Surgical approach and short-term outcomes in adults and children undergoing total pancreatectomy with islet autotransplantation: A report from the Prospective Observational Study of TPIAT

Nathan, Jaimie D.; Yang, Yi; Eaton, Anne; Witkowski, Piotr; Wijkstrom, Martin; Walsh, Matthew; Trikudanathan, Guru; Singh, Vikesh K.; Schwarzenberg, Sarah Jane; Pruett, Timothy L.; Posselt, Andrew M.; Naziruddin, Bashoo; Mokshagundam, Sri Prakash L.; Morgan, Katherine A.; Lara, Luis F.; Kirchner, Varvara; He, Jin; Gardner, Timothy B.; Freeman, Martin L.; Ellery, Kate; Conwell, Darwin L.; Chinnakotla, Srinath; Beilman, Gregory J.; Ahmad, Syed A.; Abu‐El‐Haija, Maisam; Hodges, James S.; Bellin, Melena D.

doi:10.1016/j.pan.2021.09.011

Cited by 18 publications

(31 citation statements)

References 43 publications

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“…However, selecting suitable patients is critical as, despite islet cell autotransplantation, more than 50% of patients might require lifelong exogenous insulin. Literature on minimally invasive total pancreatectomy is sparse, with variations in technique[ 102 - 105 ]. Blair et al [ 103 ], in 2016, reported the feasibility and safety of laparoscopic total pancreatectomy with islet cell autotransplantation in 20 patients with chronic pancreatitis.…”

Section: Surgical Management Of Chronic Pancreatitismentioning

confidence: 99%

“…In both the laparoscopic series, the pancreatic neck was transected, and two-stage retrieval was used, with the pancreatic head and body retrieved separately[ 102 , 104 ]. However, studies have shown the importance of preserving pancreatic arterial and venous flow until retrieval to reduce warm ischemia time during the pancreatic dissection phase and improve islet yield[ 105 ]. In the robotic series reported by Galvani et al [ 102 ] and Zureikat et al [ 104 ] the feasibility of total pancreatectomy without pancreatic neck transection and preserving vascular flow till the final step to reduce warm ischemia was documented.…”

Section: Surgical Management Of Chronic Pancreatitismentioning

confidence: 99%

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Changing trends in the minimally invasive surgery for chronic pancreatitis

Kalayarasan¹,

Shukla²

2023

World J Gastroenterol

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Chronic pancreatitis is a debilitating pancreatic inflammatory disease characterized by intractable pain resulting in poor quality of life. Conventional management of pancreatic pain consists of a step-up approach with medications and lifestyle modifications followed by endoscopic intervention. Traditionally surgery is reserved for patients who do not improve with other interventions. However, recent studies suggest that early surgical intervention is more beneficial as it can mitigate the progression of the pathological process and prevent loss of pancreatic function. Despite the widespread adoption of minimally invasive approaches in various gastrointestinal surgical disorders, minimally invasive surgery for chronic pancreatitis is slow to evolve. Technical difficulty due to severe inflammatory changes has been the major impediment to the widespread usage of minimally invasive surgery in chronic pancreatitis. With this background, the present review aimed to critically analyze the available evidence on the minimally invasive treatment of chronic pancreatitis. A Pub Med search of all relevant articles was performed using the appropriate keywords, parentheses, and Boolean operators. Most initial laparoscopic series have reported the feasibility of lateral pancreaticojejunostomy, considered an adequate procedure only in a small proportion of patients. The pancreatic head is the pacemaker of pain, so adequate decompression is critical for long-term pain relief. Recent studies have documented the feasibility of minimally invasive duodenum-preserving pancreatic head resection. With improvements in laparoscopic instrumentation and technological advances, minimally invasive surgery for chronic pancreatitis is gaining momentum. However, more high-quality evidence is required to document the superiority of minimally invasive surgery for chronic pancreatitis.

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Section: Surgical Management Of Chronic Pancreatitismentioning

confidence: 99%

Section: Surgical Management Of Chronic Pancreatitismentioning

confidence: 99%

Changing trends in the minimally invasive surgery for chronic pancreatitis

Kalayarasan¹,

Shukla²

2023

World J Gastroenterol

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“…The TPIAT surgical procedure has been described elsewhere. 2,7 A patient is considered for TPIAT only if they have failed to respond adequately to medical and endoscopic therapy (if appropriate) or other surgical procedures. Briefly, the surgical procedure consisted of complete resection of the pancreas through a midline incision.…”

Section: Total Pancreatectomy Islet Isolation and Autologous Transpla...mentioning

confidence: 99%

“…Total pancreatectomy with islet autotransplantation (TPIAT) is considered for children who have intractable recurrent acute or chronic pancreatitis without available alternative therapies. [1][2][3][4][5][6][7] Affected children often have genetic forms of pancreatitis which lead to recurrent episodes of acute pain, chronic pain, repeated hospitalizations, and missed school. 8 Removing the pancreas with total pancreatectomy (TP) can provide long-term pain relief but this comes at the cost of a major morbidity, insulin-dependent diabetes.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Islet graft function by mixed meal tolerance testing is sustained over 4 years in young children undergoing total pancreatectomy with islet autotransplantation

Gnikpingo,

Benson,

Hodges

et al. 2023

Clinical Transplantation

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Children with intractable chronic pancreatitis may require total pancreatectomy with islet autotransplantation (TPIAT) for pain relief. The IAT reduces the severity of post‐ pancreatectomy diabetes. We analyzed 635 mixed meal tolerance tests (MMTT) in 134 children undergoing TPIAT to determine whether superior survival of islet grafts explains higher rates of insulin independence previously reported in young children (n = 52, age 3–11 years) versus adolescents (n = 82, age 12–18 years). For MMTT, children consumed Boost HP and we sampled C‐peptide and glucose repeatedly over 2 h. The trajectory of outcomes before and after TPIAT was compared between children and adolescents using data from pre‐TPIAT and 3, 6 months, 1, 2, 3, and 4 years post‐TPIAT and mixed linear models with a random effect for child. Cox regression was used to analyze time outcomes (e.g., time to first off insulin). Islet mass transplanted, measured as islet equivalents (IEQ), was higher in adolescents (p = .003) but IEQ/kg was higher in young children (p < .001) because of their lower weight. AUC C‐peptide in young children increased somewhat over 4 years, but was stable in adolescents (p = .0013). AUC glucose increased more in adolescents over time post‐TPIAT (p = .0024). Islet function by AUC C‐peptide:AUC glucose ratio was better preserved in young children (p < .001). Adolescents were less likely to wean off insulin (hazard ratio .44 [95% CI .28, .69]). These data support an advantage of young age in islet graft survival after TPIAT. The greater likelihood of insulin independence in young children may be driven by better islet survival after transplant.

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