Total pancreatectomy with islet cell autotransplantation as the initial treatment for minimal-change chronic pancreatitis

Gregory C. Wilson, Jeffrey M. Sutton, Milton T. Smith, Nathan Schmulewitz, Marzieh Salehi, Kyuran A. Choe, John E. Brunner, Daniel E. Abbott, Jeffrey J. Sussman, Syed A. Ahmad

Research output: Contribution to journalArticle

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Abstract

Objectives Patients with minimal-change chronic pancreatitis (MCCP) are traditionally managed medically with poor results. This study was conducted to review outcomes following total pancreatectomy with islet cell autotransplantation (TP/IAT) as the initial surgical procedure in the treatment of MCCP. Methods All patients submitted to TP/IAT for MCCP were identified for inclusion in a single-centre observational study. A retrospective chart review was performed to identify pertinent preoperative, perioperative and postoperative data. Results A total of 84 patients with a mean age of 36.5 years (range: 15-60 years) underwent TP/IAT as the initial treatment for MCCP. The most common aetiology of chronic pancreatitis in this cohort was idiopathic (69.0%, n = 58), followed by aetiologies associated with genetic mutations (16.7%, n = 14), pancreatic divisum (9.5%, n = 8), and alcohol (4.8%, n = 4). The most common genetic mutations pertained to CFTR (n = 9), SPINK1 (n = 3) and PRSS1 (n = 2). Mean ± standard error of the mean preoperative narcotic requirements were 129.3 ± 18.7 morphine-equivalent milligrams (MEQ)/day. Overall, 58.3% (n = 49) of patients achieved narcotic independence and the remaining patients required 59.4 ± 10.6 MEQ/day (P < 0.05). Postoperative insulin independence was achieved by 36.9% (n = 31) of patients. The Short-Form 36-Item Health Survey administered postoperatively demonstrated improvement in all tested quality of life subscales. Conclusions The present report represents one of the largest series demonstrating the benefits of TP/IAT in the subset of patients with MCCP.

Original languageEnglish (US)
Pages (from-to)232-238
Number of pages7
JournalHPB
Volume17
Issue number3
DOIs
StatePublished - Mar 1 2015
Externally publishedYes

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Pancreatectomy
Autologous Transplantation
Chronic Pancreatitis
Islets of Langerhans
Narcotics
Morphine
Therapeutics
Mutation
Health Surveys
Observational Studies
Alcohols
Quality of Life
Insulin

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Wilson, G. C., Sutton, J. M., Smith, M. T., Schmulewitz, N., Salehi, M., Choe, K. A., ... Ahmad, S. A. (2015). Total pancreatectomy with islet cell autotransplantation as the initial treatment for minimal-change chronic pancreatitis. HPB, 17(3), 232-238. https://doi.org/10.1111/hpb.12341

Total pancreatectomy with islet cell autotransplantation as the initial treatment for minimal-change chronic pancreatitis. / Wilson, Gregory C.; Sutton, Jeffrey M.; Smith, Milton T.; Schmulewitz, Nathan; Salehi, Marzieh; Choe, Kyuran A.; Brunner, John E.; Abbott, Daniel E.; Sussman, Jeffrey J.; Ahmad, Syed A.

In: HPB, Vol. 17, No. 3, 01.03.2015, p. 232-238.

Research output: Contribution to journalArticle

Wilson, GC, Sutton, JM, Smith, MT, Schmulewitz, N, Salehi, M, Choe, KA, Brunner, JE, Abbott, DE, Sussman, JJ & Ahmad, SA 2015, 'Total pancreatectomy with islet cell autotransplantation as the initial treatment for minimal-change chronic pancreatitis', HPB, vol. 17, no. 3, pp. 232-238. https://doi.org/10.1111/hpb.12341
Wilson, Gregory C. ; Sutton, Jeffrey M. ; Smith, Milton T. ; Schmulewitz, Nathan ; Salehi, Marzieh ; Choe, Kyuran A. ; Brunner, John E. ; Abbott, Daniel E. ; Sussman, Jeffrey J. ; Ahmad, Syed A. / Total pancreatectomy with islet cell autotransplantation as the initial treatment for minimal-change chronic pancreatitis. In: HPB. 2015 ; Vol. 17, No. 3. pp. 232-238.
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abstract = "Objectives Patients with minimal-change chronic pancreatitis (MCCP) are traditionally managed medically with poor results. This study was conducted to review outcomes following total pancreatectomy with islet cell autotransplantation (TP/IAT) as the initial surgical procedure in the treatment of MCCP. Methods All patients submitted to TP/IAT for MCCP were identified for inclusion in a single-centre observational study. A retrospective chart review was performed to identify pertinent preoperative, perioperative and postoperative data. Results A total of 84 patients with a mean age of 36.5 years (range: 15-60 years) underwent TP/IAT as the initial treatment for MCCP. The most common aetiology of chronic pancreatitis in this cohort was idiopathic (69.0{\%}, n = 58), followed by aetiologies associated with genetic mutations (16.7{\%}, n = 14), pancreatic divisum (9.5{\%}, n = 8), and alcohol (4.8{\%}, n = 4). The most common genetic mutations pertained to CFTR (n = 9), SPINK1 (n = 3) and PRSS1 (n = 2). Mean ± standard error of the mean preoperative narcotic requirements were 129.3 ± 18.7 morphine-equivalent milligrams (MEQ)/day. Overall, 58.3{\%} (n = 49) of patients achieved narcotic independence and the remaining patients required 59.4 ± 10.6 MEQ/day (P < 0.05). Postoperative insulin independence was achieved by 36.9{\%} (n = 31) of patients. The Short-Form 36-Item Health Survey administered postoperatively demonstrated improvement in all tested quality of life subscales. Conclusions The present report represents one of the largest series demonstrating the benefits of TP/IAT in the subset of patients with MCCP.",
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AU - Sutton, Jeffrey M.

AU - Smith, Milton T.

AU - Schmulewitz, Nathan

AU - Salehi, Marzieh

AU - Choe, Kyuran A.

AU - Brunner, John E.

AU - Abbott, Daniel E.

AU - Sussman, Jeffrey J.

AU - Ahmad, Syed A.

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N2 - Objectives Patients with minimal-change chronic pancreatitis (MCCP) are traditionally managed medically with poor results. This study was conducted to review outcomes following total pancreatectomy with islet cell autotransplantation (TP/IAT) as the initial surgical procedure in the treatment of MCCP. Methods All patients submitted to TP/IAT for MCCP were identified for inclusion in a single-centre observational study. A retrospective chart review was performed to identify pertinent preoperative, perioperative and postoperative data. Results A total of 84 patients with a mean age of 36.5 years (range: 15-60 years) underwent TP/IAT as the initial treatment for MCCP. The most common aetiology of chronic pancreatitis in this cohort was idiopathic (69.0%, n = 58), followed by aetiologies associated with genetic mutations (16.7%, n = 14), pancreatic divisum (9.5%, n = 8), and alcohol (4.8%, n = 4). The most common genetic mutations pertained to CFTR (n = 9), SPINK1 (n = 3) and PRSS1 (n = 2). Mean ± standard error of the mean preoperative narcotic requirements were 129.3 ± 18.7 morphine-equivalent milligrams (MEQ)/day. Overall, 58.3% (n = 49) of patients achieved narcotic independence and the remaining patients required 59.4 ± 10.6 MEQ/day (P < 0.05). Postoperative insulin independence was achieved by 36.9% (n = 31) of patients. The Short-Form 36-Item Health Survey administered postoperatively demonstrated improvement in all tested quality of life subscales. Conclusions The present report represents one of the largest series demonstrating the benefits of TP/IAT in the subset of patients with MCCP.

AB - Objectives Patients with minimal-change chronic pancreatitis (MCCP) are traditionally managed medically with poor results. This study was conducted to review outcomes following total pancreatectomy with islet cell autotransplantation (TP/IAT) as the initial surgical procedure in the treatment of MCCP. Methods All patients submitted to TP/IAT for MCCP were identified for inclusion in a single-centre observational study. A retrospective chart review was performed to identify pertinent preoperative, perioperative and postoperative data. Results A total of 84 patients with a mean age of 36.5 years (range: 15-60 years) underwent TP/IAT as the initial treatment for MCCP. The most common aetiology of chronic pancreatitis in this cohort was idiopathic (69.0%, n = 58), followed by aetiologies associated with genetic mutations (16.7%, n = 14), pancreatic divisum (9.5%, n = 8), and alcohol (4.8%, n = 4). The most common genetic mutations pertained to CFTR (n = 9), SPINK1 (n = 3) and PRSS1 (n = 2). Mean ± standard error of the mean preoperative narcotic requirements were 129.3 ± 18.7 morphine-equivalent milligrams (MEQ)/day. Overall, 58.3% (n = 49) of patients achieved narcotic independence and the remaining patients required 59.4 ± 10.6 MEQ/day (P < 0.05). Postoperative insulin independence was achieved by 36.9% (n = 31) of patients. The Short-Form 36-Item Health Survey administered postoperatively demonstrated improvement in all tested quality of life subscales. Conclusions The present report represents one of the largest series demonstrating the benefits of TP/IAT in the subset of patients with MCCP.

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