Total pancreatectomy with islet cell autotransplantation as the initial treatment for minimal-change chronic pancreatitis. Issue 3 (March 2015)

• Record Type: Journal Article
• Authors: Wilson, Gregory C.; Sutton, Jeffrey M.; Smith, Milton T.; Schmulewitz, Nathan; Salehi, Marzieh; Choe, Kyuran A.; Brunner, John E.; Abbott, Daniel E.; Sussman, Jeffrey J.; Ahmad, Syed A.
• Is Part Of: HPB. Volume 17:Issue 3(2015:Mar.)
• Page Start: 232
• Page End: 238
• Publication Date: 2015-03
• Subjects: Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 616.362005
• DOI: 10.1111/hpb.12341
• Languages: English
• ISSNs: 1365-182X

Abstract

Abstract: Objectives: Patients with minimal-change chronic pancreatitis (MCCP) are traditionally managed medically with poor results. This study was conducted to review outcomes following total pancreatectomy with islet cell autotransplantation (TP/IAT) as the initial surgical procedure in the treatment of MCCP. Methods: All patients submitted to TP/IAT for MCCP were identified for inclusion in a single-centre observational study. A retrospective chart review was performed to identify pertinent preoperative, perioperative and postoperative data. Results: A total of 84 patients with a mean age of 36.5 years (range: 15–60 years) underwent TP/IAT as the initial treatment for MCCP. The most common aetiology of chronic pancreatitis in this cohort was idiopathic (69.0%, n = 58), followed by aetiologies associated with genetic mutations (16.7%, n = 14), pancreatic divisum (9.5%, n = 8), and alcohol (4.8%, n = 4). The most common genetic mutations pertained to CFTR ( n = 9), SPINK1 ( n = 3) and PRSS1 ( n = 2). Mean ± standard error of the mean preoperative narcotic requirements were 129.3 ± 18.7 morphine-equivalent milligrams (MEQ)/day. Overall, 58.3% ( n = 49) of patients achieved narcotic independence and the remaining patients required 59.4 ± 10.6 MEQ/day ( P < 0.05). Postoperative insulin independence was achieved by 36.9% ( n = 31) of patients. The Short-Form 36-Item Health Survey administered postoperatively demonstrated improvement in all tested quality of life subscales. Conclusions: The present report represents one of the largest series demonstrating the benefits of TP/IAT in the subset of patients with MCCP.