Total Pancreatectomy With and Without Islet Cell Transplantation for Chronic Pancreatitis

Abstract

Total pancreatectomy is effective in reducing pain and dependence on opioid analgesia in patients with chronic pancreatitis. The addition of an islet cell transplant results in a reduction in 24-hour insulin demands, as well as potentially achieving insulin independence.

Systematic review of total pancreatectomy and islet autotransplantation for chronic pancreatitis

“…Notably, the duration of chronic pancreatitis before treatment was not recorded in any of the included studies. Apart from clinical criteria, computed tomography, magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography were used in the preoperative assessment of severity and grading of chronic pancreatitis in most studies 10,12,14 . Two studies reported the patients' preoperative morphine requirement 12,14 .…”

“…On the other hand, it has been shown that purification decreases the number of islets recovered and at least 40 per cent of islet cell mass is lost during purification 14 . Ong and co-workers 28 reported that islet purification is not a compulsory step, and purification should be weighed against wastage of islet cells.…”

“…The insulin independence rate ranged from 46 per cent of patients at a mean followup of 5 years 13 to 10 per cent at 8 years 14 .…”

“…However, it is now recognized that this is associated with duodenal ischaemia as the pancreaticoduodenal vascular arcade becomes compromised. Only Garcea and colleagues 14 use of spleen-preserving, pylorus-sparing pancreatectomy. Splenic vein thrombosis is, however, common in the spleen-preserving procedure.…”

Systematic review and meta-analysis of islet autotransplantation after total pancreatectomy in chronic pancreatitis patients [Review]

“…In addition, Garcea et al reported lower HbA1c in the islet cell group [18]. Although there was no statistical significance between the islet and nonislet groups, patients receiving IAT had a significantly lower insulin requirement for a long time (60 months), the detail data was shown in their previous article [19]. C-peptide level at 6 month was reported by two studies with mean being 1.7 ng/mL (SD 0.57 ng/mL) [12], 1.4 ng/mL (SD 0.36 ng/mL) [14], respectively.…”