title: Total pancreatectomy with islet cell autotransplantation as the initial treatment for minimal-change chronic pancreatitis.
abstract: OBJECTIVE
  Patients with minimal-change chronic pancreatitis (MCCP) are traditionally managed medically with poor results. This study was conducted to review outcomes following total pancreatectomy with islet cell autotransplantation (TP/IAT) as the initial surgical procedure in the treatment of MCCP.
  
  
  METHODS
  All patients submitted to TP/IAT for MCCP were identified for inclusion in a single-centre observational study. A retrospective chart review was performed to identify pertinent preoperative, perioperative and postoperative data.
  
  
  RESULTS
  A total of 84 patients with a mean age of 36.5 years (range: 15-60 years) underwent TP/IAT as the initial treatment for MCCP. The most common aetiology of chronic pancreatitis in this cohort was idiopathic (69.0%, n = 58), followed by aetiologies associated with genetic mutations (16.7%, n = 14), pancreatic divisum (9.5%, n = 8), and alcohol (4.8%, n = 4). The most common genetic mutations pertained to CFTR (n = 9), SPINK1 (n = 3) and PRSS1 (n = 2). Mean ± standard error of the mean preoperative narcotic requirements were 129.3 ± 18.7 morphine-equivalent milligrams (MEQ)/day. Overall, 58.3% (n = 49) of patients achieved narcotic independence and the remaining patients required 59.4 ± 10.6 MEQ/day (P < 0.05). Postoperative insulin independence was achieved by 36.9% (n = 31) of patients. The Short-Form 36-Item Health Survey administered postoperatively demonstrated improvement in all tested quality of life subscales.
  
  
  CONCLUSIONS
  The present report represents one of the largest series demonstrating the benefits of TP/IAT in the subset of patients with MCCP.
authors.affiliation: Department of Surgery, University of Cincinnati Pancreatic Disease Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: Gregory C
authors.initials: GC
authors.lastname: Wilson
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Sutton
authors.forename: Milton T
authors.initials: MT
authors.lastname: Smith
authors.forename: Nathan
authors.initials: N
authors.lastname: Schmulewitz
authors.forename: Marzieh
authors.initials: M
authors.lastname: Salehi
authors.forename: Kyuran A
authors.initials: KA
authors.lastname: Choe
authors.forename: John E
authors.initials: JE
authors.lastname: Brunner
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Abbott
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Sussman
authors.forename: Syed A
authors.initials: SA
authors.lastname: Ahmad
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016381:Islets of Langerhans Transplantation / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010149:Postoperative Pain / Q000188:drug therapy / Q000503:physiopathology; D010180:Pancreatectomy / Q000379:methods* / Q000401:mortality; D050500:Pancreatitis, Chronic / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult