In the Journals

New minimally invasive surgery safe, effective for chronic pancreatitis

Laparoscopic total pancreatectomy with islet autotransplantation and intraoperative islet separation, a new minimally invasive surgical approach for treating chronic pancreatitis, was successfully completed and improved outcomes in the first 20 patients to undergo the procedure.

According to data from the case series published in JAMA Surgery, the approach reduced complications, hospital stays and the need for opioids.

“In an era of opioid addiction, performing a major operation through a minimally invasive technique can mean less pain for patients, reducing the need for opioids and their complications,” Martin A. Makary, MD, MPH, professor of surgery at the Johns Hopkins University School of Medicine, where the technique was pioneered, said in a press release.

To test the feasibility of a laparoscopic approach to total pancreatectomy with islet autotransplantation (L-TPIAT), Makary and colleagues offered the procedure to 20 patients with chronic pancreatitis at The Johns Hopkins Hospital from 2013 through 2015 (12 women; mean age, 39 years).

On average, the operation took 493 minutes, islet isolation took 185 minutes, and hospital stay was 11 days. These, as well as time to return to work, were all shorter compared with those shown in previous studies of different surgical approaches to TPIAT, according to the press release.

Thirty-five percent of patients were readmitted to the hospital within 30 days. By their 6-month follow-up appointment, 90% of patients had improved or resolved pain, and 60% no longer needed opioids. Average pain scores dropped by 33.25 out of 100.

No postoperative surgical site infections, hernias, small-bowel obstructions or deaths occurred.

After a median follow-up of 10.4 months, 95% of patients had detectable random insulin C-peptide levels, and after a median of 12.5 months, 25% of patients were insulin independent.

In a related editorial, Chirag S. Desai, MD, and Khalid M. Khan, MD, described L-TPIAT as “a natural extension to the standard surgical procedure,” noting that its main benefit is reduced postoperative pain.

“Furthermore, [the researchers] demonstrated that the pancreas can be safely removed laparoscopically in patients with a history of chronic pancreatitis,” they wrote. “Long term, however, the most important consideration along with pain relief is islet yield, which is primarily determined by the ability to retrieve the maximum number of islet cells.” This could be affected by early ligation of the gastroduodenal artery and dividing the neck of the pancreas during dissection, they noted.

Chronic pancreatitis can be a very painful and debilitating condition. Careful patient selection can match the right candidates to this new minimally invasive surgical therapy,” Makary said in the press release. – by Adam Leitenberger

Disclosures: One of the researchers reports financial relationships with AbbVie, Calcimedica and Novo Nordisk, and serves on the advisory boards for Enteromedics, Celltrion and Salix.

Laparoscopic total pancreatectomy with islet autotransplantation and intraoperative islet separation, a new minimally invasive surgical approach for treating chronic pancreatitis, was successfully completed and improved outcomes in the first 20 patients to undergo the procedure.

According to data from the case series published in JAMA Surgery, the approach reduced complications, hospital stays and the need for opioids.

“In an era of opioid addiction, performing a major operation through a minimally invasive technique can mean less pain for patients, reducing the need for opioids and their complications,” Martin A. Makary, MD, MPH, professor of surgery at the Johns Hopkins University School of Medicine, where the technique was pioneered, said in a press release.

To test the feasibility of a laparoscopic approach to total pancreatectomy with islet autotransplantation (L-TPIAT), Makary and colleagues offered the procedure to 20 patients with chronic pancreatitis at The Johns Hopkins Hospital from 2013 through 2015 (12 women; mean age, 39 years).

On average, the operation took 493 minutes, islet isolation took 185 minutes, and hospital stay was 11 days. These, as well as time to return to work, were all shorter compared with those shown in previous studies of different surgical approaches to TPIAT, according to the press release.

Thirty-five percent of patients were readmitted to the hospital within 30 days. By their 6-month follow-up appointment, 90% of patients had improved or resolved pain, and 60% no longer needed opioids. Average pain scores dropped by 33.25 out of 100.

No postoperative surgical site infections, hernias, small-bowel obstructions or deaths occurred.

After a median follow-up of 10.4 months, 95% of patients had detectable random insulin C-peptide levels, and after a median of 12.5 months, 25% of patients were insulin independent.

In a related editorial, Chirag S. Desai, MD, and Khalid M. Khan, MD, described L-TPIAT as “a natural extension to the standard surgical procedure,” noting that its main benefit is reduced postoperative pain.

“Furthermore, [the researchers] demonstrated that the pancreas can be safely removed laparoscopically in patients with a history of chronic pancreatitis,” they wrote. “Long term, however, the most important consideration along with pain relief is islet yield, which is primarily determined by the ability to retrieve the maximum number of islet cells.” This could be affected by early ligation of the gastroduodenal artery and dividing the neck of the pancreas during dissection, they noted.

Chronic pancreatitis can be a very painful and debilitating condition. Careful patient selection can match the right candidates to this new minimally invasive surgical therapy,” Makary said in the press release. – by Adam Leitenberger

Disclosures: One of the researchers reports financial relationships with AbbVie, Calcimedica and Novo Nordisk, and serves on the advisory boards for Enteromedics, Celltrion and Salix.