M.B. Charron1, M.D. Bellin1, A. Eaton2, G. Trikudanathan1, V.K. Singh3, J.D. Nathan4,5, M. Abu-El-Haija4, S. Ahmad7, T.B. Gardner8, L.F. Lara7,9, K. Morgan6, S. Mokshagundam10, B. Naziruddin11, A. Posselt12, M. Wijkstrom13, P. Witkowski14, J. He3, G.J. Beilman1 1University Of Minnesota, Minneapolis, MN, USA 2University Of Minnesota, School Of Public Health, Minneapolis, MN, USA 3Johns Hopkins University School Of Medicine, Baltimore, MD, USA 4Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA 5Nationwide Children’s Hospital, Columbus, OH, USA 6The Medical University Of South Carolina, Charleston, SC, USA 7University Of Cincinnati, Cincinnati, OH, USA 8Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA 9The Ohio State Wexner University Medical Center, Columbus, OH, USA 10University Of Louisville, Louisville, KY, USA 11Baylor University Medical Center, Dallas, TX, USA 12University Of California – San Francisco, San Francisco, CA, USA 13University Of Pittsburg, Pittsburgh, PA, USA 14University Of Chicago, Chicago, IL, USA
Introduction:
Chronic pancreatitis is associated with significant chronic pain and disability. When conservative management fails, surgical intervention with total pancreatectomy and islet autotransplant (TPIAT) improve quality of life and reduce pain. Surgical approaches to gastrointestinal (GI) reconstruction vary. While substantial literature exists on quality of life, pain control, islet graft function, and nutritional status, there is a little information available on the effect of GI reconstruction on short-term surgical and GI outcomes. Thus, we aimed at comparing outcomes of TPIAT patients with or without a pylorus-preserving approach.
Methods:
Data were obtained from the Prospective Observation Study of TPIAT (POST), a multicenter, prospective cohort study of adult and pediatric TPIAT patients from 12 collaborating centers across the United States. Participants were enrolled 1/2017 to 3/2022, with 406 participants (adults and children) undergoing surgery. Children being distinct from adults in disease characteristics, surgical approach (92% pylorus sparing), and nutritional outcomes, the current analysis was restricted to adult participants. Data are gathered through medical records, patient interviews, and surveys, and include operative details, and pain, quality of life, diabetes and nutritional outcomes. We compared hospital length of stay, readmission within 30 days, nutritional status (vitamin A, D, and E measures) at 12 months post-TPIAT, and readmission for GI issues within 12 months of TPIAT. These outcomes were compared between patients based on pylorus preserving status.
Results:
Of 276 adult patients included in this study, 91 (33%) were non-pylorus preserving TPIATs and 185 (67%) were pylorus-preserving reconstructions. The pylorus resection cohort participants were slightly older (median 40 vs 37 years old) and proportionally more female (69% vs 63%) compared to the pylorus preservation cohort. Median baseline BMI was 26.7 in the pylorus resection cohort and 24.7 in their counterpart (see Table). 77% of patients in the pylorus-preserved cohort and 70% in the not preserved cohort avoided GI-related hospitalisations in the 12 months following surgery (p=0.8). Fifteen percent in the pylorus resected cohort were underweight postoperatively compared to 7% in the pylorus-preserved group, although not statistically significant (p=0.2).
Conclusion:
While patients who underwent pylorus resection had shorter hospital stays, patients with pylorus preservation experienced fewer postoperative complications and exhibited more favorable nutritional outcomes. These findings suggest that pylorus preservation should be considered for GI reconstruction following TPIAT.