Pancreatectomy and autotransplantation reduces pain in patients with chronic pancreatitis

The University of Minnesota Medical Center is one of the few academic hospitals in the United States that offers a treatment alternative for such patients. Surgeons at the University of Minnesota remove the pancreas to alleviate pain. According to a study pre- sented at the 2005 annual Clinical Congress of the American College of Surgeons, the operation significantly decreased pain for a majority of patients. Dr. Sutherland and his col-leagues reported that 63 percent of patients had complete relief from pain and 22 percent experienced partial relief. The remaining 15 percent of patients had no change in the degree of pain. The study included more than 140 patients who had undergone pancreatectomy for pain associated with chronic pancreatitis.

Because the operation results in the removal of most or all of the gland that produces insulin, patients develop diabetes following the surgical procedure. However, a second pro- cedure done in conjunction with pancreatectomy reduced patients’ need to inject themselves with insulin to manage their diabetes. This procedure, which is known as autotransplantation, involves isolating pancreatic islets (the cells directly responsible for releasing insulin into the bloodstream) from each patient before the operation and transplanting them back into the patient immediately following pancreatectomy. Among 51 patients who received more than 2,000 (islet equivalents) per kg, 72 percent could manage their diabetes without regular injections of insulin. Forty-seven percent required no insulin at all after the operation, and 25 percent required only intermittent treatments with insulin, Dr. Sutherland said.

“Some patients who come to us for treatment of the pain associated with chronic pan-creatitis already have diabetes because their disease has destroyed the insulin-producing cells in the gland. For them, there’s little downside to pancreatectomy. But for patients who don’t have diabetes before surgery, there is often a tradeoff: they get diabetes in return for relief of pain and getting off narcotics. Almost every patient says nothing is worse than being on narcotics and still having pain,” said Dr. Sutherland. On the other hand, the transplantation of islet cells from the patient prevents diabetes for most patients. “It is a secondary gain for patients,” he added.

In addition to the University of Minnesota Medical Center, only University Hospital, Cincinnati, routinely performs autotransplantation of pancreatic islet cells along with pancrea-tectomy for patients with chronic pancreatitis. The limiting factor for other centers is having a laboratory that can meet the Good Manufacturing Practice standards set forth by the US Food and Drug Administration, Dr. Sutherland explained.

However, Dr. Sutherland predicts that increasing numbers of academic medical centers will be developing these laboratories and performing the combined pancreatectomy and auto-transplantation of islet cells to meet the needs of a patient population with few treatment options. “The patients I see have been turned down at other places. Out of desperation, patients look for alternatives and learn about the surgery from our Web site,” he said.

Although the University of Minnesota performs only about 20 or 30 pancreatectomies with autotransplantation of islet cells every year, Dr. Sutherland believes there are far more pa-tients who may be helped by the surgical procedure. “I have the impression that there are many patients who are on narcotics and are told there is nothing more that can be done. I’m not really sure, but there could be a couple of thousand patients who could be helped every year,” he said.

Tun Jie, MD, Bernhard Hering, MD; Jeff Ansite; Tom Gilmore; Daniel Fraga; Gregory Beilman, MD, FACS; David L. Dunn, MD, PhD, FACS; John Najarian, MD, FACS; and Timothy Sielaff, MD, PhD, FACS, joined Dr. Sutherland in the study of pancreatectomy and auto-islet transplantation in patients with chronic pancreatitis.

The Academic Health Center is home to the University of Minnesota’s six health professional schools and colleges as well as several health-related centers and institutes. Founded in 1851, the University is one of the oldest and largest land grant institutions in the country. The AHC prepares the new health professionals who improve the health of communities, discover and deliver new treatments and cures, and strengthen the health economy. Contact: Jonell Rusinko, Academic Health Center, 612-624-5680 and Sarah Buss, Academic Health Center, 612-624-2449