The role of total pancreatectomy with islet autotransplantation in the treatment of chronic pancreatitis: A report from the International Consensus Guidelines in chronic pancreatitis |
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| Affiliation: | 1. Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA;2. Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA;3. Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Japan;4. Department of Surgery, University of Minnesota Medical Center, Minneapolis, MN, USA;5. Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, the Netherlands;6. Department of Surgery, University of Colorado Anschutz Medical Campus, Denver, CO, USA;7. Department of Surgery, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany;8. Department of Hepatobiliary and Pancreatic Surgery, University of Leicester, UK;9. Department of Surgery, University of Miami, Miami, FL, USA;10. Department of Medicine, University of Minnesota, Minneapolis, MN, USA;11. Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Germany;12. Department of Visceral, Vascular and Endocrine Surgery, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany;13. Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Faculty of Medicine and Health Technology, Tampere University, Finland;14. Division of Transplant Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA;15. Division of Pediatric General and Thoracic Surgery Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA;p. Department of General, Visceral, and Transplant Surgery, University of Munich, LMU, Germany;q. Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand;r. Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany;s. Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK;t. Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan;u. Department of Medicine, Cell Biology & Physiology, and Human Genetics, University of Pittsburgh, Pittsburgh, PA, USA;v. Department of Pediatrics, University of Minnesota Masonic Children’s Hospital, Minneapolis, MN, USA;1. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children''s Hospital Medical Center, Cincinnati, OH, United States;2. Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children''s Hospital Medical Center, Cincinnati, OH, United States;3. Division of Pediatric General and Thoracic Surgery, Cincinnati Children''s Hospital Medical Center, Cincinnati, OH, United States;1. Department of Surgery, Division of Transplantation, Upstate Medical University, 750 E. Adams Street, Syracuse, NY, 13210, USA;2. Baylor Annette C. and Harold C. Simmons Transplant Institute, 3410 Worth Street, Suite 950, Dallas, TX, 75246, USA;3. Islet Cell Laboratory, Baylor Scott and White Research Institute, 3812 Elm Street, Dallas, TX, 75226, USA;4. Department of Surgery, Hume-Lee Transplant Center, VCU Health, 1250 East Marshall Street, Richmond, VA, 23298, USA;1. Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, USA;2. Department of Gastroenterology, Endocrinology and Metabolism, University Hospital, Philipps-Universität Marburg, Marburg, Germany;3. Department of Surgery, Amsterdam University Medical Centers, Location AMC, and Amsterdam Gastroenterology & Metabolism (AG&M), PO Box 22660, Meibergdreef 9, Amsterdam, the Netherlands;4. Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, 980-8574, Japan;5. Service de Pancréatologie-Gastroentérologie, Pôle des Maladies de L’Appareil Digestif, DHU UNITY, Hôpital Beaujon, APHP, Clichy Cedex, And Université Paris 7, 92118, France;6. Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan;7. Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, USA;8. Department of Gastroenterology, Doxkkyo Medical University, Mibu, Tochigi, Japan;9. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA;10. Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan;11. Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India;12. Department of Surgery, Mie University Graduate School of Medicine, Japan;13. Department of Gastroenterology, Tohoku University Graduate School of Medicine, Japan;14. Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, UK;15. Department of Medicine University of Pittsburgh and UPMC, Pittsburgh, PA, USA;p. Department of General Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany;1. Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, the Netherlands;2. Department of Surgery, Royal Liverpool University Hospital, Liverpool, United Kingdom;3. Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany;4. Department of Surgery, Koc University, Istanbul, Turkey;5. Department of General Surgery, Massachusetts General Hospital, Boston, MA, USA;6. Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Japan;7. Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Germany;8. Department of Visceral, Vascular, and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Germany;9. Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Faculty of Medicine and Health Technology, Tampere University, Finland;10. Institute of Translational Medicine, University of Liverpool, United Kingdom;11. Division of Gastroenterology, Tohoku University Graduate School of Medicine, Japan;12. Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh and UPMC, PA, USA;13. HBP/Upper GI Unit, Auckland City Hospital/Department of Surgery, University of Auckland, New Zealand;14. Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, China;15. Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands;1. Department of Endocrinology and Metabolism, SBU Diskapi Training and Research Hospital, Ankara, Turkey;2. Schulze Diabetes Institute, University of Minnesota, Minneapolis, MN, USA;3. Department of Surgery, University of Minnesota, Minneapolis, MN, USA;4. Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA;5. Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA |
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| Abstract: | BackgroundAdvances in our understanding of total pancreatectomy with islet autotransplantation (TPIAT) have been made. We aimed to define indications and outcomes of TPIAT.MethodsExpert physician-scientists from North America, Asia, and Europe reviewed the literature to address six questions selected by the writing group as high priority topics. A consensus was reached by voting on statements generated from the review.ResultsConsensus statements were voted upon with strong agreement reached that (Q1) TPIAT may improve quality of life, reduce pain and opioid use, and potentially reduce medical utilization; that (Q3) TPIAT offers glycemic benefit over TP alone; that (Q4) the main indication for TPIAT is disabling pain, in the absence of certain medical and psychological contraindications; and that (Q6) islet mass transplanted and other disease features may impact diabetes mellitus outcomes. Conditional agreement was reached that (Q2) the role of TPIAT for all forms of CP is not yet identified and that head-to-head comparative studies are lacking, and that (Q5) early surgery is likely to improve outcomes as compared to late surgery.ConclusionsAgreement on TPIAT indications and outcomes has been reached through this working group. Further studies are needed to answer the long-term outcomes and maximize efforts to optimize patient selection. |
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| Keywords: | TPIAT Pancreatectomy Autoislet Pancreatitis Diabetes |
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