title: Total pancreatectomy with islet autotransplantation for chronic pancreatitis: do patients with prior pancreatic surgery have different outcomes?
abstract: Total pancreatectomy with immediate islet autotransplantation (IAT) can be an effective therapy in patients with chronic pancreatitis. Patient selection criteria for radical resection are not well defined. The impact of prior pancreatic surgery on quality of life outcomes in patients  undergoing IAT is evaluated. A retrospective review of a prospectively collected database of patients undergoing pancreatectomy with islet autotransplantation was undertaken. Patients having undergone prior pancreatic resection and/or drainage procedures were compared with those without prior  pancreatic operative history. Sixty-one patients underwent pancreatectomy with IAT for pancreatitis. Twenty-three patients had a prior history of pancreatic surgery (Group S); 38 had no prior history of pancreatic surgery (Group NS). Demographics between the groups were similar. Patients in  Group S took more daily oral morphine equivalents and had a lower psychological quality of life preoperatively. Operative times and blood loss were similar between the patient groups. Islet yields were lower for patients in Group S. Postoperatively, daily insulin requirements at 6 months and  1 year trended higher in Group S. Postoperative quality of life scores at 6 months were improved and similar between the groups. Quality of life metrics continued to improve beyond 1 year of follow-up, with a trend toward greater improvement in the NS Group. Total pancreatectomy for chronic  pancreatitis improves quality of life in patients with and without a prior history of pancreatic surgery. This study demonstrates that IAT without preceding pancreatic surgery may enhance outcomes measured by long term insulin requirements and quality of life.
authors.affiliation: Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Morgan
authors.forename: Tom
authors.initials: T
authors.lastname: Theruvath
authors.forename: Stefanie
authors.initials: S
authors.lastname: Owczarski
authors.forename: David B
authors.initials: DB
authors.lastname: Adams
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage; D004322:Drainage; D005260:Female; D006801:Humans; D007328:Insulin / Q000008:administration & dosage; D016381:Islets of Langerhans Transplantation / Q000379:methods*; D008297:Male; D010180:Pancreatectomy / Q000379:methods*; D050500:Pancreatitis, Chronic / Q000601:surgery*; D011788:Quality of Life; D012086:Reoperation; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D007328:Insulin