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Propensity Score Matching Analysis of the Safety of Completion Total Pancreatectomy for Remnant Pancreatic Tumors Versus that of Initial Total Pancreatectomy for Primary Pancreatic Tumors

  • Pancreatic Tumors
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Abstract

Background

The safety and feasibility of completion total pancreatectomy (TP) for remnant pancreatic neoplasms remain controversial and are rarely compared with that of initial TP. Thus, we aimed to compare the safety of these two procedures inducing a pancreatic state.

Methods

Patients who underwent TP for pancreatic neoplasms between 2006 and 2018 at our institution were included in this study. Tumor pathologies were classified into three subgroups according to survival curves. We used 1:1 propensity score matching (PSM) to analyze age, sex, Charlson Comorbidity Index, and tumor stage. Finally, we analyzed the primary outcome Clavien–Dindo classification (CDC) grade, risks of other safety-related outcomes, and the survival rate of patients with invasive cancer.

Results

Of 54 patients, 16 underwent completion TP (29.6%) and 38 (70.4%) underwent initial TP. Before PSM analysis, age and Charlson Comorbidity Index were significantly higher, and T category and stage were significantly lower for the completion TP group. Upon PSM analysis, these two groups were equivalent in CDC grade [initial TP vs. completion TP: 71.4% (10/14) vs. 78.6% (11/14); p = 0.678] and other safety-related outcomes. Additionally, while the overall survival and recurrence-free survival of patients with invasive cancer were not significantly different between these two groups, the T category and stage tended to be remarkably severe in the initial TP group.

Conclusions

PSM analysis for prognostic factors showed that completion TP and initial TP have similar safety-related outcomes that can be used as a decision-making reference in the surgery of pancreatic tumors.

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Acknowledgment

The authors thank Yukiko Shimizu and Yu Aimi for data management, and Editage (www.editage.com) for English language editing.

Funding

This study was supported by a Grant from the Japan Society for the Promotion of Science (JSPS) [KAKENHI 21K08732] awarded to TM.

Author information

Authors and Affiliations

  1. Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    Eisho Kanemitsu MD, PhD, Toshihiko Masui MD, PhD, Kazuyuki Nagai MD, PhD, Takayuki Anazawa MD, PhD, Yosuke Kasai MD, PhD, Akitada Yogo MD, PhD, Tatsuo Ito MD, PhD, Akira Mori MD, PhD, Kyoichi Takaori MD, PhD & Etsuro Hatano MD, PhD

  2. Shiga University of Medical Science, Otsu, Shiga, Japan

    Shinji Uemoto MD, PhD

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  1. Eisho Kanemitsu MD, PhD
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Contributions

Conceptualization: EK, AM, KT, and TM. Methodology: EK and TM. Investigation: EK and TM. First draft—writing: EK, TM, KN, TA, YK, AY, TI, AM, KT, and EH. Funding acquisition: TM. Resources: TM and EH. Supervision: TM, AM, KT, SU, and EH.

Corresponding author

Correspondence to Toshihiko Masui MD, PhD.

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Disclosures

Eisho Kanemitsu, Toshihiko Masui, Kazuyuki Nagai, Takayuki Anazawa, Yosuke Kasai, Akitada Yogo, Tatsuo Ito, Akira Mori, Kyoichi Takaori, Shinji Uemoto, and Etsuro Hatano declare they have no potential conflicts of interest to disclose.

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Kanemitsu, E., Masui, T., Nagai, K. et al. Propensity Score Matching Analysis of the Safety of Completion Total Pancreatectomy for Remnant Pancreatic Tumors Versus that of Initial Total Pancreatectomy for Primary Pancreatic Tumors. Ann Surg Oncol 30, 4392–4406 (2023). https://doi.org/10.1245/s10434-023-13309-6

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