Systematic review and meta-analysis of islet autotransplantation after total pancreatectomy in chronic pancreatitis patients [Review]

Wu, Qian; Zhang, Mei; Yao, Qin; Jiang, Ruimei; Cui, Heng; Xu, Xinyu; Yang, Tao; Jiang, Kuirong; Miao, Yi

doi:10.1507/endocrj.ej14-0510

Cited by 42 publications

(27 citation statements)

References 25 publications

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“…Two systematic reviews which carried out metaanalyses reported pooled insulin independence rates of 27% (95% CI: 21-33%) and 28.4% (95% CI: 15.7-46.0) at one year and 21% (95% CI: 16-27%) and 19.7% (95% CI: 5.1-52.6%) at two years, respectively [44,45].…”

Section: Group 4-atypical Presentation Of Cpmentioning

confidence: 99%

The role of surgery in chronic pancreatitis

et al. 2019

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Background Chronic pancreatitis (CP) remains a complex condition resulting in significant morbidity and suffering in patients, often over a long period of time. Treatment is mostly centred on a conservative approach, with a variety of more aggressive options being trialled over the years utilising numerous endoscopic and surgical techniques. Methods This review provides an overview of current treatment options for CP, the literature search was performed via PubMed. Personal experiences from the authors on how to approach the disease from the surgeon's perspective are added. The outline includes pathophysiologic aspects, classifications and patientcentred surgical approaches. Results There has not been a standardized treatment for CP so far as clinical and radiological appearance of the disease have a wide range due to great heterogeneity of this complex disease; therefore, level 1 evidence for treatment of CP remains low. More recently, different approaches to surgical management have been trialled. With personalized surgery, long-term pain relief is achievable in up to 90% with low morbidity. Autologous islet cell transplantation is a feasible option in selected patients to avoid endocrine insufficiency. Conclusion A tailored approach to CP patients is mandatory in this heterogeneous disease. Surgery provides good outcomes especially as prophylaxis for and treatment of chronic pain. A multidisciplinary approach is mandatory, including physicians, pancreatic surgeons, endoscopists, dieticians and radiologists.

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Section: Group 4-atypical Presentation Of Cpmentioning

confidence: 99%

The role of surgery in chronic pancreatitis

et al. 2019

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“…At the same time TP is proposed, with or without simultaneous auto-islet transplantation, for some types of chronic pancreatitis [7] and also for the treatment of locally advanced pancreatic cancer requiring arterial resection and reconstruction [8]. Total pancreatectomy combined with autologous islet transplantation has also been proposed for patients with a high-risk for complications resulting from the pancreatic anastomosis [9].…”

Section: Introductionmentioning

confidence: 99%

Are there still indications for total pancreatectomy?

et al. 2016

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Total pancreatectomy is associated with short- and long-term high complication rate and without evidence of oncologic advantages. Several metabolic consequences are co-related with the apancreatic state. The unstable diabetes related to the total resection of the pancreas expose the patients to short- and long-term life-threatening complications. Severe hypoglycemia is a short-term dangerous complication that can also cause patients’ death. Chronic complications of severe diabetes (cardiac and vascular diseases, neuropathy, nephropathy, and retinopathy) are also cause of morbidity, mortality and worsening of quality of life. For this reasons the number of total pancreatectomies performed has certainly decreased over time. However, today there are still some indications for this kind of procedures. Chronic pancreatitis untreatable with conventional treatments, surgical treatment of precancerous pancreatic lesions, surgical treatment of locally advanced pancreatic cancer and the management of patients with extraordinary high-risk pancreatic texture after pancreaticoduodenectomy represent possible indications for total pancreatectomy and are analyzed in the present paper.

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“…Wu et al reported rates at 1 and 2 years follow-up off 28.4% and 19.7%, respectively. 37,38 Also a clinical dilemma is the treatment of patients with CP and an enlarged pancreatic head. About half of the responder would opt for a PPPD, while the other half would perform an endoscopic treatment first.…”

Section: Discussionmentioning

confidence: 99%