In‐hospital and 90‐day outcomes after total pancreatectomy with islet autotransplantation for pediatric chronic and acute recurrent pancreatitis

摘要

Total pancreatectomy with islet autotransplantation ( TPIAT ) is used to treat debilitating chronic pancreatitis ( CP ) and acute recurrent pancreatitis ( ARP ) that has failed medical and endoscopic therapy. We performed a retrospective review of TPIAT patients at a free‐standing children's hospital to evaluate perioperative outcomes. Twenty patients (median age 13, 65% female) underwent TPIAT (2015 through 2017). Of the 20 patients, 95% had CP and 1 patient (5%) had ARP alone. Seventy‐five percent of the patients had a pancreatitis‐associated genetic mutation; 40% had pancreas divisum. The median surgical time was 757 ( IQR 657 to 835) minutes. Median islet equivalents per kg of body weight ( IEQ /kg) were 6404 ( IQR 5018 to 7554). At 90?days postoperatively vs preoperatively, significantly fewer patients were receiving parenteral nutrition (0% vs 25%, P? = ? .006) and opioids (45% vs 75%, P? = ? .01). Short Form 36‐Item Health Survey (SF‐36) physical health module scores and total scores improved (34.0 preoperatively vs 54.6 at 90?days, P? = ? .008, and 47.1 vs 65.3, P? = ? .007, respectively); SF ‐10 physical health scores also improved (13.4 vs 33.1, P?=? .02). Insulin requirement decreased from 0.5 unit/kg/day to 0.4 unit/kg/day between discharge and 90?days ( P? = ? .02). TPIAT is an effective option when debilitating disease persists despite maximal medical and endoscopic therapy. Opioid, parenteral nutrition, and exogenous insulin use can successfully be weaned within 90?days after TPIAT , with gains in health‐related quality of life.