title: Results of open and robot-assisted pancreatectomies with autologous islet transplantations: treating chronic pancreatitis and preventing surgically induced diabetes.
abstract: For patients with chronic pancreatitis (CP), standard surgical procedures (eg, partial or total resections, drainage procedures) are inadequate treatment options, because they do not confer pain relief and they leave patients prone to brittle diabetes and hypoglycemia. The combination of total pancreatectomy and islet autotransplantation (TP-IAT), however, can create insulin-independent and pain-free states. At our center, from August 2009 through August 2013, 61 patients with CP underwent either open or robot-assisted TP-IAT. The 30-day mortality rate was 0%. The transplanted islet equivalents per body weight ranged from 10,000 to 17,770. In all, 19% of the patients became insulin independent (after a range of 1-24 months); 27% of patients required <10 units of insulin. Moreover, at 12 months after surgery, 71% of the patients were pain free and no longer required analgesics. Our metabolic outcomes could have been even better if most patients had been referred at an earlier disease stage; instead, ∼80% had already undergone surgical procedures, and 91% had abnormal results on preoperative continuous glucose monitoring tests. Only if patients with CP are referred early for a TP-IAT-rather than being subjected to additional inadequate endoscopic and surgical procedures-can insulin-independent and pain-free states be accomplished in most.
authors.affiliation: Department of Surgery, University of Arizona, Tucson, Arizona; Mel and Enid Zuckerman College of Public Health, Univeristy of Arizona, Tucson, Arizona. Electronic address: rgruessner@surgery.arizona.edu.
authors.forename: R W G
authors.initials: RW
authors.lastname: Gruessner
authors.affiliation: Department of Surgery, University of Arizona, Tucson, Arizona.
authors.forename: R
authors.initials: R
authors.lastname: Cercone
authors.affiliation: Department of Surgery, University of Arizona, Tucson, Arizona.
authors.forename: C
authors.initials: C
authors.lastname: Galvani
authors.affiliation: Department of Surgery, University of Arizona, Tucson, Arizona.
authors.forename: A
authors.initials: A
authors.lastname: Rana
authors.affiliation: Department of Surgery, University of Arizona, Tucson, Arizona.
authors.forename: M
authors.initials: M
authors.lastname: Porubsky
authors.affiliation: Department of Surgery, University of Arizona, Tucson, Arizona.
authors.forename: A C
authors.initials: AC
authors.lastname: Gruessner
authors.affiliation: Department of Surgery, University of Arizona, Tucson, Arizona.
authors.forename: H
authors.initials: H
authors.lastname: Rilo
mesh_terms: D000328:Adult; D000368:Aged; D059350:Chronic Pain / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D016381:Islets of Langerhans Transplantation; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D050500:Pancreatitis, Chronic / Q000150:complications / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D014182:Transplantation, Autologous
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin