Glycemic outcomes of parenchymal preserving surgery compared to total pancreatectomy with autologous islet cell transplant when stratified by pre-operative type 3 diabetic status

Abstract

Introduction: Surgery for chronic pancreatitis (CP) can result in type 3c diabetes with severe hypoglycemic events (SHE) and hypoglycemic unawareness (HU). The aim of this study is to compare glycemic outcomes between total pancreatectomy and autologous islet cell transplant (TPAIT) and parenchymal preserving surgery (PPS). Methods: All patients undergoing CP surgery at a single center from 2017-2019 were included. Glycemic outcomes were compared between 2 groups: (1) TPAIT and (2) PPS and stratified between pre-operatively diabetic/pre-diabetic (DM) and non-diabetic (NDM). Results: 32 patients underwent surgery, 14 (43.8%) TPAIT and 18 (56.2%) PPS. In Group 1, 6 (42.9%) patients had DM pre-operatively. Following TPAIT, 9 (64.3%) patients were insulin dependent at discharge (6 [100%] DM vs. 3 [37.5%] NDM, p = 0.02). In Group 2, 12 (66.7%) had DM pre-operatively, 2 (16.7%) insulin dependent. While 4 (33.3%) in Group 2 required insulin at discharge, 2 had weaned off by 3-month follow up. Between TPAIT and PPS, there was a significant difference in number of patients requiring insulin in the immediate post-operative period (64.3% vs. 22.2%, p =0.02). However, by 3 months there was no significant difference when stratified by pre-operative DM status. No patient in either group experienced SHE or HU. Conclusion: While more patients required insulin following TPAIT than PPS, when stratified by pre-operative diabetic status, there was no statistical difference in glycemic outcomes over time. Therefore, apprehension regarding type 3c diabetes should not be a hinderance to choosing TPAIT in patients with diffuse pancreatic disease.PP04-052Number of patients requiring insulin when stratified by pre-operative type 3 diabetic statusTotal (n= 32)Non-diabetic TPAIT (n= 8)Non-diabetic PPS (n=6)p ValueDM/Pre-DM TPAIT (n= 6)DM/Pre-DM PPS (n=12p ValuePre- operatively, n (%)3 (9.4%)0 (0)0 (0)NA1 (16.7%)2 (16.7%)1.00At Discharge, n (%)13 (40.6%)3 (37.5%)0 (0)0.096 (100%)4 (33.3%)0.007At 1 month, n (%)13 (56.5%)4 (80.0%)0 (0)0.026 (100%)3 (37.5%)0.02At 3 months, n (%)11 (61.1%)3 (50.0%)0 (0)0.16 (100)2 (66.7)0.1 Open table in a new tab