Pancreatic Resection with Islet Cell Autotransplant for the Treatment of Severe Chronic Pancreatitis

Abstract

Pancreatic resection can alleviate pain in properly selected patients with severe chronic pancreatitis (CP), although the apancreatic state causes “brittle” diabetes. Islet auto-transplantation (IAT) after resection can decrease diabetes-related morbidity. Twenty-six consecutive patients with CP who underwent 27 pancreatic resections with IAT from April 2005 to December 2007 were evaluated in this retrospective case control study. Data were collected by chart and operative note reviews and query of hospital databases. Subgroup analysis was performed on 21 cases of total pancreatectomy and six cases of pancreaticoduodenectomy (PD). Mean age was 43.8 years and 46.2 per cent of patients were female. The most common etiology of CP was alcoholism (34.6%), followed by idiopathic causes (30.8%) and pancreatic divisum (23.1%). There was no mortality and the complication rate was 56 per cent. Islet equivalents infused and islet equivalents/gram of pancreas were 82,094 and 2,739 respectively. Mean discharge insulin dose was 10.7 units/day. Mean follow-up was 6.5 months. At 6 months, 80 per cent of patients reporting had decreased or eliminated their use of narcotic medication and all total pancreatectomy patients required insulin (mean 23 units/day). In appropriately selected patients, pancreatic resection with IAT is safe and effective for the treatment of intractable pain associated with CP.

Total pancreatectomy with islet autotransplantation: an overview

“…Higher islet equivalents per kilogram of body weight have been shown to correlate with insulin independence 15,41 although the correlation is not as straightforward as long‐term insulin independence had been demonstrated in patients who received as little as 882 IEQs/kg body weight 44 . In addition, a significant proportion of patients who are not insulin independent after islet autotransplantation only require very small amounts of exogenous insulin to achieve excellent control of their blood sugar 3,12,20,41 …”

“…The Leicester, Minnesota, Cincinnati and Alabama groups have all adopted a multidisciplinary approach in the patient selection process for total pancreatectomy with/without islet autotransplantation 3,5,12,13 Table 1. shows the basic demographics of the patients who underwent pancreatectomy and islet autotransplantation in these centres.…”

“…Treatment options are limited but include extensive surgery in an attempt to remove or dramatically reduce symptoms, less invasive endoscopic procedures which aim to alleviate chronic pain and medical management which encompasses analgesia and regional blocks (with almost inevitable symptom recurrence). Total pancreatectomy, although a radical approach, is occasionally the only treatment option that can provide complete relief in these patients 3 . The indications for the operation include patients with small duct disease without focal abnormalities or those in whom an endoscopic drainage procedure or previous resectional surgery have failed to relieve pain 4,5 .…”

Autotransplantation of culture-positive islet product: is dirty always bad?

“…Total pancreatectomy has received renewed interest in centres worldwide as a method of alleviating pain and improving quality of life in patients with CP in whom other options (endoscopic or lesser surgical interventions) have failed . As prolonged CP can lead to the destruction of islets for autotransplantation with risk for beta cell apoptosis, early intervention with TPIAT has been considered for better islet yields .…”

Percutaneous transhepatic islet cell autotransplantation after pancreatectomy for chronic pancreatitis: a novel approach

“…Islet autotransplantation, pioneered at the University of Minnesota, has been performed at several centres with good outcomes 11–17 . The most common method of islet infusion involves intraoperative infusion through a direct branch of the portal vein or superior mesenteric vein.…”