Total or partial pancreatectomy: Indications, surgical and functional outcomes

The research presented in this thesis provides insight in the indications, surgical and functional outcomes after total and partial pancreatectomy on an international and national level. A survey regarding the surgical management strategy of IPMN with main duct involvement revealed a clinically relevant lack of consensus in the treatment strategy in MD/MT-IPMN among experts worldwide. The multicentre study in the Netherlands showed that surgical morbidity, mortality and recurrence rates did not differ between partial and total pancreatectomy. These data support the current restrictive use of total pancreatectomy in MD/MT-IPMN. A cohort study of all patients that patients who had undergone a total pancreatectomy (TP) between 2006 and 2016 in the Netherlands showed that patients were satisfied with their diabetes therapy and experienced similar diabetes-related distress as patients with type 1 diabetes. A systematic review showed a clinical relevant risk of new-onset diabetes 16% after a less extensive operation and that the quality of life of patients seems moderately affected by TP. Minimally invasive TP we studied in the largest multicenter propensityscore-matched cohort study on this topic , and showed that MITP is associated with a 16% lower major morbidity rate, comparable lengths of hospital stay, functional outcomes, and overall survival compared to OTP. However, the mean operative time was longer after MITP. During total pancreatectomy with islet cell autotransplantation (TP-IAT), the pancreatic islet cells are isolated and infused into the liver via the portal vein. After the procedure, the islet cells will engraft in the liver parenchyma. This, to prevent loss of islet cell function. We studied this in treatment refractory, chronic pancreatitis patients and the rational for this is mainly pain control. This systematic review and meta-analysis showed a 63% morphine free rate, a 30% insulin free rate and improved quality of life 1-year after TP-IAT. We also developed the PROPAN program for patients with high-risk to develop pancreatic cancer, with main-duct IPMN or hereditary pancreatitis who which to discuss prophylactic TP. Because this is not an option in the international guidelines.
In conclusion, these thesis-data enrich the information, which can be provided to patients and their relatives to facilitate shared decision making when faced with the decision to undergo TP and hopefully stimulates surgeons worldwide to perform a partial or total pancreatectomy carefully.