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Pancreatology. 2014 Jan-Feb;14(1):27-35. doi: 10.1016/j.pan.2013.10.009. Epub 2013 Nov 13.

Total pancreatectomy and islet autotransplantation in chronic pancreatitis: recommendations from PancreasFest.

Author information

1
Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA. Electronic address: bell0130@umn.edu.
2
Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
3
Department of Medicine, University of Chicago, Chicago, IL, USA.
4
Department of Medicine, University of Pittsburgh, PA, USA.
5
Department of Neurology, University of Minnesota, Minneapolis, MN, USA.
6
Department of Surgery, University of Pittsburgh, PA, USA.
7
Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
8
Department of Pediatrics, University of Pittsburgh, PA, USA; Children's Hospital of Pittsburgh, PA, USA.
9
Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
10
Department of Medicine, University of Pittsburgh, PA, USA. Electronic address: whitcomb@pitt.edu.
11
Department of Surgery, University of Chicago, Chicago, IL, USA.

Abstract

DESCRIPTION:

Total pancreatectomy with islet autotransplantation (TPIAT) is a surgical procedure used to treat severe complications of chronic pancreatitis or very high risk of pancreatic cancer while reducing the risk of severe diabetes mellitus. However, clear guidance on indications, contraindications, evaluation, timing, and follow-up are lacking.

METHODS:

A working group reviewed the medical, psychological, and surgical options and supporting literature related to TPIAT for a consensus meeting during PancreasFest.

RESULTS:

Five major areas requiring clinical evaluation and management were addressed: These included: 1) indications for TPIAT; 2) contraindications for TPIAT; 3) optimal timing of the procedure; 4) need for a multi-disciplinary team and the roles of the members; 5) life-long management issues following TPIAP including diabetes monitoring and nutrition evaluation.

CONCLUSIONS:

TPIAT is an effective method of managing the disabling complications of chronic pancreatitis and risk of pancreatic cancer in very high risk patients. Careful evaluation and long-term management of candidate patients by qualified multidisciplinary teams is required. Multiple recommendations for further research were also identified.

KEYWORDS:

Diabetes mellitus; Hereditary pancreatitis; Pancreatic adenocarcinoma; Pancreatic cancer; Pancreatic surgery

Comment in

PMID:
24555976
PMCID:
PMC4058640
DOI:
10.1016/j.pan.2013.10.009
[Indexed for MEDLINE]
Free PMC Article

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