TY - JOUR
T1 - Efficacy of total pancreatectomy with islet autotransplantation on opioid and insulin requirement in painful chronic pancreatitis: A systematic review and meta-analysis
AU - Dutch Pancreatitis Study Group
AU - Kempeneers, Marinus A.
AU - Scholten, Lianne
AU - Verkade, Charissa R.
AU - van Hooft, Jeanin E.
AU - van Santvoort, Hjalmar C.
AU - Busch, Olivier R.
AU - DeVries, J. Hans
AU - Issa, Yama
AU - Dennison, Ashley
AU - Besselink, Marc G.
AU - Boermeester, Marja A.
N1 - Funding Information: Supported by a grant from Mylan N.V. for studies on exocrine insufficiency (M.A.K and M.A.B.), a grant from ZEALAND for studies on postpancreatectomy diabetes management (L.S.), and a grant from the Dutch Cancer Society (grant number UVA2013-5842) for studies on pancreatic cancer (M.G.B.). Publisher Copyright: © 2019 Elsevier Inc.
PY - 2019/9
Y1 - 2019/9
N2 - Background: The rationale for total pancreatectomy in painful, treatment refractory, chronic pancreatitis is pain control. Concomitant islet cell autotransplantation can prevent the loss of islet cell function. This study aimed to systematically examine the impact of total pancreatectomy with islet cell autotransplantation on pain and quality of life. Methods: This meta-analysis was conducted according the Meta-analyses of Observational Studies in Epidemiology guideline. The Cochrane Library, PubMed, and Embase were searched for the following terms (1990 through April 2018): total pancreatectomy and chronic pancreatitis. Studies were included when addressing total pancreatectomy with islet cell autotransplantation for chronic pancreatitis in adults. Studies that reported no data on pain, endocrine function, or quality of life were excluded. Quality was assessed using the Newcastle-Ottawa scale for evaluation of all studies. Results: We included 15 observational studies evaluating 1,255 patients, of whom 28% had had endoscopic and 23% operative therapy. One year after total pancreatectomy with islet cell autotransplantation, the opioid-free rate had improved from between 0% and 15% to 63% (95% CI 46–77), and the insulin-free rate had decreased from between 89.5% and 100% to 30% (95% CI 20–43). An alcoholic etiology was associated with a lesser insulin-free rate after total pancreatectomy with islet cell autotransplantation. Quality of life improved statistically after total pancreatectomy with islet cell autotransplantation. Publication bias was present for both opioid and insulin outcomes. Conclusion: In selected patients with painful, treatment refractory, chronic pancreatitis, evidence shows that total pancreatectomy with islet cell autotransplantation is effective for pain control in almost two-thirds of patients, whereas the insulin-free rate is relatively low.
AB - Background: The rationale for total pancreatectomy in painful, treatment refractory, chronic pancreatitis is pain control. Concomitant islet cell autotransplantation can prevent the loss of islet cell function. This study aimed to systematically examine the impact of total pancreatectomy with islet cell autotransplantation on pain and quality of life. Methods: This meta-analysis was conducted according the Meta-analyses of Observational Studies in Epidemiology guideline. The Cochrane Library, PubMed, and Embase were searched for the following terms (1990 through April 2018): total pancreatectomy and chronic pancreatitis. Studies were included when addressing total pancreatectomy with islet cell autotransplantation for chronic pancreatitis in adults. Studies that reported no data on pain, endocrine function, or quality of life were excluded. Quality was assessed using the Newcastle-Ottawa scale for evaluation of all studies. Results: We included 15 observational studies evaluating 1,255 patients, of whom 28% had had endoscopic and 23% operative therapy. One year after total pancreatectomy with islet cell autotransplantation, the opioid-free rate had improved from between 0% and 15% to 63% (95% CI 46–77), and the insulin-free rate had decreased from between 89.5% and 100% to 30% (95% CI 20–43). An alcoholic etiology was associated with a lesser insulin-free rate after total pancreatectomy with islet cell autotransplantation. Quality of life improved statistically after total pancreatectomy with islet cell autotransplantation. Publication bias was present for both opioid and insulin outcomes. Conclusion: In selected patients with painful, treatment refractory, chronic pancreatitis, evidence shows that total pancreatectomy with islet cell autotransplantation is effective for pain control in almost two-thirds of patients, whereas the insulin-free rate is relatively low.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85065449258&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/31085044
U2 - https://doi.org/10.1016/j.surg.2019.03.014
DO - https://doi.org/10.1016/j.surg.2019.03.014
M3 - Article
C2 - 31085044
SN - 0039-6060
VL - 166
SP - 263
EP - 270
JO - Surgery
JF - Surgery
IS - 3
ER -