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Background: Quality of life studies after pancreatic resection and islet cell autotransplantation have shown improvement and already been published. Mortality rates have improved, but morbidity remains high after pancreatic operations, in particular total pancreatectomy (TP) and pancreaticoduodenectomy (PD). Few studies have evaluated outcomes after pancreatic operations specifically for chronic pancreatitis, with or without islet cell autotransplantation (IAT), and compared these to operations for pancreatic cancer.

Methods: A retrospective review for patients undergoing operation for chronic pancreatitis from 2005-2011 by a single surgeon at an academic center. Morbidity was evaluated to 90 days according to the Clavien Classification (CC). Patients undergoing pancreatic resection with IAT were evaluated as a subgroup. Both groups were compared to those undergoing similar operations for pancreatic cancer. Statistical analysis was applied.

Results: Of the 200 patients (55% men, mean age 49 years), ninety-eight underwent resection alone (65 PD, 27 distal (DP) and 6 TP)), 67 underwent resection with IAT (47 TP, 18 PD, 2 DP), and 22 underwent drainage with lateral pancreaticojejunostomy (LPJ). There was no mortality; however, the overall morbidity rate was 55% (CC 1 - 5) and 29% of these experienced a more severe complication requiring intervention (CC 3-4). Severe complications (CC3 - 4) occurred more commonly after TP (29%) than DP (28%), LPJ (10%), or PD (10%) (p < 0.01). Resections with IAT did not have a higher overall (66% v. 53%) (p > 0.05) nor severe (20% v. 16%) complication rate than those without IAT (p > 0.05). Specifically looking at PD with and without IAT, length of stay (14 v. 10) and complication rate (72% v. 46%) appeared to be higher, but neither reached statistical significance (both p > 0.05). There was no difference in complication rate between TP-IAT and PD-IAT (67% v. 72%) (p > 0.05). Overall (CC1-5) and severe (CC3-4) complication rate was similar when all pancreatic resections with IAT (65% and 20%) and those without IAT (53% and 16%) were compared to those undergoing PD for pancreatic cancer (n = 133, 65% and 20%) (all p > 0.05). Reoperation for bleeding after IAT was not different than after PD for pancreatic cancer (p >0.05). Partial portal vein thrombosis (4%)after IAT and had no long term sequelae.

Conclusions: Operations for chronic pancreatitis are well established and pose no greater risk than resections, specifically PD, for malignancy. Complication rates remain formidable and mortality rates are low. Improvements to quality of life after IAT have been documented; furthermore, the addition of IAT to resections for chronic pancreatitis adds no risk when compared to those for malignancy. At institutions with capability, IAT should be offered to patients during resection for chronic pancreatitis.