title: Morbidity of total pancreatectomy with islet cell auto-transplantation compared to total pancreatectomy alone.
abstract: BACKGROUND
  In pancreatitis, total pancreatectomy (TP) is an effective treatment for refractory pain. Islet cell auto-transplantation (IAT) may mitigate resulting endocrinopathy. Short-term morbidity data for TP + IAT and comparisons with TP are limited.
  
  
  METHODS
  This study, using 2005-2011 National Surgical Quality Improvement Program data, examined patients with pancreatitis or benign neoplasms. Morbidity after TP alone was compared with that after TP + IAT.
  
  
  RESULTS
  In 126 patients (40%) undergoing TP and 191 (60%) patients undergoing TP + IAT, the most common diagnosis was chronic pancreatitis. Benign neoplasms were present in 46 (14%) patients, six of whom underwent TP + IAT. Patients in the TP + IAT group were younger and had fewer comorbidities than those in the TP group. Despite this, major morbidity was more frequent after TP + IAT than after TP [n = 79 (41%) versus n = 36 (29%); P = 0.020]. Transfusions were more common after TP + IAT [n = 39 (20%) versus n = 9 (7%); P = 0.001], as was longer hospitalization (13 days versus 9 days; P < 0.0001). There was no difference in mortality.
  
  
  CONCLUSIONS
  This study is the only comparative, multicentre study of TP and TP + IAT. The TP + IAT group experienced higher rates of major morbidity and transfusion, and longer hospitalizations. Better data on the longterm benefits of TP + IAT are needed. In the interim, this study should inform physicians and patients regarding the perioperative risks of TP + IAT.
authors.affiliation: Program for Liver, Pancreas and Foregut Tumors, Penn State Cancer Institute, Hershey, PA, USA.
authors.forename: Neil H
authors.initials: NH
authors.lastname: Bhayani
authors.forename: Laura M
authors.initials: LM
authors.lastname: Enomoto
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Miller
authors.forename: Gail
authors.initials: G
authors.lastname: Ortenzi
authors.forename: Jussuf T
authors.initials: JT
authors.lastname: Kaifi
authors.forename: Eric T
authors.initials: ET
authors.lastname: Kimchi
authors.forename: Kevin F
authors.initials: KF
authors.lastname: Staveley-O'Carroll
authors.forename: Niraj J
authors.initials: NJ
authors.lastname: Gusani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001803:Blood Transfusion; D015897:Comorbidity; D005260:Female; D006801:Humans; D016381:Islets of Langerhans Transplantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects* / Q000401:mortality; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D050500:Pancreatitis, Chronic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult