title: Total pancreatectomy with and without islet cell transplantation for chronic pancreatitis: a series of 85 consecutive patients.
abstract: 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.
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, United Kingdom. gg43@le.ac.uk
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Garcea
authors.forename: James
authors.initials: J
authors.lastname: Weaver
authors.forename: John
authors.initials: J
authors.lastname: Phillips
authors.forename: Cristina A
authors.initials: CA
authors.lastname: Pollard
authors.forename: Severine C
authors.initials: SC
authors.lastname: Ilouz
authors.forename: M'balu A
authors.initials: MA
authors.lastname: Webb
authors.forename: David P
authors.initials: DP
authors.lastname: Berry
authors.forename: Ashley R
authors.initials: AR
authors.lastname: Dennison
mesh_terms: 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
chemical_list: D000701:Analgesics, Opioid; D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin