The use and clinical outcome of total pancreatectomy in the United States, Germany, the Netherlands, and Sweden

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Abstract

Background: Total pancreatectomy has high morbidity and mortality and differences among countries are currently unknown. This study compared the use and postoperative outcomes of total pancreatectomy among 4 Western countries. Methods: Patients who underwent one-stage total pancreatectomy were included from registries in the United States, Germany, the Netherlands, and Sweden (2014–2018). Use of total pancreatectomy was assessed by calculating the ratio total pancreatectomy to pancreatoduodenectomy. Primary outcomes were major morbidity (Clavien Dindo ≥3) and in-hospital mortality. Predictors for the primary outcomes were assessed in multivariable logistic regression analyses. Sensitivity analysis assessed the impact of volume (low-volume <40 or high-volume ≥40 pancreatoduodenectomies annually; data available for the Netherlands and Germany). Results: In total, 1,579 patients underwent one-stage total pancreatectomy. The relative use of total pancreatectomy to pancreatoduodenectomy varied up to fivefold (United States 0.03, Germany 0.15, the Netherlands 0.03, and Sweden 0.15; P <.001). Both the indication and several baseline characteristics differed significantly among countries. Major morbidity occurred in 423 patients (26.8%) and differed (22.3%, 34.9%, 38.3%, and 15.9%, respectively; P <.001). In-hospital mortality occurred in 85 patients (5.4%) and also differed (1.8%, 10.2%, 10.8%, 1.9%, respectively; P <.001). Country, age ≥75, and vascular resection were predictors for in-hospital mortality. In-hospital mortality was lower in high-volume centers in the Netherlands (4.9% vs 23.1%; P =.002), but not in Germany (9.8% vs 10.6%; P =.733). Conclusion: Considerable differences in the use of total pancreatectomy, patient characteristics, and postoperative outcome were noted among 4 Western countries with better outcomes in the United States and Sweden. These large, yet unexplained, differences require further research to ultimately improve patient outcome.

Detaljer

Författare
  • Anouk E.J. Latenstein
  • Tara M. Mackay
  • Joal D. Beane
  • Olivier R. Busch
  • Susan van Dieren
  • Elizabeth M. Gleeson
  • Bas Groot Koerkamp
  • Hjalmar C. van Santvoort
  • Ulrich F. Wellner
  • Caroline Williamsson
  • Bobby Tingstedt
  • Tobias Keck
  • Henry A. Pitt
  • Marc G. Besselink
  • Global Audits on Pancreatic Surgery Group (GAPASURG)
Enheter & grupper
Externa organisationer
  • Ohio State University
  • Icahn School of Medicine at Mount Sinai
  • Erasmus University Medical Center
  • University Medical Center Utrecht
  • Skåne University Hospital
  • University of Amsterdam
  • VU University Medical Center
  • St. Antonius Hospital
  • University Medical Center Schleswig-Holstein Campus Lubeck
  • Rutgers University: The State University of New Jersey
Forskningsområden

Ämnesklassifikation (UKÄ) – OBLIGATORISK

  • Cancer och onkologi
  • Kirurgi
Originalspråkengelska
TidskriftSurgery (United States)
StatusE-pub ahead of print - 2021
PublikationskategoriForskning
Peer review utfördJa