Open AccessTotal pancreatectomy and salvage completion pancreatectomy-early and late outcomes without Islet cell auto-transplantation
Author(s) -
Dhiresh Kumar Maharjan,
Prabin Thapa
Publication year - 2020
Publication title -
journal of the kathmandu medical college
Language(s) - English
Resource type - Journals
eISSN - 2091-1793
pISSN - 2091-1785
DOI - 10.3126/jkmc.v9i3.36421
Subject(s) - medicine , total pancreatectomy , pancreatectomy , quality of life (healthcare) , surgery , islet , distal pancreatectomy , diabetes mellitus , general surgery , resection , endocrinology , nursing
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.