TP/IAT — a total pancreatectomy with islet autotransplantation — is becoming a viable surgical option for chronic pancreatitis patients who do not respond to less extreme interventions. In the procedure, the pancreas is removed, and the islet cells (which produce insulin) are fed into the liver, where they will hopefully take root. If successful, the result is that the patient no longer suffers from the pain and inflammation of CP but does not become diabetic — or at least requires minimal insulin support.
To date, the procedure has been a last option for those whose pancreatic function is in jeopardy and whose quality of life is poor. The surgery is major, lasting an average of over nine hours and typically requiring up to two weeks in the hospital.
A recent article now suggests that the procedure may be effective for much earlier stage CP patients. The article, written by doctors at the University of Cincinnati’s Pancreatic Disease Center, examined use of the TP/IAT surgery as the initial treatment for those with “minimal change chronic pancreatitis” — in other words, where there are signs of CP but not the calcification, cysts, or other indications of late-stage disease.
The results were encouraging. The study population had significant narcotic use to control pain pre-operation; post surgery, 58.3% achieved narcotics independence. About 37% were insulin-independent at follow-up, leaving definite room for improvement. Quality of life scores improved across all measures. The authors conclude that this provides some evidence that this is a viable option for earlier stage disease.
An abstract of the article is available here. The lead author presented the findings at the recent symposium on chronic pancreatitis. The video is only 11 minutes long and moves quickly through the findings, making it worthwhile for anyone considering surgical options.
Note that the presenter acknowledges that use of the procedure at an early stage is controversial…so we should not expect that many doctors will recommend it. But given that even early stage disease can have a profound effect on quality of life, it is worth starting the conversation.