Total pancreatectomy

Introduction

Total pancreatectomy is associated with significant metabolic consequences secondary to the loss of exocrine and endocrine function. Resultant brittle type III diabetes can be difficult to manage and result in severe recurrent hypoglycemia in some patients. Outcomes after total pancreatectomy for pancreatic adenocarcinoma (PDAC) are particularly poor, and this operation is rarely indicated in this setting. More appropriate indications include chronic, recurrent acute, or hereditary pancreatitis, as well as main duct intraductal papillary mucinous neoplasm (IPMN) involving the entire gland (see Chapters 53 , 56 , 58 , and 60 ; Box 117C.1 ). ^, Islet auto transplant is offered at select centers and may be considered, particularly for benign disease. With advances in pancreatic enzyme supplementation and insulin management, total pancreatectomy can be performed safely with acceptable quality of life in appropriately selected patients. ^,