Systematic review of total pancreatectomy and islet autotransplantation for chronic pancreatitis

Abstract

Background: Total pancreatectomy and islet autotransplantation (TP/IAT) is a treatment option in a subset of patients with chronic pancreatitis. A systematic review of the literature was performed to evaluate the outcome of this procedure, with an attempt to ascertain when it is indicated. The impact on quality of life was poorly reported. The studies reviewed did not provide evidence for optimal timing of TP/IAT in relation to the evolution of chronic pancreatitis. Conclusion:This systematic review showed that TP/IAT had favourable outcomes with regard to pain reduction. Concurrent IAT enabled a significant proportion of patients to remain independent of insulin supplementation.

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

“…As a latest systematic review conducted by K. Bramis which included five studies showed that, TP/IAT had favourable outcomes of pain reduction and can enabled a large proportion of patients to remain insulin independent [25], we recommend more centers to do this procedure to promote the development of the technology.…”

Total Pancreatectomy for Pancreatic Pathology: Contraindication or Privileged Indication?

“…TP has been considered as a potential option in the management of chronic pancreatitis refractory to treatment, locally advanced pancreatic cancer, multifocal or recurrent exocrine and endocrine tumours [1][2][3][4][5][6]. In addition to this, surgeons have carried out TP to treat or avoid perioperative complications, arising from pancreatic anastomotic insufficiency with or without bleeding, following pancreaticoduodenectomy or distal pancreatectomy [3,4].…”

“…These complications may occur increasingly, while dealing with a soft pancreas during primary surgery, which may prompt some surgeons to opt for TP [4,7]. However the concern has been, about the management of these patients in a pancreatic state, with its attendant total endocrine and exocrine insufficiency [1][2][3][4][5]. This includes the complete insulin deficiency and the necessity of insulin therapy, exocrine insufficiency with steatorrhea and the need for durable pancreatic enzyme replacement and the development of steatohepatis with progressive liver failure.…”

“…One of the commonest indications for TP that is often reported in the literature is for intractable pain in chronic pancreatitis [1][2][3][4] (Figure 1). While in the past some of these patients underwent TP alone, off late they are managed with TP and Islet Autotransplantation (IAT) [1,5].…”

“…While in the past some of these patients underwent TP alone, off late they are managed with TP and Islet Autotransplantation (IAT) [1,5]. The main objective of TP and IAT is to relieve intractable pain from chronic pancreatitis while preventing or reducing the severity of surgically induced diabetes [1][2][3][4].…”