Journal of Gastrointestinal Surgery

, Volume 16, Issue 8, pp 1469–1477

Improved Quality of Life Following Total Pancreatectomy and Auto-islet Transplantation for Chronic Pancreatitis

Authors

    • Department of General SurgeryDigestive Disease Institute, Cleveland Clinic
    • Department of Surgery A100Cleveland Clinic
  • J. R. Aguilar Saavedra
    • Department of General SurgeryDigestive Disease Institute, Cleveland Clinic
  • G. Lentz
    • Department of General SurgeryDigestive Disease Institute, Cleveland Clinic
  • A. D. Guerron
    • Department of General SurgeryDigestive Disease Institute, Cleveland Clinic
  • J. Scheman
    • Department of Neurological Center for Pain, Neurological Cole InstituteCleveland Clinic
  • T. Stevens
    • Department of Gastroenterology, Digestive Disease InstituteCleveland Clinic
  • M. Trucco
    • Department of PediatricsUniversity of Pittsburgh, Division of Immunogenetics
  • R. Bottino
    • Department of PediatricsUniversity of Pittsburgh, Division of Immunogenetics
  • B. Hatipoglu
    • Department of Endocrinology, Endocrinology and Metabolism InstituteCleveland Clinic
Original Article

DOI: 10.1007/s11605-012-1914-6

Cite this article as:
Walsh, R.M., Saavedra, J.R.A., Lentz, G. et al. J Gastrointest Surg (2012) 16: 1469. doi:10.1007/s11605-012-1914-6

Abstract

Background

Total pancreatectomy (TP) with auto-islet transplant (AIT) is an extreme treatment for chronic pancreatitis, and we reviewed our experience to assess the impact on quality of life (QOL).

Methods

A prospective cohort study from 2007 through 2010 with pre- and postoperative assessments of the Depression Anxiety Stress Scale, Pain Disability Index, and visual analogue pain scale was performed.

Results

Twenty patients underwent TP-AIT with a median follow-up of 12 months (6.75–24 months). All patients reported moderate (45 %) to severe (55 %) pain prior to surgery. TP-AIT resulted in significant decreases in abdominal pain (p < 0.001), 80 % reporting no or mild pain. Despite pain improvement, only 30 % discontinued narcotics. Improvements in all PDI QOL domains improved from 79 to 90 % (p = 0.002), with greatest improvements seen in those without prior pancreatic surgery, younger patients, and in those with higher levels of preoperative pain. Patients were less affected by depression and anxiety prior to surgery, but 60 and 70 % did show improvement in depression and anxiety, respectively (p = 0.033). Sixteen patients (80 %) required exogenous insulin at last follow-up (mean total dose of insulin 11.6 U/day).

Conclusions

TP-AIT significantly improves pain and QOL measures in appropriately selected patients with CP.

Keywords

Chronic pancreatitisQuality of lifeTotal pancreatectomyAutologous islet transplant

Copyright information

© The Society for Surgery of the Alimentary Tract 2012