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Journal of Gastrointestinal Surgery

, Volume 16, Issue 1, pp 129–134 | Cite as

Pain Control and Quality of Life After Pancreatectomy with Islet Autotransplantation for Chronic Pancreatitis

  • Katherine MorganEmail author
  • Stefanie M. Owczarski
  • Jeffrey Borckardt
  • Alok Madan
  • Michael Nishimura
  • David B. Adams
2011 SSAT Plenary Presentation

Abstract

Introduction

In selected patients with chronic pancreatitis, total pancreatectomy with islet autotransplantation can be effective for the treatment of intractable pain while ameliorating postoperative diabetes. Improved quality of life scores and decreased daily narcotic use, as indicators of successful pain relief, are expected after total pancreatectomy. These outcomes and their relationship have not been well examined in this patient group.

Methods

A prospectively collected database of patients undergoing extensive pancreatectomy with islet autotransplantation for pancreatitis was reviewed. Data pertaining to daily oral morphine equivalents (MEs) and quality of life (QOL), as measured by the SF-12 questionnaire, in the preoperative and postoperative period were reviewed. Approval from the IRB for the evaluation of human subjects was obtained.

Results

Over a 20-month period, 33 patients (25 women, median age 42) underwent extensive pancreatectomy with islet autotransplantation for pancreatitis. Mean follow-up was 9 months with a range of 6–12 months. Postoperative complications occurred in 16 patients (48%). Preoperative QOL scores were a mean 25 for physical component and 32 for mental health component. Postoperatively, physical component scores averaged 33 at 6 months (p = 0.025) and 36 at 12 months (mean increase of 11); the mental health component scores averaged 43 at 6 months (p = 0.007) and 44 at 12 months (mean increase of 12). Preoperative MEs averaged 357 mg daily. At discharge from the hospital, this number increased to 536 mg average MEs daily, a 50% increase, as expected after major surgery in the chronic pain patient. At 6 months, 15 out of 31 patients (48%) required less daily MEs than preoperatively and averaged 161 mg daily (−55%). By 12 months, 11 out of 17 patients (65%) required less daily MEs than preoperatively and averaged 128 mg daily (−64%); four were narcotic-free (23%). Of the six patients who did not decrease their analgesic requirements at 1 year, five (83%) still had an improved physical QOL score (one patient was unchanged) and all six had an improved mental health QOL.

Conclusion

Total pancreatectomy with islet autotransplant is an effective surgery for end-stage chronic pancreatitis. Quality of life improves early postoperatively while decreased narcotic analgesia requirements occur later. Both improved quality of life and decreased narcotic analgesia requirements continue to occur at least up to 1 year postoperatively. Further investigation is needed to assess the durability of total pancreatectomy with islet autotransplantation for severe chronic pancreatitis with respect to pain relief and improved quality of life.

Keywords

Islet autotransplant Autologous islet transplant Pancreatectomy Chronic pancreatitis Quality of life Pain control 

Notes

References

  1. 1.
    Demir IE, Teiftrunk E, Maak M, Friess H, and Ceyhan GO. Pain mechanisms in chronic pancreatitis: of a master and his fire. Langenbecks Arch Surg 2011; 396:151–160.PubMedCrossRefGoogle Scholar
  2. 2.
    Gruessner RWG, Sutherland DER, Dunn DL, Najarian JS. Transplant options for patients undergoing total pancreatectomy for chronic pancreatitis. JACS 2004; 198:559–67.Google Scholar
  3. 3.
    Argo JL, Contreras JL, Wesley MM, Christein JD. Pancreatic resection with islet cell autotransplant for the treatment of severe chronic pancreatitis. Am Surg 2008; 74:530–6.PubMedGoogle Scholar
  4. 4.
    Garcea G, Weaver J, Phillips J, Pollard CA, Ilouz SC, et al. Total pancreatectomy with and without islet cell transplantation for chronic pancreatitis. A series of 85 consecutive patients. Pancreas 2009; 38:1–7.PubMedCrossRefGoogle Scholar
  5. 5.
    JieT, Hering B, Ansite J, Gilmore T. Pancreatectomy and Auto Islet transplantation in patients with chronic pancreatitis. JACS 2005; 201: S14.Google Scholar
  6. 6.
    Rilo HR, Ahmad SA, D’Alessio D. Total pancreatectomy and autologous islet cell transplant as a means to treat severe chronic pancreatitis. J Gastrointest Surg 2003; 7:978–89.CrossRefGoogle Scholar
  7. 7.
    Morgan KA, Uflacker R, Nishimura M, Adams DB. Percutaneous transhepatic islet cell autotransplantation after pancreatectomy for chronic pancreatitis: a novel approach. HPB 2011.Google Scholar
  8. 8.
    McCullagh EP, Cook JR, Shirley EK. Diabetes following total pancreatectomy: clinical observations of ten cases. Diabetes 1958;7:298–307.PubMedGoogle Scholar
  9. 9.
    Lambert MA, Linehan IP, Russell RCG. Duodenum preserving total pancreatectomy for end stage chronic pancreatitis. Br J Surg 1987; 74:35–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Braasch JW, Vito L, Nugent FW. Total pancreatectomy for end-stage chronic pancreatitis. Ann Surg 1978; 188:317–22PubMedCrossRefGoogle Scholar
  11. 11.
    Gall FP, Muhe E, Gebhardt C. Result of partial and total pancreaticoduoenectomy in 117 patients with chronic pancreatitis. World J Surg 1981; 5:269–75.PubMedCrossRefGoogle Scholar
  12. 12.
    Dresler CM, Fortner JG, McDermott K, Bajorunas DR. Metabolic consequences of (regional) total pancreatectomy. Ann Surg 1991; 214:131–140.PubMedCrossRefGoogle Scholar
  13. 13.
    Linehan IP, Lambert MA, Brown DC, Kurtz AB, Cotton PB, Russell RCG. Total pancreatectomy for chronic pancreatitis. Gut 1988;29: 358–65.PubMedCrossRefGoogle Scholar
  14. 14.
    Cooper MG, Williamson RCN, Benjamin IS, Carter DC, Cuschieri A, Linehan IP, Russell RCG, Torrance HB. Total pancreatectomy for chronic pancreatitis. Br J Surg 1987; 74:912–5.PubMedCrossRefGoogle Scholar
  15. 15.
    Stone WM, Sarr MG, Nagorney DM, Mcilarth DC. Chronic pancreatitis:result of whipple’s resection and total pancreatectomy. Arch Surg 1988; 123:815–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Flemming WR, Williamson RCN. The role of total pancreatectomy in the treatment of patients with end stage chronic pancreatitis. Br J Surg 1995; 82:1409–12.CrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2011

Authors and Affiliations

  • Katherine Morgan
    • 1
    Email author
  • Stefanie M. Owczarski
    • 1
  • Jeffrey Borckardt
    • 1
  • Alok Madan
    • 1
  • Michael Nishimura
    • 1
  • David B. Adams
    • 1
  1. 1.Medical University of South CarolinaCharlestonUSA

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