Patient Demographics, Perioperative Testing, and Symptom Management in Total Pancreatectomy with Islet Autotransplantation: A Brief Review

Background Chronic pancreatitis and its resultant pain, glandular dysfunction, and detriment to quality of life is a challenging and resource-intensive problem for health care systems despite the plethora of modalities developed to treat it. Removal of the gland and source of pain via total pancreatectomy is an effective, albeit drastic solution, with the potential for morbidity due to the complete loss of endocrine and exocrine function. The consequent “brittle diabetes” due to loss of endocrine function and glucagon-dependent counter-regulation may be ameliorated by autologous islet transplantation. Unfortunately, factors leading to optimal outcomes are poorly defined. Results Data is mixed and limited to case series from institutions currently performing the procedure, but factors predictive of islet cell yields and overall insulin-independence include: disease etiology, metabolic status, and duration and severity of the disease. Imaging studies may prove an appropriate method for determination of pancreatic volume and disease complications prior to operative intervention. Although potentially overlooked, the resultant malabsorptive diarrhea, traditionally treated with pancreatic enzyme replacement therapy, is a significant barrier to postoperative quality of life and still requires further research and investigation. Discussion T otal pancreatectomy with autologous islet transplantation is a proven and effective method for treating those with intractable pain from chronic pancreatitis, but remains barred from widespread use due to cost, limited availability, and potential morbidity. Though great advances have been made, additional efforts at perioperative optimization, appropriate candidate selection and time to intervention must still be sought to further improve post-operative outcomes.