Total pancreatectomy and autologous Islet cell transplantation as a means to treat severe chronic pancreatitis

Total pancreatectomy with islet cell transplantationvsintrathecal narcotic pump infusion for pain control in chronic pancreatitis

“…Our results from TP + ICT have been consistent with several previous series reporting successful pain control and narcotic independence in 70%-80% of subjects within 6-12 mo after surgery [8,9,18,19] .…”

“…between 25 and 68% but major complications constituted approximately 14%-18% based on their reporting [7,9,18] . Several series from single centers reported a perioperative mortality rate (usually defined as mortality within 2 wk of surgery) of 0% to 3.5% from total pancreatectomy [7][8][9][18][19][20] . Our multi-center based data was incomplete as we were unable to record the morbidity and mortality among all 57 surgical patients.…”

“…Therefore, the success rate of pain control after pancreatectomy seems to depend largely on the definition of "success " [21] . Nonetheless, the most effective and most durable pancreatic surgeries performed for pain control in chronic pancreatitis seem to involve resection of the head of pancreas when compared with denervation or decompression procedures [18][19][20][21] . Our series had a 3 years median duration of follow up raising the question about the durability of the reported rate of 80%.…”

“…Our series had a 3 years median duration of follow up raising the question about the durability of the reported rate of 80%. The complete success of the autologous islet cell graft with resulting insulin independence has variably been reported to range from zero up to 40% within duration of follow up between 6 and 24 mo [8,9,18,19] . Garcea et al [20] again showed in his series that insulin independence dropped from 14.1% post engraftment to 5.9% after a median follow up duration of 8 years.…”

“…However, this need to be evaluated independently [20,22] . Female gender, lower body weight and higher number of islet cells transplanted have been suggested to be positive predictive factors of graft survival [8,18,19] . Our data show a complete preservation of islet cells graft function in 15% of pts after a median follow up of 3 years (range 0.5-10 years) and an acceptable glucose control (average HbA1c 7.35%) with moderate insulin requirements (average 25 units/d) compared to patients with type 1 diabetes.…”