OBJECTIVE: To assess outcomes among patients undergoing total pancreatectomy (TP) including predictors for complications and in-hospital mortality. BACKGROUND: Current studies on TP mostly originate from high-volume centers and span long time periods and therefore may not reflect daily practice. METHODS: This prospective pan-European snapshot study included patients who underwent elective (primary or completion) TP in 43 centers in 16 European countries (June 2018-June 2019). Subgroup analysis included cutoff values for annual volume of pancreatoduodenectomies (<60 vs ≥60).Predictors for major complications and in-hospital mortality were assessed in multivariable logistic regression. RESULTS: In total, 277 patients underwent TP, mostly for malignant disease (73%). Major postoperative complications occurred in 70 patients (25%). Median hospital stay was 12 days (IQR 9-18) and 40 patients were readmitted (15%). In-hospital mortality was 5% and 90-day mortality 8%. In the subgroup analysis, in-hospital mortality was lower in patients operated in centers with ≥60 pancreatoduodenectomies compared <60 (4% vs 10%, P = 0.046). In multivariable analysis, annual volume <60 pancreatoduodenectomies (OR 3.78, 95% CI 1.18-12.16, P = 0.026), age (OR 1.07, 95% CI 1.01-1.14, P = 0.046), and estimated blood loss ≥2L (OR 11.89, 95% CI 2.64-53.61, P = 0.001) were associated with in-hospital mortality. ASA ≥3 (OR 2.87, 95% CI 1.56-5.26, P = 0.001) and estimated blood loss ≥2L (OR 3.52, 95% CI 1.25-9.90, P = 0.017) were associated with major complications. CONCLUSION: This pan-European prospective snapshot study found a 5% inhospital mortality after TP. The identified predictors for mortality, including low-volume centers, age, and increased blood loss, may be used to improve outcomes.

Department of Abdominal Surgery University Medical Centre Ljubljana Ljubljana Slovenia

Department of Digestive Surgery and Liver Transplantation Croix Rousse University Hospital Hospices Civils de Lyon University of Lyon 1 Lyon France

Department of Digestive Surgery Clinical center of Serbia Faculty of Medicine University of Belgrade Belgrade Serbia

Department of General and Digestive Surgery University Hospital of Guadalajara Guadalajara Spain

Department of General Surgery Medical School University of Cyprus Nicosia Cyprus

Department of Hepato Pancreato Biliary Surgery Oslo University Hospital Oslo Norway

Department of Hepatopancreatobiliary and Transplant surgery Hospital Vall d'Hebrón Barcelona Spain

Department of HPB and Liver Transplant Surgery Queen Elizabeth Hospital University Hospitals of Birmingham NHS Trust Birmingham UK

Department of HPB and Transplant Surgery St Vincent's University Hospital Dublin Ireland

Department of Pathology Hospital Clínico Universitario ''Virgen de la Arrixaca '' Murcia Spain

Department of Surgery Cancer Center Amsterdam Amsterdam UMC University of Amsterdam Amsterdam the Netherlands

Department of Surgery Central Military Hospital Prague Prague Czech Republic

Department of Surgery Hospital Cli´nico Universitario ''Virgen de la Arrixaca ''Murcia Spain

Department of Surgery in Linköping and Department of Biomedical and Clinical Sciences Linköping University Linköping Sweden

Department of Surgery Koc University Istanbul Turkey

Department of Surgery Paracelsus Medical University Salzburg Austria

Department of Surgery Salzkammergut Klinikum Vöcklabruck Austria

Department of Surgery University of Salamanca HospitalUniversitario de Salamanca Salamanca Spain

Department of Visceral Transplant and Thoracic Surgery Medical University of Innsbruck Innsbruck Austria

Department of Visceral Vascular and Endocrine Surgery Martin Luther University Halle Wittenberg Germany

General and Pancreatic Surgery Department Pancreas Institute University and Hospital Trust of Verona Verona Italy

HPB Unit Department of Upper GI diseases Karolinska University Hospital Stockholm Sweden

ISS Aragón Department of Surgery Miguel Servet University Hospital Zaragoza Spain

Pancreatic Surgery Unit Humanitas Clinical and Research Center IRCCS and Humanitas University Department of Biomedical Sciences Rozzano Pieve Emanuele Milan Italy

Pancreatic Surgical Unit Pederzoli Hospital Peschiera del Garda Verona Italy

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