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Invited Commentary
June 2017

Critical Issues in Surgical Approach and Isolation Site for Islet Autotransplantation

Author Affiliations
  • 1Department of Surgery, University of North Carolina, Chapel Hill
  • 2Department of Pediatrics, Georgetown University Hospital, Washington, DC
JAMA Surg. 2017;152(6):556-557. doi:10.1001/jamasurg.2016.5709

Total pancreatectomy with islet autotransplantation (TPIAT) is the most appropriate option for patients with refractory chronic or recurrent pancreatitis with the primary aims of controlling pain, preventing brittle type 3C diabetes, and mitigating the risk of pancreatic cancer. The quality of life improves significantly after the procedure in adults and children.1,2 The timing of TPIAT in relation to the natural history of disease is critical although not universally agreed on. The ideal time is when maximum islet yield can be obtained while restoring the patient’s life to normalcy, although that time is often modified by the progress of the disease at presentation, patient symptoms, and patient preparedness to undergo major surgery. Outcomes of TPIAT can be influenced by previous procedures, surgical operations, and dependence and duration of narcotic requirements, which should be kept in mind when determining the timing of surgery.3

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