Original Investigation 

International Reference Values for Surgical Outcomes of Total Pancreatectomy

Philip C. Müller, Caroline Berchtold, Christoph Kuemmerli, et al

JAMA Surg Published Online: November 12, 2025

doi: 10.1001/jamasurg.2025.4941

Key Points

Question  What are international reference values for total pancreatectomy based on a low-risk cohort treated at expert centers?

Findings  In this international, multicenter, case-control study including 994 patients from 25 reference centers, 20 surgical and oncological reference values for total pancreatectomy were defined and included a relevant rate of major complications and 90-day postoperative mortality.

Meaning  This study found global reference values for total pancreatectomy, which indicate significantly higher postoperative morbidity and mortality as compared with pancreatoduodenectomy, especially in patients with vascular resections.

Abstract

Importance  Total pancreatectomy (TP) is indicated for advanced pancreatic cancer or multifocal tumors. Furthermore, TP may be performed to avoid the risk of pancreatic fistula in selected patients to improve the perioperative risk profile.

Objective  To define reference values for TP based on a low-risk cohort treated at expert centers.

Design, Setting, and Participants  This multicenter study analyzed outcomes from patients undergoing primary TP for malignant or benign lesions from 25 international expert centers from January 2017 to November 2023. Low-risk patients undergoing TP (LR-TP) were without vascular resections or significant comorbidities.

Exposures  TP.

Main Outcomes and Measures  Twenty reference values were derived from the 75th or the 25th percentile of the median values of all centers. Outcomes of LR-TP were compared with a cohort of TP with vascular resection, TP due to high-risk pancreatic anastomosis, and the benchmark values for low-risk pancreatoduodenectomy.

Results  Of 994 patients, 333 (33.5%; median [IQR] age, 66 [58-72] years; 171 male [51.4%]) qualified as the LR-TP cohort. Reference values included blood loss (≤1000 mL), major complications (≤37%), 3-month postoperative mortality (<6%), and retrieved lymph nodes (≥29). Compared with TP with vascular resections, reference cutoffs were not met for major complications (51% vs LR-TP ≤37%) and 90-day mortality (11% vs LR-TP ≤6%). For TP due to high-risk anastomosis, failure to rescue rate (38% vs ≤6%) and 90-day mortality (11% vs LR-TP ≤6%) were not met. Compared with pancreatoduodenectomy, reference values for postoperative mortality were 3 times higher for LR-TP (≤2% vs ≤6%) and less for resected lymph nodes (≥16 vs ≥29).

Conclusions and Relevance  This case-control study provided global reference values for TP, indicating significantly higher postoperative morbidity and mortality compared with pancreatoduodenectomy. Perioperative morbidity of TP was especially increased in patients with vascular resections. These reference values can serve for quality control of pancreatic surgery.