Total Pancreatectomy—Still a Last-Resort Procedure

Total pancreatectomy (TP) may be performed for both benign and malignant indications. TP is becoming increasingly common, especially at specialized high-volume centers and for patients deemed high risk for postoperative pancreatic fistula (POPF). Although technically feasible, TP carries profound metabolic and quality-of-life consequences that distinguish it from other pancreatic resections. Despite this, quality metrics and reference values for postoperative outcomes and complications have yet to be established. These metrics, usually established based on low-risk populations, are vital for comparing surgical outcomes across settings, identifying gaps between actual and ideal outcomes, assessing cost-effectiveness, and evaluating quality improvement initiatives. Benchmarks have been determined for other pancreatic procedures, including pancreaticoduodenectomy (PD).