Introduction: Total pancreatectomy with islet autotransplantation (TPIAT) is an effective treatment to retain pancreatic endocrine function while alleviating intractable pain in Chronic Pancreatitis. The role of the preservation of the pylorus in TPIAT patients has not been studied.

Methods: Baylor Simmons Transplant Institute patient database was queried to identify all patients undergoing TPIAT from October 2006 to January 2015. Total 83 patients were categorized into two groups based on the absence or presence of pylorus resection: the TP with antrectomy (N=17) and PPTP (N=66) groups. All patients with previously diagnosed chronic pancreatitis were evaluated by multidisciplinary team. Preoperative patient background, intraoperative conditions, postoperative complications, long-term nutritional status and islet graft function were investigated to evaluate the clinical significance of the preservation of the pylorus ring. The Wilcoxon two-sample test, Kaplan-Meier and linear mixed regression models were used to compare groups.

Results: Patients in the two surgical groups had comparable ages. Median age in the PPTP group was 41.5 years versus 41 years in the TP group. The incidence of delayed gastric emptying was not significantly different in the PPTP and TP groups (18.2 and 17.6%, respectively). Estimated blood loss seemed higher in the TP group compared to the PPTP group but did not reach significance (median 600 vs. 500 mg; p-value=0.057). Moreover, intraoperative blood transfusions and hospital and ICU stay were also comparable between two groups. Weights changed significantly over time but the two surgical procedures did not attain statistical significance. Islet graft function and pain score as well as narcotic requirements were not statistically different in TP and PPTP groups for one year follow up.

Conclusion: Early outcome of long-term nutritional status in TP with antrectomy and PPTP were similar. Our results suggest that pylorus preservation and antrectomy are equivalent in TPIAT, with perhaps somewhat less intra-operative blood loss in the pylorus-preserving group.

CITATION INFORMATION: Shahbazov R, Dabous A, Yoshimatsu G, Fernandez H, Saracino G, Naziruddin B, Onaca N, Kim P, Levy M. Effect of Pylorus Preservation Procedure on Patient and Graft Outcome in Total Pancreatectomy with Islet Autotransplantation. Am J Transplant. 2016;16 (suppl 3).

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