Clinical Outcomes and Prognostic Factors After Total Pancreatectomy: A Single-center Retrospective Study of 43 Cases.

[OBJECTIVES] Total pancreatectomy (TP) remains a challenging procedure due to the complex postoperative management required, although recent advances have expanded the indications for this surgery. In this study, we analyzed the surgical outcomes and prognostic factors in patients who underwent TP.

[METHODS] We retrospectively analyzed the data of patients who underwent TP at our institution between January 2013 and December 2023. Re-pancreatectomy of the remnant pancreas were excluded. The patient characteristics, surgical outcomes, postoperative course, and survival outcomes were evaluated, with particular attention paid to the nutritional status.

[RESULTS] The median age of the 43 patients was 68 years, and pancreatic ductal adenocarcinoma/invasive IPMC accounted for 62.8% of all cases. The 90-day mortality rate was 2.3% and the 90-day readmission rate was 34.9%. The median overall survival was 28.8 months, with a 5-year survival rate of 38.1%. The PNI exhibited consistent prognostic significance across all three postoperative outpatient visits (P=0.0191, 0.0003, and 0.0492, respectively). A low PNI (≤ 40) at the second postoperative outpatient visit (HR 42.0, P =0.0006) and a histological diagnosis of pancreatic ductal adenocarcinoma/invasive IPMC (HR 5.27,P =0.0085) were identified as poor prognostic factors.

[CONCLUSIONS] Postoperative nutritional status, as measured by the PNI, was found to exert a significant influence on long-term survival after TP, with the underlying histological diagnosis serving as another critical determinant of the postoperative outcomes. These findings highlight the importance of systematic nutritional monitoring and intervention throughout the postoperative period.