title: Systematic review of total pancreatectomy and islet autotransplantation for chronic pancreatitis.
abstract: BACKGROUND
  Total pancreatectomy and islet autotransplantation (TP/IAT) is a treatment option in a subset of patients with chronic pancreatitis. A systematic review of the literature was performed to evaluate the outcome of this procedure, with an attempt to ascertain when it is indicated.
  
  
  METHODS
  MEDLINE (1950 to present), Embase (1980 to present) and the Cochrane Library were searched to identify studies of outcomes in patients undergoing TP/IAT. Cohort studies that reported the outcomes following the procedure were included. The MOOSE guidelines were used as a basis for this review.
  
  
  RESULTS
  Five studies met the inclusion criteria. The techniques reported for pancreatectomy and islet cell isolation varied between studies. TP/IAT was successful in reducing pain in patients with chronic pancreatitis. Comparing morphine requirements before and after the procedure, two studies recorded significant reductions. Concurrent IAT reduced the insulin requirement after TP; the rate of insulin independence ranged from 46 per cent of patients at 5 years' mean follow-up to 10 per cent at 8 years. The impact on quality of life was poorly reported. The studies reviewed did not provide evidence for optimal timing of TP/IAT in relation to the evolution of chronic pancreatitis.
  
  
  CONCLUSIONS
  This systematic review showed that TP/IAT had favourable outcomes with regard to pain reduction. Concurrent IAT enabled a significant proportion of patients to remain independent of insulin supplementation.
authors.affiliation: Department of Hepatobiliary and Transplant Surgery, Churchill Hospital, Oxford Radcliffe Hospitals NHS Trust, Oxford, UK.
authors.forename: K
authors.initials: K
authors.lastname: Bramis
authors.forename: A N
authors.initials: AN
authors.lastname: Gordon-Weeks
authors.forename: P J
authors.initials: PJ
authors.lastname: Friend
authors.forename: E
authors.initials: E
authors.lastname: Bastin
authors.forename: A
authors.initials: A
authors.lastname: Burls
authors.forename: M A
authors.initials: MA
authors.lastname: Silva
authors.forename: A R
authors.initials: AR
authors.lastname: Dennison
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D016381:Islets of Langerhans Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use; D010180:Pancreatectomy / Q000379:methods*; D050500:Pancreatitis, Chronic / Q000601:surgery*; D014182:Transplantation, Autologous / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D007328:Insulin; D009020:Morphine