BACKGROUND: Best practice to select patients with chronic pancreatitis for surgical management with total pancreatectomy with islet autotransplantation (TPIAT) is in evolution as new discoveries are made in the pathogenesis of chronic pancreatitis. STUDY DESIGN: A prospectively maintained database of patients undergoing TPIAT was reviewed. Islet function was inferred from daily insulin requirement. Pain relief was evaluated by healthcare use and narcotic use. Quality of life (QOL) was measured with the RAND 12-Item Short Form Survey. RESULTS: One hundred and ninety-five patients (141 women, aged 40.3 years, BMI 26.5 kg/m2) underwent TPIAT. Mean duration of disease before operation was 8.1 years. Fifty-six (29%) patients had pancreatic operations before TPIAT, 37 (19%) patients were diabetic preoperatively, and 52 (27%) patients were smokers. A mean of 3,253 islet equivalents transplanted/kg were harvested. Insulin independence was achieved in 29%, 28%, and 23% of patients at 1, 2, and 5 years postoperative. Nonsmokers with a shorter duration of chronic pancreatitis and no earlier pancreas operation were more likely to be insulin free. Median number of preoperative emergency department visits and hospitalizations were 6.6 and 4.3 annually, respectively, compared with 0 at 1, 2, and 5 years postoperative. Median oral morphine equivalents were 214 mg/kg preoperation and 60, 64, 69, at 1, 2, 5 years postoperative. Preoperative, 1, 2, 5 years postoperative QOL scores were 29, 36, 34, and 33 (physical; p < 0.01) and 39, 44, 42, and 42 (mental health; p < 0.02). Genetic pancreatitis patients were more often narcotic free and had better QOL than patients with pancreatitis of other causes. At 5 years, overall survival was 92.3%. CONCLUSIONS: Total pancreatectomy with islet autotransplantation is a durable operation, with islet function, pain relief, and QOL improvements persisting to 5 years postoperative. Patients with genetic pancreatitis, short duration of disease, and nonsmokers have superior outcomes.
BACKGROUND: Best practice to select patients with chronic pancreatitis for surgical management with total pancreatectomy with islet autotransplantation (TPIAT) is in evolution as new discoveries are made in the pathogenesis of chronic pancreatitis. STUDY DESIGN: A prospectively maintained database of patients undergoing TPIAT was reviewed. Islet function was inferred from daily insulin requirement. Pain relief was evaluated by healthcare use and narcotic use. Quality of life (QOL) was measured with the RAND 12-Item Short Form Survey. RESULTS: One hundred and ninety-five patients (141 women, aged 40.3 years, BMI 26.5 kg/m2) underwent TPIAT. Mean duration of disease before operation was 8.1 years. Fifty-six (29%) patients had pancreatic operations before TPIAT, 37 (19%) patients were diabetic preoperatively, and 52 (27%) patients were smokers. A mean of 3,253 islet equivalents transplanted/kg were harvested. Insulin independence was achieved in 29%, 28%, and 23% of patients at 1, 2, and 5 years postoperative. Nonsmokers with a shorter duration of chronic pancreatitis and no earlier pancreas operation were more likely to be insulin free. Median number of preoperative emergency department visits and hospitalizations were 6.6 and 4.3 annually, respectively, compared with 0 at 1, 2, and 5 years postoperative. Median oral morphine equivalents were 214 mg/kg preoperation and 60, 64, 69, at 1, 2, 5 years postoperative. Preoperative, 1, 2, 5 years postoperative QOL scores were 29, 36, 34, and 33 (physical; p < 0.01) and 39, 44, 42, and 42 (mental health; p < 0.02). Genetic pancreatitispatients were more often narcotic free and had better QOL than patients with pancreatitis of other causes. At 5 years, overall survival was 92.3%. CONCLUSIONS: Total pancreatectomy with islet autotransplantation is a durable operation, with islet function, pain relief, and QOL improvements persisting to 5 years postoperative. Patients with genetic pancreatitis, short duration of disease, and nonsmokers have superior outcomes.
Authors: Jaimie D Nathan; Yi Yang; Anne Eaton; Piotr Witkowski; Martin Wijkstrom; Matthew Walsh; Guru Trikudanathan; Vikesh K Singh; Sarah J Schwarzenberg; Timothy L Pruett; Andrew Posselt; Bashoo Naziruddin; Sri Prakash Mokshagundam; Katherine Morgan; Luis F Lara; Varvara Kirchner; Jin He; Timothy B Gardner; Martin L Freeman; Kate Ellery; Darwin L Conwell; Srinath Chinnakotla; Gregory J Beilman; Syed Ahmad; Maisam Abu-El-Haija; James S Hodges; Melena D Bellin Journal: Pancreatology Date: 2021-09-29 Impact factor: 3.996
Authors: Srinath Chinnakotla; Gregory J Beilman; David Vock; Martin L Freeman; Varvara Kirchner; Ty B Dunn; Timothy L Pruett; Stuart K Amateau; Guru Trikudanathan; Sarah J Schwarzenberg; Elissa Downs; Matthew Armfield; Karthik Ramanathan; David E R Sutherland; Melena D Bellin Journal: Ann Surg Date: 2022-06-28 Impact factor: 13.787
Authors: Stefan Ludwig; Marius Distler; Undine Schubert; Janine Schmid; Henriette Thies; Thilo Welsch; Sebastian Hempel; Torsten Tonn; Jürgen Weitz; Stefan R Bornstein; Barbara Ludwig Journal: Commun Med (Lond) Date: 2022-03-03
Authors: Luis F Lara; Solvejg Wastvedt; James S Hodges; Piotr Witkowski; Martin Wijkstrom; R Matthew Walsh; Vikesh K Singh; Sarah J Schwarzenberg; Timothy L Pruett; Andrew Posselt; Bashoo Naziruddin; Jaimie D Nathan; Katherine A Morgan; Rebecca Mitchell; Varvara A Kirchner; SriPrakash L Mokshagundam; Betul Hatipoglu; Timothy B Gardner; Martin L Freeman; Srinath Chinnakotla; Gregory J Beilman; Maisam Abu-El-Haija; Darwin L Conwell; Melena D Bellin Journal: Pancreas Date: 2021-07-01 Impact factor: 3.243
Authors: Dhiraj Yadav; Tonya M Palermo; Anna E Phillips; Melena D Bellin; Darwin L Conwell Journal: Curr Opin Gastroenterol Date: 2021-09-01 Impact factor: 2.741