Patient outcomes after total pancreatectomy: a single centre contemporary experience

Abstract

TP results in significant metabolic derangements and exocrine insufficiency, diabetic control and weight maintenance remain a challenge and readmission rates are high. Survival in those with malignant disease remains poor. However, the mortality appears to be decreasing and the morbidities associated with TP appear acceptable compared with the benefits of resection in selected patients.

Total Pancreatectomy and Islet Autotransplantation for Chronic Pancreatitis

“…It should also be mentioned that exocrine deficiency can be a serious problem after TP, with or without an IAT (Stauffer et al, 2009), and unpredictable absorption can make diabetic management more difficult . Exocrine deficiency has more of an impact on diabetic management after TP in those who do not than those that do have an IAT, especially those who are insulin-independent.…”

“…Pancreas resection is indicated in CP patients who have small-duct disease or those in whom endoscopic drainage fail, ideally with an IAT but many centers do or have done TP without an IAT (Behrman & Mulloy, 2006;Casadei et al, 2010a;Casadei et al, 2010b;Fujino Y et al, 2009;Gruessner et al, 2008;Janot et al, 2010;Muller et al, 2007;Stauffer et al, 2009). A TP is the most likely operation to relieve pain, and for CP patients who are already diabetic, there is little reason not to do it.…”

“…There are many articles on surgical technique of TP (with or without IAT) and the complications there of and these should be read by all who perform such surgery (Behrman & Mulloy, 2006;Casadei et al, 2009;Casadei et al, 2010a;Casadei et al, 2010b;Fujino Y et al, 2009;Janot et al, 2010;Muller et al, 2007;Murphy et al, 2009;Parsaik et al, 2010;Simons et al, 2009;Stauffer et al, 2009). In addition, there are recent reports of pancretectomy done laproscopically, either hand assisted (Kitasato et al, 2011) or using the DaVinci Robotic Device (Giulianotti et al, 2009;Giulianotti et al, 2011), with the first TP-IAT for CP done at the University of Minnesota in 2008 (Marquez et al, 2010) .…”

“…The main rationale from the beginning, however, was to relieve the pain of CP in patients in whom other measures had failed (Morrow et al, 1984), and to preserve beta (ß)-cell mass and insulin secretory capacity in order to prevent or minimize the otherwise inevitable surgical diabetes (Blondet et al, 2007;Najarian et al, 1980). Surgical diabetes is often described as brittle (Pezzilli, 2006), in part because of erratic food absorption from exocrine deficiency (Stauffer et al, 2009), but there are reports where metabolic parameters after TP are similar to patients with type 1 diabetes (Fujino et al, 2009). …”

“…al , 2004) neoplasias, as well as for acute relapsing pancreatitis (ARP) before evolution to CP occurs (Sutherland et al, 2011a), the major application of TP-IAT has been in patients who have CP and intractable pain (Blondet et al, 2007;Carlson et al, 2007;Dong et al, 2011;Hermann et al, 2010;Matsumoto, 2011;Onaca et al, 2007;Ong et al, 2009;Robertson, 2010a;Sutherland et al, 2011a). TP, with or without (Behrman & Mulloy, 2006;Casadei et al, 2010a;Casadei et al, 2010b;Fujino Y et al, 2009;Gruessner et al, 2008;Heidt et al, 2007;Janot et al, 2010;Muller et al, 2007;Mullhaupt & Ammann, 2010;Stauffer et al, 2009) IAT, may appear to be a radical treatment, but for the CP patients in whom it is done, the alternative is even more radical: persistent pain and/or lifetime narcotic use (Ahmad et al, 2005;Braganza et al, 2011;Gachago & Draganov, 2008;Mullhaupt & Ammann, 2010). Thus, an appreciation of the spectrum of the disease, the inconsistency in correlation between imaging and gross and microscopic pathology results and the degree of pain, and the various mechanisms by which CP causes pain are relevant for patient selection and for interpretation of the outcomes in the TP-IAT series reviewed here.…”