Background
Total pancreatectomy (TP) is actually considered a viable option in selected patients even if large comparative studies between partial versus total pancreatectomy are not currently available. However, new insights on pancreatic oncology, associated with the evidence of the side effects of total pancreatectomy, have made this procedure less appealing. Our aim was to evaluate our results in patients undergoing TP.

Methods:
In 2 HBP center, retrospective study of 46 patients undergoing TP from January 2008 to January 2016 was performed regarding postoperative outcomes, long-term Patient data and clinical outcomes were collected and entered into a database. Disease-free survival and overall survival were estimated using the Kaplan–Meier method.

Results
46 consecutive elective total pancreatectomies Fifteen males and 29 females with a median age of 66.6 years underwent TP for non-invasive intraductal papillary mucinous neoplasms (IPMN) (11), invasive IPMN (2), pancreatic adenocarcinoma (28), other neoplasm (4), and chronic pancreatitis (1). Median hospital stay 22 days. Thirty-three patients (73.3%) underwent a planned TP and 13 patients underwent a single-stage unplanned TP after an initial partial pancreatectomy that required TP because of remnant pancreas problem (3) diffuse involvement of lesions (3) and positive pancreatic resection margin (7). Thirty-day major morbidity and mortality was 6.7% and 0%, respectively. With a median follow-up length of 21.5 months, 31 (67.4%) patients were alive at last follow-up. Estimated overall survival at 1, 3 and 5 years for the entire cohort was 89.5%, 81.8% and 54.9%, and for those with pancreatic adenocarcinoma was 79.1%, 71.9% and 51.3%, respectively. Median HbA1c values at 12 months after surgery were 7.8.

Conclusions From this study, it seems reasonable to suggest that TP can be considered as safe and acceptable treatment for borderline and malignant tumor of the pancreas when partial pancreatectomy is not feasible option.