BACKGROUND: Pancreatectomy or drainage has been advocated for pain due to chronic pancreatitis. Islet cell autotransplantation (IAT) may improve quality of life (QOL); optimal patient selection has not been established. STUDY DESIGN: Outcomes of 100 patients who underwent pancreatectomy with islet isolation between 2005 and 2012 were assessed by etiology (alcoholic pancreatitis [AP] 30%, and nonalcoholic pancreatitis [NAP] 70%). Insulin requirement, Short Form-36, and McGill Pain Questionnaires were assessed. Data were analyzed using SASv9.2. RESULTS: Of the 100 patients, isolation was unsuccessful in 9 patients due to fibrosis. Alcoholic pancreatitis was associated with 7 of 9 failed isolations (23% vs 3%, p < 0.01), and all of these patients are now diabetic. Ninety-one patients (age 44 years, follow-up 19 months, 23% AP) underwent resection with IAT. Total islet yield (islet cell equivalents [IEQ]) and IEQ/kg body weight were less for patients with AP (81,000 vs 150,000, p < 0.01; 1,260 vs 2,190, respectively, p = 0.01) overall and more specifically, for total pancreatectomy (92,000 vs 188,000, respectively, p = 0.02). Twenty-eight (34%) of all patients who had resections and 15% of those undergoing total pancreatectomy are insulin free. Multivariate analysis identified AP as an independent predictor of insulin units/day (p = 0.01). Complete pre- and postoperative QOL and pain surveys were available on 69 patients. Patients with AP had less QOL improvement (1 of 8 vs 5 of 8 domains, p < 0.01) and "present pain" improvement at 2 years from preoperative levels in those with NAP; no improvement in QOL was seen in those with AP (NAP 2.7 to 1.2, p < 0.01; AP 2.7 to 2.2, p > 0.05). CONCLUSIONS: After pancreatic resection with planned IAT, AP resulted in failed isolations, lower yields, higher insulin requirements, poor long-term QOL improvement, and no improvement in pain scores compared with NAP. Further studies should define criteria for resection and IAT for patients with alcoholic chronic pancreatitis.
BACKGROUND: Pancreatectomy or drainage has been advocated for pain due to chronic pancreatitis. Islet cell autotransplantation (IAT) may improve quality of life (QOL); optimal patient selection has not been established. STUDY DESIGN: Outcomes of 100 patients who underwent pancreatectomy with islet isolation between 2005 and 2012 were assessed by etiology (alcoholic pancreatitis [AP] 30%, and nonalcoholic pancreatitis [NAP] 70%). Insulin requirement, Short Form-36, and McGill Pain Questionnaires were assessed. Data were analyzed using SASv9.2. RESULTS: Of the 100 patients, isolation was unsuccessful in 9 patients due to fibrosis. Alcoholic pancreatitis was associated with 7 of 9 failed isolations (23% vs 3%, p < 0.01), and all of these patients are now diabetic. Ninety-one patients (age 44 years, follow-up 19 months, 23% AP) underwent resection with IAT. Total islet yield (islet cell equivalents [IEQ]) and IEQ/kg body weight were less for patients with AP (81,000 vs 150,000, p < 0.01; 1,260 vs 2,190, respectively, p = 0.01) overall and more specifically, for total pancreatectomy (92,000 vs 188,000, respectively, p = 0.02). Twenty-eight (34%) of all patients who had resections and 15% of those undergoing total pancreatectomy are insulin free. Multivariate analysis identified AP as an independent predictor of insulin units/day (p = 0.01). Complete pre- and postoperative QOL and pain surveys were available on 69 patients. Patients with AP had less QOL improvement (1 of 8 vs 5 of 8 domains, p < 0.01) and "present pain" improvement at 2 years from preoperative levels in those with NAP; no improvement in QOL was seen in those with AP (NAP 2.7 to 1.2, p < 0.01; AP 2.7 to 2.2, p > 0.05). CONCLUSIONS: After pancreatic resection with planned IAT, AP resulted in failed isolations, lower yields, higher insulin requirements, poor long-term QOL improvement, and no improvement in pain scores compared with NAP. Further studies should define criteria for resection and IAT for patients with alcoholic chronic pancreatitis.
Authors: Noaman Ali; Colin O'Rourke; Kevin El-Hayek; Sricharan Chalikonda; D Rohan Jeyarajah; R Matthew Walsh Journal: HPB (Oxford) Date: 2014-12-29 Impact factor: 3.647
Authors: Melena D Bellin; Andres Gelrud; Guillermo Arreaza-Rubin; Ty B Dunn; Abhinav Humar; Katherine A Morgan; Bashoo Naziruddin; Cristiana Rastellini; Michael R Rickels; Sarah J Schwarzenberg; Dana K Andersen Journal: Pancreas Date: 2014-11 Impact factor: 3.327
Authors: Michelle A Anderson; Venkata Akshintala; Kathryn M Albers; Stephen T Amann; Inna Belfer; Randall Brand; Suresh Chari; Greg Cote; Brian M Davis; Luca Frulloni; Andres Gelrud; Nalini Guda; Abhinav Humar; Rodger A Liddle; Adam Slivka; Rachelle Stopczynski Gupta; Eva Szigethy; Jyothsna Talluri; Wahid Wassef; C Mel Wilcox; John Windsor; Dhiraj Yadav; David C Whitcomb Journal: Pancreatology Date: 2015-11-11 Impact factor: 3.996
Authors: Gregory C Wilson; Jeffrey M Sutton; Milton T Smith; Nathan Schmulewitz; Marzieh Salehi; Kyuran A Choe; John E Brunner; Daniel E Abbott; Jeffrey J Sussman; Syed A Ahmad Journal: HPB (Oxford) Date: 2014-10-09 Impact factor: 3.647
Authors: Melena D Bellin; Martin L Freeman; Andres Gelrud; Adam Slivka; Alfred Clavel; Abhinav Humar; Sarah J Schwarzenberg; Mark E Lowe; Michael R Rickels; David C Whitcomb; Jeffrey B Matthews; Stephen Amann; Dana K Andersen; Michelle A Anderson; John Baillie; Geoffrey Block; Randall Brand; Suresh Chari; Marie Cook; Gregory A Cote; Ty Dunn; Luca Frulloni; Julia B Greer; Michael A Hollingsworth; Kyung Mo Kim; Alexander Larson; Markus M Lerch; Tom Lin; Thiruvengadam Muniraj; R Paul Robertson; Seth Sclair; Shalinender Singh; Rachelle Stopczynski; Frederico G S Toledo; Charles Melbern Wilcox; John Windsor; Dhiraj Yadav Journal: Pancreatology Date: 2013-11-13 Impact factor: 3.996
Authors: Srinath Chinnakotla; Gregory J Beilman; Ty B Dunn; Melena D Bellin; Martin L Freeman; David M Radosevich; Mustafa Arain; Stuart K Amateau; J Shawn Mallery; Sarah J Schwarzenberg; Alfred Clavel; Joshua Wilhelm; R Paul Robertson; Louise Berry; Marie Cook; Bernhard J Hering; David E R Sutherland; Timothy L Pruett Journal: Ann Surg Date: 2015-10 Impact factor: 12.969