Total pancreatectomy with and without islet cell transplantation for chronic pancreatitis: a series of 85 consecutive patients.
OBJECTIVE
This study examined 85 consecutive patients undergoing total pancreatectomy (+/-islet cell transplant), examining pain relief, insulin requirements, and glycemic control postoperatively.


METHODS
A prospective database of all patients undergoing total pancreatectomy for chronic pancreatitis was used to record preoperative and postoperative details from 1996 to 2006.


RESULTS
There were 3 postoperative deaths (1 islet recipient and 2 nonislet patients). The median number of acute admissions for pain fell from 5 to 2 after pancreatectomy, and the median length of stay from 6.2 days to 3.3 days. At 12 months postoperatively, the number of patients on regular opiate analgesia fell from 90.6% to 40.2% and by 5 years to 15.9%. There was a significant reduction in the patients' visual analogue pain score after surgery from 9.7 to 3.7 (P < 0.001). Five patients were insulin independent at 5 years. Median 24-hour insulin requirements were significantly lower in the islet group (15.5 vs 40 units at 5 years postoperatively; P < 0.001).


CONCLUSIONS
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.
Garcea
Giuseppe
G
Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, United Kingdom. gg43@le.ac.uk
Weaver
James
J
Phillips
John
J
Pollard
Cristina A
CA
Ilouz
Severine C
SC
Webb
M'balu A
MA
Berry
David P
DP
Dennison
Ashley R
AR
D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D001786:Blood Glucose / Q000187:drug effects; D019992:Databases as Topic; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use*; D016381:Islets of Langerhans Transplantation / Q000009:adverse effects; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000517:prevention & control; D010147:Pain Measurement; D010180:Pancreatectomy / Q000009:adverse effects; D050500:Pancreatitis, Chronic / Q000150:complications / Q000378:metabolism / Q000401:mortality / Q000601:surgery*; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D000701:Analgesics, Opioid; D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin