Comprehensive comparisons of total pancreatectomy versus pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: a double-center, retrospective study.

BackgroundTotal pancreatectomy (TP) is necessary in some cases to treat pancreatic cancer. However, TP is still controversial due to its unsatisfactory short- and long-term clinical outcomes previously. This study aimed to compare the perioperative outcomes, long-term survival and quality of life (QoL) between TP and the widely recognized pancreaticoduodenectomy (PD) in patients with pancreatic ductal adenocarcinoma (PDAC).MethodsA total of 68 patients with PDAC who underwent elective TP at Beijing Chao-Yang Hospital and Beijing Hospital from January 2021 to December 2023 were retrospectively reviewed. Another 68 patients receiving PD during the same time period were also randomly selected for comparison. Perioperative data were retrospectively reviewed. Survival status was recorded by regular follow-up, and the end date of follow-up was December 31, 2024. Questionnaires were sent to the survivors to evaluate their long-term endo-exocrine insufficiency and QoL.ResultsNo significant differences were found in postoperative morbidity, mortality or total hospitalization costs between the two groups, while the postoperative hospital stay of the TP group was even shorter (19 vs. 23 days, P<0.001). Overall survival (OS) (P=0.91) was also comparable between the two groups. Concerning postoperative endo-exocrine insufficiency and QoL, there were also no significant differences between the two groups in terms of all the questionnaires (P>0.05).ConclusionsThe TP procedure may be as safe, feasible and efficacious as PD with similar short- and long-term clinical outcomes for patients with PDAC.