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Total Pancreatectomy With Islet Autotransplantation for Chronic Pancreatitis: the Price Patients Pay for Improvements in Quality of Life
Katherine a. Morgan*1, Stefanie M. Owczarski1, Jeffrey J. Borckardt2, Wendy Balliet2, Hongjun Wang1, David B. Adams1
1Department of Surgery, Medical University of South Carolina, Charleston, SC; 2Department of Psychiatry and Behavioral Medicine, Medical University of South Carolina, Charleston, SC
BACKGROUND: For selected patients with debilitating pain from chronic pancreatitis total pancreatectomy with islet autotransplantation (TPIAT) has been undertaken with recently increased enthusiasm. Safety and efficacy, i.e. "patient-centered cost", of this radical procedure has not been well assessed previously.
METHODS: A retrospective review of a prospectively collected database of patients undergoing TPIAT was undertaken. Perioperative morbidity, quality of life (QOL, SF-12), and insulin use were assessed preoperatively and at 12 and 24 months postoperatively.
RESULTS: One hundred twenty patients (93 women, mean age 41, mean BMI 26.2) underwent TPIAT. Duration of pancreatitisprior to TPIAT averaged 7.6 years (0.5-40). Mean operative time was 237 minutes (75-395), EBL was 618 cc (50-7800), and median islet equivalents transplanted were256,470(969-1,168,725), or 3640IEQ/kg (14-16010). Average length of hospitalization was 12 days. Twelve patients required reoperation in the 30-day post-operative period (10%). Postoperative morbidity overall was 68% and 23% of patients had a complication requiring intervention (Clavien-DindoIIIa or greater). Perioperative mortality was 1.6%. Five patients (4%) died in the follow-up period. Eighty-fivepatients were available for at least 12 monthfollow-up. Physical QOL went from mean 27 preoperatively to 35 and 33 at 12 and 24 months (p=0.001, 0.003)and mental health QOL went from 38 to 42 and 41 (p=0.02, 0.2).Insulin independence was achieved in 26%and 29% at 12 and 24 months respectively.
CONCLUSION: Quality of life is significantly improved in patients who undergo TPIAT for chronic pancreatitis, but with notable costsin postoperative morbidity and diabetes. Improvements in physical and mental QOL are sustained up to two years after surgery.
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