Traditional decompressive and/or pancreatic resection procedures have been the cornerstone of operative
therapy for refractory
abdominal pain secondary to
chronic pancreatitis. Management of patients that fail these traditional interventions represents a clinical dilemma.
Salvage therapy with completion
pancreatectomy and islet cell
autotransplantation (CPIAT) is an emerging treatment option for this patient population; however, outcomes after this procedure have not been well-studied.
METHODS: All patients undergoing CPIAT after previous decompressive and/or pancreatic resection for the treatment of
chronic pancreatitis at our institution were identified for inclusion in this single-center observational study. Study end points included islet yield,
narcotic requirements,
glycemic control, and quality of life (QOL). QOL was assessed using the Short Form (SF)-36 health questionnaire.
RESULTS: Sixty-four patients underwent CPIAT as
salvage therapy. The median age at time of CPIAT was 38 years (interquartile range [IQR], 14.7-65.4). The most common etiology of
chronic pancreatitis was idiopathic
pancreatitis (66%; n = 42) followed by genetically linked
pancreatitis (9%; n = 6) and
alcoholic pancreatitis (8%; n = 5). All of these patients had previously undergone prior limited pancreatic resection or decompressive procedure. The majority of patients (50%; n = 32) underwent prior
pancreaticoduodenectomy, whereas the remainder had undergone distal
pancreatectomy (17%; n = 11), Frey (13%; n = 8), Puestow (13%; n = 8), or Berne (8%; n = 5) procedures. Median time from initial surgical intervention to CPIAT was 28.1 months (IQR, 13.6-43.0). All of these patients underwent a successful CPIAT. Mean
operative time was 502.2 minutes with average hospital duration of stay of 13 days. Islet cell isolation was feasible despite previous procedures with a mean islet yield of 331,304 islet cell equivalents, which totaled an islet cell
autotransplantation of 4,737 ± 492 IEQ/kg
body weight. Median patient follow-up was 21.2 months (IQR, 7.9-36.8). Before CPIAT, all patients required a mean of 120.8
morphine equivalent milligrams per day (MEQ/d), which improved to 48.5 MEQ (P < .001 compared with preoperative requirements) at most recent follow-up. Of these patients, 44% (n = 28) achieved
narcotic independence. All patients were able to achieve stable
glycemic control with a mean
insulin requirement of 16 units per day. Of these patients, 20% (n = 13) were
insulin independent after CPIAT. Mean postoperative
glycosylated hemoglobin was 7.8% (range, 4.6-12.5). Islet cell viability was confirmed with endocrine testing and mean
C-peptide levels 6 months after CPIAT were 0.91 ng/mL (range, 0.1-3.0). The SF-36 QOL survey administered postoperatively demonstrated improvement in all tested modules.
CONCLUSION: