Comparative outcomes of total pancreatectomy and autologous islet cell transplant to parenchymal preserving surgery in patients with chronic pancreatitis when the surgical team has options to choose

Abstract

Listen

Translate article

Presenter: Brittney M Williams MD, MPH | University of North Carolina at Chapel Hill Background: Surgical management of refractory chronic and recurrent acute pancreatitis is challenging due to lack of standardized guidelines for patient selection. Patients are often selected based on individual surgeon preference, center’s availability and expertise for parenchymal preserving surgery (PPS) or total pancreatectomy with autologous islet cell transplant (TPAIT). We aim to evaluate perioperative outcomes of TPAIT vs. PPS following use of a patient-centered selection algorithm rather than therapeutic availability-centered decisions. Methods: From 2017 to 2020, patients with chronic or recurrent acute pancreatitis were evaluated and offered surgery based on an algorithm designed with consideration of dominant area of disease, ductal dilatation, and glycemic control. Surgeries were performed by same team under one lead surgeon eliminating technical bias. Retrospective analysis of all surgical patients was performed and perioperative outcomes were compared. Results: 50 patients underwent surgery (20 [40%] TPAIT and 30 [60%] PPS – 1 [2%] completion pancreatectomy, 13 [26%] distal pancreatectomies, 2 [4%] Frey procedures, 1 [2%] Roux-en-Y biliary bypass procedure, 4 [8%] total pancreatectomies, and 9 [18%] Whipple procedures). There was no significant difference in baseline characteristics. 4 (13%) PPS patients required non-operative intervention for leak and 2 (10%) TPAIT patients underwent re-laparotomy for bleeding. There was no significant difference in delayed feeding, wound infection, or readmission rate between groups; however, length of stay was longer following TPAIT. There was no incidence of portal vein thrombosis in TPAIT group. There was no mortality in either group. Conclusion: Operative intervention for chronic pancreatitis using a patient selection algorithm can result in similar perioperative outcomes between approaches. While TPAIT does require a longer length of surgery due to the islet isolation procedure, patients appropriately selected for this surgery have minimal perioperative complications and similar outcomes.