The development, evolution, and eventual abandonment of total pancreatectomy for cancer of the head of the pancreas is analogous to the earlier historic fate of total gastrectomy for gastric cancer. Total extirpation of both organs was originally thought to be incompatible with life, but major surgical, scientific, and technical advances in the second quarter of the past century allowed the surgeon to completely excise both organs with impunity. Such radical operations were, however, reserved exclusively for advanced tumors with high morbidity and mortality and negligible long-term survival. In the past 25 years, our understanding of the resulting derangements in gastrointestinal tract function and metabolic processes have led to a more selective, realistic, and conservative approach to operations on both organs.
Moossa AR. Results of Total Pancreatectomy for Adenocarcinoma of the Pancreas—Invited Critique. Arch Surg. 2001;136(1):48. doi:10.1001/archsurg.136.1.48