Nationwide Outcome after Pancreatoduodenectomy in Patients at Very High-risk (ISGPS-D) for Postoperative Pancreatic Fistula

Background: Recently, the International Study Group for Pancreatic Surgery (ISGPS) created four risk categories (A-D) for developing postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD). Recent studies suggest total pancreatectomy as alternative to PD in patients in the highest risk category (ISGPS-D) to improve postoperative outcome. Whereas a recent transatlantic audit study reported 5.4% mortality and 26.8% major morbidity after elective total pancreatectomy (n=1,579), nationwide outcomes after ISGPS-D PD are lacking.