Outcomes of total pancreatectomy with islet autotransplantation: A systematic review and meta-analysis

Abstract

BACKGROUND Despite the increased use of total pancreatectomy with islet autotransplantation (TPIAT), systematic evidence of its outcomes remains limited. AIM To evaluate the outcomes of TPIAT. METHODS We searched PubMed, EMBASE, and Cochrane databases from inception through March 2019 for studies on TPIAT outcomes. Data were extracted and analyzed using comprehensive meta-analysis software. The random-effects model was used for all variables. Heterogeneity was assessed using the I 2 measure and Cochrane Q-statistic. Publication bias was assessed using Egger’s test. RESULTS Twenty-one studies published between 1980 and 2017 examining 1011 patients were included. Eighteen studies were of adults, while three studied pediatric populations. Narcotic independence was achieved in 53.5% [95% Confidence Interval (CI): 45-62, P < 0.05, I 2 = 81%] of adults compared to 51.9% (95%CI: 17-85, P < 0.05, I 2 = 84%) of children. Insulin-independence post-procedure was achieved in 31.8% (95%CI: 26-38, P < 0.05, I 2 = 64%) of adults with considerable heterogeneity compared to 47.7% (95%CI: 20-77, P < 0.05, I 2 = 82%) in children. Glycated hemoglobin (HbA 1C ) 12 mo post-surgery was reported in four studies with a pooled value of 6.76% ( P = 0.27). Neither stratification by age of the studied population nor meta-regression analysis considering both the study publication date and the islet-cell-equivalent/kg weight explained the marked heterogeneity between studies. CONCLUSION These results indicate acceptable success for TPIAT. Future studies should evaluate the discussed measures before and after surgery for comparison.

Nutrition challenges following total pancreatectomy with islet autotransplantation

“…As illustrated in Table 2, case series have shown that TP decreases the amount of pain that the patients experience 2,19‐24 . Additionally, in a meta‐analysis by Khazaaleh et al, 21 studies from 1980 to 2017 including 1011 patients revealed that narcotic independence was achieved in 53.5% of adults after TPIAT 25 . The degree of narcotic independence and the time it takes for patients to reduce their narcotic usage tends to be specific to each patient.…”

“…2,[19][20][21][22][23][24] Additionally, in a metaanalysis by Khazaaleh et al, 21 studies from 1980 to 2017 including 1011 patients revealed that narcotic independence was achieved in 53.5% of adults after TPIAT. 25 The degree of narcotic independence and the time it takes for patients to reduce their narcotic usage tends to be specific to each patient. However, reduction in narcotic usage after TPIAT has been associated with increased postoperative narcotic use, previous pancreatic stent placement, early sphincterotomy, and a high number of previous stents.…”

Management of chronic pancreatitis: recent advances and future prospects

“…It showed that 31.8% of adult patients and 47.7 children patients were insulin-independent after TPIAP. 104 As for the quality of life, Takaki et al from Japan evaluated the efficacy of TPIAP among five patients with CP followed-up for 12 months and found a significant improvement in quality of life among these patients. 105 …”