Total Pancreatectomies in Germany - Epidemiology, Trends, (ToPaGe)

Medizinische Hochschule Brandenburg Theodor Fontane

Status: Completed

Conditions: Pancreas Disease

Treatments: Procedure: Total pancreatectomy

Study type: Observational

Funder types: Other

Identifiers

NCT06466928

ToPaGe

Details and patient eligibility

About

The purpose of this study was to evaluate the real-world mortality rates of total pancreatectomy across Germany and to understand the impact of hospital caseload on surgical outcomes.

Full description

This retrospective observational study analyzed routine data from the nationwide German diagnosis-related group statistics, covering the years 2010 to 2020. The data included all inpatient episodes from acute care hospitals. The study focused on mortality rates associated with total pancreatectomy and examined how these rates varied with the complexity of the surgeries and the volume of procedures performed by different hospitals.

The mortality rates for total pancreatectomy in Germany were found to be more than three times higher than those reported by specialized pancreatic centers. Mortality rates increased significantly with the complexity of the total pancreatectomy procedures, especially those involving arterial resections. Hospitals with lower total pancreatectomy caseloads had higher mortality rates compared to high-volume centers.

Results showed that total pancreatectomies are associated with high mortality rates, particularly in hospitals with lower surgical volumes. The findings suggest that the promising outcomes from specialized centers cannot be generalized to all hospitals performing pancreatic surgeries, highlighting the need for a thorough understanding of the learning curve and specialization in pancreatic surgery to reduce mortality risks.

Enrollment: 12,938 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• total pancreatectomy between January 2010 and December 2020
• 18 years or older

Exclusion criteria

• postmortem pancreatectomy (OPS code 5-525.4)
• removal of a pancreas transplant (OPS code 5-525.3)

Trial design

12,938 participants in 4 patient groups

Standard Total pancreatectomy

Description:

Total pancreatectomy without vascular or adjacent organ resection. In cases with concomitant liver resection, only an excisional biopsy or wedge resection was to be performed

Treatment:

Procedure: Total pancreatectomy

Total pancreatectomy with venous resection

Description:

Total pancreatectomy with portal vein and/or superior mesenteric vein resection

Treatment:

Procedure: Total pancreatectomy

Total pancreatectomy with multivisceral resection

Description:

Total pancreatectomy with additional adjacent organ resection. The procedure extended beyond pylorus preserving, pylous resecting, and procedures with antrectomy and included the partial or total resection of additional organs with the exception of partial or total splenectomy. Procedures with liver resections, that required a larger atypical, segmental, bisegmental or major (hemihepatectomy) resection.

Treatment:

Procedure: Total pancreatectomy

Total pancreatectomy with arterial resection

Description:

Total pancreatectomy with arterial resection: superior mesenteric artery resections, hepatic artery resections, aortic resections, or resections of the celiac axis

Treatment:

Procedure: Total pancreatectomy