Total pancreatectomy and salvage completion pancreatectomy-early and late outcomes without Islet cell auto-transplantation

Authors

  • Dhiresh Kumar Maharjan Assistant Professor, Department of Surgery, Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal https://orcid.org/0000-0001-9212-3179
  • Prabin Bikram Thapa Professor, Department of Surgery, Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal

DOI:

https://doi.org/10.3126/jkmc.v9i3.36421

Keywords:

Completion pancreatectomy; Islet cell auto transplant; Total pancreatectomy; Whipple operation.

Abstract

Background: Total pancreatectomy was abandoned for decades because of high peri and post-operative morbidity and mortality. However, with better peri-operative outcome and post-operative management of exocrine and endocrine insufficiency, the hesitancy to perform total pancreatectomy has been disappearing. 

Objectives: This study aims to study exocrinal and endocrinal effects of total pancreatectomy without Islet cell auto-transplantation and compare quality of life index among total pancreatectomy with Whipple patients.

Methodology: This is a prospectively conducted matched-pairs study. Group A underwent total or completion pancreatectomy after non-salvageable complications of Whipple operation. A matched-pairs analysis of quality of life index of these patients by using SF-36 questionnaire were compared with Group B who underwent Whipple operation during the same period of time, according to age, gender and pre-operative diagnosis. 

Results: In four years (from February 2016 to February 2020), 160 patients underwent Whipple operation. The mean age of the patients was 59.9 +/-14.3 years. A total of nine patients underwent total pancreatectomy, among which two had per-operative decision of total pancreatectomy and seven had completion pancreatectomy. Median post-operative hospital stay was 11 days with two mortalities. Median follow-up of 12 months and quality of life index of total pancreatectomy patients were comparable to Whipple patients, although a few single quality of life items were reduced. 

Conclusion: Exocrinal pancreatic supplements and long acting insulin have augmented control of diabetes despite of not using Islet cell auto-transplantation. Quality of life index of total pancreatectomy patients were comparable to that of Whipple patients. Hence, this study signifies the   importance of completion pancreatectomy following non-salvageable complications after Whipple operation in order to save life.

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Published

2020-09-30

How to Cite

Maharjan, D. K., & Thapa, P. B. (2020). Total pancreatectomy and salvage completion pancreatectomy-early and late outcomes without Islet cell auto-transplantation. Journal of Kathmandu Medical College, 9(3), 154–160. https://doi.org/10.3126/jkmc.v9i3.36421

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Original Research Articles

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