcinoma (2). Soon, recommendations were made from several centers for total pancreatectomy in anticipation to cure pancreatic cancer (3). In the early 1970s, total pancreatectomy was advocated by several groups as the preferred resection for pancreatic adenocarcinoma. The reasoning for this decision was several-fold. Most surgeons were dissatisfied by survival outcomes after pancreatoduodenectomy and were looking for reasons that might explain the inordinately high recurrence rate (4). The option of total pancreatectomy was based on the belief that pancreatic adenocarcinoma was multicentric with undetected foci of neoplasm within the remnant gland (up to 30%) which would be addressed by complete excision. The operation provided a generous pancreatic parenchymal margin with a potentially better oncologic resection (lymphadenectomy and soft tissue clearance), all of which were felt to be advantageous for survival. The absence of need for a pancreaticoenterostomy and its associated morbidity was welcomed by elimination of pancreatic fistulae which at the time were associated with high mortality. The inevitable loss of endocrine and exocrine pancreatic function and the associated splenectomy with its infectious sequelae, although taken into consideration, may not have been appreciated fully. In the mid-1980s, it became evident that total pancreatectomy did not provide a superior outcome compared to other forms of pancreatic resections, and the true incidence of multicentricity has been shown to be quite low (5, 6). Currently, the concept of total pancreatectomy as a routine procedure in the management of pancreatic adenocarcinoma is rejected, and only a selected approach is still in use.

Keywords

Pancreatic Cancer Lynch Syndrome Pancreatic Adenocarcinoma Pancreatic Fistula Distal Pancreatectomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  • Thomas Schnelldorfer
    • 1
  • Kaye M. Reid Lombardo
    • 1
  • Michael B. Farnell
    • 2
  • Michael G. Sarr
    • 1
  1. 1.Mayo Clinic College of MedicineRochesterUSA
  2. 2.Mayo Clinic College of SurgeryRochesterUSA

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