Introduction: Surgical management of refractory chronic and recurrent acute pancreatitis is challenging due to lack of standardized guidelines for patient selection. Type of surgery offered to these patients, whether parenchymal preserving surgery (PPS) or total pancreatectomy with autologous islet cell transplant (TPAIT), often depends on surgeon preference and the center’s availability and expertise. TPAIT is considered an aggressive procedure due to its metabolic consequences amongst non-transplant specialist. Centers that publish large series on either PPS or TPAIT have few to no comparative data and there is a scarcity in literature addressing both procedures at the same time. We aim to evaluate outcomes of TPAIT vs. PPS following use of a patient-centered selection algorithm rather than therapeutic availability-centered decisions. 

Methods: From 2017 to 2021, chronic pancreatitis patients were offered surgery based on an algorithm designed with consideration of dominant area of disease, ductal dilatation, and glycemic control. These were retrospectively evaluated and outcomes were compared. 

Results: 51 patients underwent surgery (20 [39.2%] TPAIT, 4 [7.8%] total pancreatectomy, and 27 [52.9%] PPS – 9 Whipple procedures, 15 distal pancreatectomies, and 3 duct drainage procedures). There was no significant difference in baseline characteristics. Median length of surgery was longer for TPAIT (11 hours [IQR 10-12] vs 6 hours [IQR 5-8], p <0.001). Three (11.1%) PPS patients required non-operative intervention for leak and 2 (10%) TPAIT patients underwent re-laparotomy for bleeding. There was no significant difference in delayed feeding, wound infection, or readmission rate between groups; however, length of stay was longer following TPAIT attributed to insulin requirement. There was no incidence of portal vein thrombosis in TPAIT group and no mortality in either group.

Conclusion: TPAIT provides safe outcomes for patients as compared to PPS when appropriate selection is made.