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Smoking Negatively Affects Outcomes After Total Pancreatectomy With Islet Autotransplantation
William Lancaster*, David Adams, Katherine a. Morgan
Surgery, Medical University of South Carolina, Charleston, SC
Introduction
Selected patients with pain from chronic pancreatitis (CP) benefit from total pancreatectomy with islet autotransplantation (TPIAT). Recent studies have implicated smoking as an etiologic factor in the development of fibrosing chronic pancreatitis. The effects of smoking on outcomes after TPIAT have not been previously examined.
Methods
Evaluation of a prospectively-collected database of patients undergoing TPIAT from March 2009 to October 2014 was conducted, with particular attention to demographics, smoking status, and outcomes as measured by SF-12 quality of life (QOL). Two-tailed t-tests were used comparing continuous data and Fisher's exact test comparing categorical data.
Results
141 patients (102 women,76%; mean age 40.4years) underwent TPIAT. Forty-four patients were smokers (31%). Patients who smoked had lower preoperative physical quality of life (physQOL) than nonsmokers (25.4vs29.2,p=0.03) as well as lower postoperative physQOL at 1 year(30.4vs37.3, p=0.003). The islets harvested were significantly fewer in smokers (2781 vs. 3860 IE/kg, p=0.05). There was a trend toward lower insulin independence rates in smokers (20,17,11% at 1,2,3 years postoperative vs 32,28,21%, p=0.10).
Conclusions
Smoking is associated with poorer outcomes after TPIAT, including lower physQOL and islet harvest. Smoking cessation should be counseled and smoking might be considered a relative contraindication to TPIAT.
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