Published online Jan 18, 2023. doi: 10.5500/wjt.v13.i1.10
Peer-review started: October 7, 2022
First decision: November 14, 2022
Revised: November 24, 2022
Accepted: December 23, 2022
Article in press: December 23, 2022
Published online: January 18, 2023
Despite the increased use of total pancreatectomy with islet autotransplantation (TPIAT), systematic evidence of its outcomes remains limited.
To evaluate the outcomes of TPIAT.
We searched PubMed, EMBASE, and Cochrane databases from inception through March 2019 for studies on TPIAT outcomes. Data were extracted and analyzed using comprehensive meta-analysis software. The random-effects model was used for all variables. Heterogeneity was assessed using the I2 measure and Cochrane Q-statistic. Publication bias was assessed using Egger’s test.
Twenty-one studies published between 1980 and 2017 examining 1011 patients were included. Eighteen studies were of adults, while three studied pediatric populations. Narcotic independence was achieved in 53.5% [95% Confidence Interval (CI): 45-62, P < 0.05, I2 = 81%] of adults compared to 51.9% (95%CI: 17-85, P < 0.05, I2 = 84%) of children. Insulin-independence post-procedure was achieved in 31.8% (95%CI: 26-38, P < 0.05, I2 = 64%) of adults with considerable heterogeneity compared to 47.7% (95%CI: 20-77, P < 0.05, I2 = 82%) in children. Glycated hemoglobin (HbA1C) 12 mo post-surgery was reported in four studies with a pooled value of 6.76% (P = 0.27). Neither stratification by age of the studied population nor meta-regression analysis considering both the study publication date and the islet-cell-equivalent/kg weight explained the marked heterogeneity between studies.
These results indicate acceptable success for TPIAT. Future studies should evaluate the discussed measures before and after surgery for comparison.
Core Tip: Surgical intervention is required for the management of debilitating and refractory abdominal pain in chronic pancreatitis (CP) patients failing medical therapy. Since first introduced in 1978, total pancreatectomy with islet autotransplantation (TPIAT) has shown promising results in CP patients, but the literature remains limited. This systematic review and meta-analysis found that TPIAT provided acceptable levels of pain relief and insulin independence.