JOP. J Pancreas (Online) 2011 Nov
10; 12(6):616.
Total Pancreatectomy and Quality of Life
Raffaele Pezzilli
Pancreas Unit, Department of
Digestive Diseases and Internal Medicine, Sant’Orsola-Malpighi Hospital, Alma
Mater Studiorum, University of Bologna. Bologna, Italy
Intractable
pain is one of the main indications for a surgical approach in chronic
pancreatitis. In some cases, especially when the main pancreatic duct is not
dilated and when other treatment measures have failed, one surgical approach is
a total pancreatectomy. A complication of this approach is diabetes and islet autotransplantation
has been suggested in recent years as a good option for minimizing or preventing
diabetes. The studies published up to now have shown that pain relief is
obtained in most patients, and insulin independence is preserved long term in
about one-third, with another third having sufficient beta cell function so
that the surgically-caused diabetes is mild [1]. However, the quality of life
in these patients should be evaluated using a structured questionnaire. In this
respect, the recent paper of Morgan et al. is welcome [2]. Over a
20-month period, the authors evaluated 33 patients who underwent extensive
pancreatectomy with islet autotransplantation for pancreatitis. In these patients,
they evaluated data pertaining to daily oral morphine equivalents and the quality
of life was measured by the SF-12 questionnaire in both the preoperative and the
postoperative periods. The mean follow-up was nine months and postoperative
complications occurred in 48% of the patients enrolled. Preoperative quality of
life scores showed a mean of 25 for the physical component and 32 for the
mental health component. Postoperatively, the physical component score increased
significantly at 6 months and at 12 months, as did the mental health component
score. The data of the SF-12 were also confirmed by the decreased number of morphine
equivalents which was preoperatively equal to 357 mg daily and was 161 mg daily
at 6 months (-55%). At 12 months, the average of the morphine equivalents was
128 mg daily (-64%). In conclusion, total pancreatectomy with islet
autotransplantation should be considered as an effective surgical option for
intractable pain in chronic pancreatitis; the quality of life of patients
improves and narcotic use decreases. This research should be continued because additional
information is needed on the long-term results of this surgical approach. In
the meantime, we must take into consideration the message of the authors and a total
pancreatectomy should be associated with islet autotransplantation in order to
improve the quality of life of patients.
Key
words
Outcome Assessment (Health Care); Pancreatectomy; Pancreatitis, Chronic;
Quality of Life
Conflict of interest None
Correspondence Raffaele Pezzilli
Unità Pancreas
Dipartimento di Malattie Apparato Digerente e Medicina Interna
Ospedale Sant’Orsola-Malpighi
Via G. Massarenti, 9
40138 Bologna
Italy
Phone: +39-051.636.4148
Fax: +39-051.636.4148
E-mail: raffaele.pezzilli@aosp.bo.it
References
1. Blondet
JJ, Carlson AM, Kobayashi T, Jie T, Bellin M, Hering BJ, et al. The role of
total pancreatectomy and islet autotransplantation for chronic pancreatitis.
Surg Clin North Am 2007; 87:1477-501. (More details: [1]).
2. Morgan
K, Owczarski SM, Borckardt J, Madan A, Nishimura M, Adams DB. Pain control and
quality of life after pancreatectomy with islet autotransplantation for chronic
pancreatitis. J Gastrointest Surg 2011; Nov 1. (More details: [2]).