***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: The aim of our study was to determine the success of radical pancreatic resection in relieving the  pain of chronic pancreatitis . From 1974 to 1985 , 30 consecutive patients underwent radical pancreatic resection for the treatment of debilitating pain ( 15 underwent Whipple 's resection and 15 underwent total pancreatectomy ) . Patients were not r and omized but were subjected to the procedure deemed indicated for their clinical presentation ; thus , the two groups were not strictly comparable . There was no operative mortality ; major morbidity occurred in three patients ( 20 % ) in each group ( four patients experienced anastomotic bile leak and two experienced abdominal sepsis ) . Following Whipple 's resection , mean follow-up was 6.2 years ( range , 1.5 to 12.1 years ) . Complete pain relief occurred in eight patients ( 53 % ) and significant relief in an additional four ( 27 % ) . Endocrine insufficiency developed in six patients and exocrine insufficiency in eight . Following total pancreatectomy , mean follow-up was 9.1 years ( range , 2.1 to 13.1 years ) . Complete pain relief occurred in only four patients ( 27 % ) and significant relief in an additional six ( 40 % ) . Significant pain persisted in about 33 % of patients after total pancreatic resection . We concluded that radical pancreatic resection can be performed safely in patients with chronic pancreatitis but with gratifying results in only 67 % to 80 % of patients . Whipple 's resection may be preferable for disease located primarily in the head of the gl and BACKGROUND The aim was to assess the outcome of a total pancreatectomy ( TP ) . METHODS From 1993 to 2010 , 56 patients underwent an elective TP for intraductal papillary mucinous neoplasia ( n = 42 ) , endocrine tumours ( n = 6 ) , adenocarcinoma ( n = 5 ) , metastases ( n = 2 ) and chronic pancreatitis ( n = 1 ) .  Morbidity and survival were analysed . Long-term survivors were assessed prospect ively using quality -of-life ( QoL ) question naires . RESULTS Five patients developed gastric venous congestion intra-operatively . Post-operative morbidity and mortality rates were 45 % and 3.6 % , respectively . An anastomotic ulcer occurred in seven patients , but none after proton pump inhibitor therapy . There were five inappropriate TPs according to definitive pathological examination . Overall 3- and 5-year survival rates were 62 % and 55 % respectively ; five deaths were related to TP ( two postoperative deaths , one hypoglycaemia , one ketoacidosis and one anastomotic ulcer ) . Prospect i ve evaluation of 25 patients found that 14 had been readmitted for diabetes and that all had hypoglycaemia within the past month  . The glycated haemoglobin ( HbA1c ) was 7.8 % ( 6.3 - 10.3 ) . Fifteen patients experienced weight loss . The QLQ-C30 question naire showed a decrease in QoL predominantly because of fatigue and diarrhoea , and the QLQ-PAN26 showed an impact on bowel habit , flatulence and eating-related items . DISCUSSION Morbidity and mortality rates of TP are acceptable , although diabetes- and TP-related mortality still occurs . Endocrine and exocrine insufficiency impacts on the long-term quality of life HYPOTHESIS Total pancreatectomy for infiltrating ductal adenocarcinoma is not superior to pancreaticoduodenectomy or distal pancreatectomy . DESIGN A retrospective analysis of a prospect i ve data base of patients . SETTING Memorial Sloan-Kettering Cancer Center , New York , NY . PATIENTS All patients ( n = 488 ) undergoing pancreatic resection .  MAIN OUTCOME MEASURES Duration of operation , estimated blood loss , complications , length of stay , number of positive lymph nodes , presence of a positive margin , and survival times were analyzed . RESULTS Thirty-five patients were identified who underwent total pancreatectomy , 28 of whom had adenocarcinoma .  Median length of stay was 32 days ; 19 ( 54 % ) developed postoperative complications , of which 63 % were infectious . Thirty-day mortality was 3 % ( 1 patient ) . Median survival was 9.3 months ( range , 0.6 - 172 months ) . There was no significant difference between patients with and without adenocarcinoma in terms of duration of operation , estimated blood loss , complications , length of stay , or number of readmissions . In patients with adenocarcinoma , margin or nodal status were not significant survival variables . Patients undergoing total pancreatectomy for adenocarcinoma had a significantly worse overall survival than those undergoing total pancreatectomy for other reasons ( P<.001 ) , or compared with a contemporaneous cohort with adenocarcinoma undergoing pancreaticoduodenectomy  ( n = 409 ) and  distal pancreatectomy ( n = 51 ) ( 7.9 vs 17.2 months ; P<.002 ) . CONCLUSIONS Total pancreatectomy can be performed safely with low mortality ; survival is predicted by the underlying pathologic findings : patients undergoing total pancreatectomy for adenocarcinoma have a uniformly poor outcome . Those undergoing total pancreatectomy for benign disease or nonadenocarcinoma variants can have long-term survival . In patients who require total pancreatectomy for ductal adenocarcinoma , the survival is so poor as to bring into question the value of the operation Background . This study aim ed to analyse the most common current indications for total pancreatectomy ( TP )  at a high-volume pancreas center . Method . Prospect ively collected data on indications and short-term outcome of all TP 's performed from January 2004 until June 2008 were analysed . Results . The  total pancreatectomies ( TP ) were 63 , i.e. , 6.7 % of all pancreatic procedures ( n = 948 ) . Indications for TP were classified into 4 groups : tumors of advanced stage , n = 23 ( 36.5 % ) , technical problems due to soft pancreatic tissue , n = 18 ( 28.6 % ) , troubles due to perioperative surgical complications , n = 15 ( 23.8 % ) , and therapy-resistant pain due to chronic pancreatitis , n = 7 ( 11.1 % ) . Surgical complications occurred in 23 patients ( 36.5 % ) . The mortality in elective TP was 6.25 % . Median postoperative stay was 21 days . Mortality , morbidity and the other perioperative parameters differed substantially according to the indication for pancreatectomy . Conclusion . Total pancreatectomy is definitely indicated for a limited range of elective and emergency situations . Indications can be : size or localisation of pancreatic tumor , trouble , technical diffuculties and therapy-refractory pain in chronic pancreatitis . A TP due to perioperative complications ( troubles ) after pancreatic resections is doomed by extremely high morbidity and mortality and should be avoided Objective : To evaluate the perioperative and long-term results of total pancreatectomy ( TP ) , and to assess whether it provides morbidity , mortality , and quality of life ( QoL ) comparable to those of the pylorus-preserving (pp)-Whipple procedure in patients with benign and malignant pancreatic disease . Summary Background Data : TP was ab and oned for decades because of high peri- and postoperative morbidity and mortality . Because selected pancreatic diseases are best treated by TP , and pancreatic surgery and postoperative management of exocrine and endocrine insufficiency have significantly improved , the hesitance to perform a TP is disappearing . Patients and Methods : In a prospect i ve study conducted from October 2001 to November 2006 , all patients undergoing a TP ( n = 147 ; 100 primary elective TP [ group A ] , 24 elective TP after previous pancreatic resection [ group B ] , and 23 completion pancreatectomies for complications ) were included , and perioperative and late follow-up data , including the QoL ( EORTC QLQ-C30 question naire ) , were evaluated . A matched-pairs analysis with patients receiving a pp-Whipple operation was performed . Results : Indications for an elective TP ( group A + B ) were pancreatic and periampullary adenocarcinoma ( n = 71 ) , other neoplastic pancreatic tumors ( intraductal papillary mucinous neoplasms , neuroendocrine tumors , cystic tumors ; n = 34 ) , metastatic lesions ( n = 8) , and chronic pancreatitis ( n = 11 ) . There were 73 men and 51 women with a mean age of 60.9 ± 11.3 years . Median intraoperative blood loss was 1000 mL and median operation time was 380 minutes . Postoperative surgical morbidity was 24 % , medical morbidity was 15 % , and mortality was 4.8 % . The relaparotomy rate was 12 % . Median postoperative hospital stay was 11 days . After a median follow-up of 23 months , global health status of TP patients was comparable to that of pp-Whipple patients , although a few single QoL items were reduced . All patients required insulin and exocrine pancreatic enzyme replacements . The mean HbA1c value was 7.3 % ± 0.9 % . Conclusion : In this cohort study , mortality and morbidity rates after elective TP are not significantly different from the pp-Whipple . Because of improvements in postoperative management , QoL is acceptable , and is almost comparable to that of pp-Whipple patients . Therefore , TP should no longer be generally avoided , because it is a viable option in selected patients UNLABELLED In patients undergoing pancreaticoduodenectomy ( PD ) for pancreatic adenocarcinoma ( PC ) , conversion to total pancreatectomy ( TP ) may be necessary to achieve R0 resection . HYPOTHESIS We sought to examine the oncologic benefit of conversion of PD to TP to achieve an R0 resection in patients with an isolated positive neck margin . METHODS We conducted a retrospective analysis of prospect ively collected data at Indiana University and Johns Hopkins Medical Institutions . A review of 1,579 patients who underwent PD or TP for PC at these institutions between 1992 and 2006 was performed . Sixty-one patients were eligible . RESULTS Twenty-eight patients underwent PD with an isolated positive neck margin found on pathologic examination ; 33 patients had conversion to TP for isolated neck margin involvement to achieve R0 resection . Patients undergoing TP versus PD had a greater median survival ( 18 vs 10 months ; P = .04 ) . Mortality ( 6 % vs 7 % ) and morbidity ( 36 % vs 54 % ; P = .20 ) for TP versus PD were comparable . Multivariate analysis revealed PD and greater tumor size as the only independent predictors of poor long-term survival ( hazard ratio [ HR ] , 2.2 ; P = .01 and HR , 1.3 ; P = .005 ) . CONCLUSIONS Conversion of PD to TP to achieve an R0 resection in patients with pancreatic adenocarcinoma is associated with a survival benefit Non-r and omised studies of the effects of interventions are critical to many areas of healthcare evaluation , but their results may be biased . It is therefore important to underst and and appraise their strengths and weaknesses . We developed ROBINS-I ( “ Risk Of Bias In Non-r and omised Studies - of Interventions ” ) , a new tool for evaluating risk of bias in estimates of the comparative effectiveness ( harm or benefit ) of interventions from studies that did not use r and omisation  to allocate units ( individuals or clusters of individuals ) to comparison groups . The tool will be particularly useful to those undertaking systematic review s that include non-r and omised studies Abstract . During the late 1960s total pancreatectomy was advocated on theoretic grounds as an operation superior to subtotal ( Whipple ) resection in patients with pancreatic cancer . There are , however , no prospect i ve r and omized studies and only few institutional comparisons between the two operations . The aim of the present paper was to report the clinical outcome of total and subtotal pancreatectomy , respectively , in a consecutive series of patients with exocrine pancreatic cancer . The short- and long-term results of 89 consecutive patients who underwent total pancreatectomy ( 1959–1984 ) for pancreatic cancer were retrospectively compared with a similar group of 36 patients who had a subtotal pancreatectomy ( 1985–1992 ) for the same diagnosis . The clinical characteristics were on the whole similar in the two groups . Postoperative mortality and morbidity , the amount of intraoperative bleeding , operation time , reoperation rate , postoperative days in the intensive care unit , and duration of hospital stay were statistically significantly increased after total pancreatectomy . The 5-year survival rate was lower after total pancreatectomy when hospital deaths were included in the analysis . At multivariate analysis total pancreatectomy adversely influenced long-term survival compared to subtotal resection , as did positive lymph nodes and poor histologic differentiation . Better early and long-term results were found after subtotal than 
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In addition , morbidity was not significantly different between the two groups ( OR : 1.41 , 95 % CI : 1.01 - 1.97 ; P=0.05 ) ; however , the results showed that the TP group tended to have more complications than the PD group .
Conclusion : This systematic review and meta- analysis suggested that TP may not be as feasible and safe as PD .
However , TP and PD may have the same efficacy