VAI TRÒ VÀ KẾT QUẢ CỦA CẮT TOÀN BỘ TỤY TRONG ĐIỀU TRỊ BỆNH LÝ TỤY PHỨC TẠP: NGHIÊN CỨU CHÙM BỆNH TẠI BỆNH VIỆN BẠCH MAI

Abstract

Objective: To evaluate patient characteristics, indications, surgical techniques, and perioperative outcomes of total pancreatectomy (TP) at the Center of Digestive Surgery, Bach Mai Hospital. Participants and

Methods: A prospective descriptive case series with longitudinal follow-up. All patients undergoing TP from October 2020 to December 2024 were consecutively included if complete medical records were available and informed consent was obtained.

Results: Twenty-four patients were included; 79.2% were male. Mean age was 59.92 ± 13.48 years (31–76) and mean BMI was 20.84 ± 2.41 kg/m². Indications were pancreatic cancer (50.0%), pancreatitis/complications (25.0%), IPMC/IPMN (16.7%), and NET (8.3%). Most procedures were scheduled (87.5%); open approach was used in 91.7% and laparoscopy in 8.3%. Mean operative time was 322.1 ± 83.6 minutes (n=22) with blood loss 177.7 ± 113.7 mL (n=22). Extended lymphadenectomy was performed in 50.0% and standard in 37.5%; total mesopancreas excision in 87.5%. Venous management was required in 33.3% and left gastric vein preservation achieved in 62.5%. Complications were mainly Clavien–Dindo I–II (75.0%); IIIa 8.3%, IIIb 12.5%, with in-hospital mortality 4.2%. Common events were lymphatic leak (5 cases) and postoperative bleeding (3 cases). Postoperative length of stay was 17.0 ± 7.7 days; 95.9% were discharged. In neoplasms (n=18), 66.7% involved the pancreatic head and 55.6% were >3 cm. Among pancreatic ductal adenocarcinoma (n=12), stage II and grade G2 each accounted for 66.7%; nodal metastasis (station 14) was 26.3% and mesopancreas invasion/metastasis 31.6% (n=19).

Conclusion: TP at Bach Mai was predominantly elective and open, with frequent use of radical techniques. Perioperative outcomes were acceptable, though in-hospital mortality underscores the need for optimized preoperative preparation and rigorous complication control.