Actual 10-year survival after total pancreatectomy: a multicenter study

PURPOSE: Total pancreatectomy (TP) has attracted increasing attention because short-term outcomes have improved. However, long-term data remain limited. This study evaluated long-term outcomes after TP, focusing on actual 10-year survivors and causes of death. METHODS: This study included patients who underwent elective TP for pancreatic disease and were followed for at least 10 years or until death. Patients were classified as 10-year survivors or non-survivors. Clinicopathological characteristics, long-term survival, and causes of death were analyzed. RESULTS: Forty-nine patients were included. Single-stage TP was performed in 30 patients (61.2%) and completion TP in 19 (38.8%). Pancreatic ductal adenocarcinoma accounted for 57.1% of indications for TP. R0 resection was achieved in 87.8% of patients, with no in-hospital mortality. The actual 5- and 10-year overall survival rates were 28.6% and 18.4%, respectively. Nine patients (18.4%) were actual 10-year survivors; none underwent vascular resection and reconstruction (p = 0.019), multivisceral resection (p = 0.322), or R1/2 resection (p = 0.577). One-third of the 10-year survivors had non-invasive intraductal papillary mucinous neoplasms (p = 0.016). In multivariate analysis, vascular resection and reconstruction was associated with worse overall survival (p = 0.016). Most deaths occurred within 5 years after TP and were mainly attributable to disease progression. CONCLUSION: Long-term outcomes after TP appear to be influenced predominantly by oncological factors. Actual 10-year survivors were observed mainly among patients with benign or more favorable tumor characteristics who did not require extended resection. Given the heterogeneity of underlying diseases and surgical indications, these findings should be interpreted as primarily descriptive.