Improved quality of life following total pancreatectomy and auto-islet transplantation for chronic pancreatitis.
BACKGROUND
Total pancreatectomy (TP) with auto-islet transplant (AIT) is an extreme treatment for chronic pancreatitis, and we reviewed our experience to assess the impact on quality of life (QOL).


METHODS
A prospective cohort study from 2007 through 2010 with pre- and postoperative assessments of the Depression Anxiety Stress Scale, Pain Disability Index, and visual analogue pain scale was performed.


RESULTS
Twenty patients underwent TP-AIT with a median follow-up of 12 months (6.75-24 months). All patients reported moderate (45 %) to severe (55 %) pain prior to surgery. TP-AIT resulted in significant decreases in abdominal pain (p < 0.001), 80 % reporting no or mild pain. Despite pain improvement, only 30 % discontinued narcotics. Improvements in all PDI QOL domains improved from 79 to 90 % (p = 0.002), with greatest improvements seen in those without prior pancreatic surgery, younger patients, and in those with higher levels of preoperative pain. Patients were less affected by depression and anxiety prior to surgery, but 60 and 70 % did show improvement in depression and anxiety, respectively (p = 0.033). Sixteen patients (80 %) required exogenous insulin at last follow-up (mean total dose of insulin 11.6 U/day).


CONCLUSIONS
TP-AIT significantly improves pain and QOL measures in appropriately selected patients with CP.
Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA. walshm@ccf.org
R M
RM
Walsh
J R Aguilar
JR
Saavedra
G
G
Lentz
A D
AD
Guerron
J
J
Scheman
T
T
Stevens
M
M
Trucco
R
R
Bottino
B
B
Hatipoglu
D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D001007:Anxiety / Q000209:etiology; D003131:Combined Modality Therapy; D003863:Depression / Q000209:etiology; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D016381:Islets of Langerhans Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods*; D016577:Pancreaticoduodenectomy; D050500:Pancreatitis, Chronic / Q000150:complications / Q000523:psychology / Q000601:surgery*; D011183:Postoperative Complications / Q000188:drug therapy / Q000517:prevention & control; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology; D014182:Transplantation, Autologous; D016896:Treatment Outcome
D007004:Hypoglycemic Agents; D007328:Insulin