Nowadays, TPis a safe surgical procedure indicated for neoplastic and not neoplastic
diffuse and otherwise untreatable pancreatic diseases. Main indications are
premalignant lesions like pancreatic intraepithelial neoplasia, and intraductal
papillary mucinous neoplasm; familial pancreatic cancers (essentially due to
mutations of BRCA2, STK11, p16/CDKN2 and PALB2 genes); recurrent, multicentric
and locally advanced neuroendocrine tumors; pancreatic fistula; and
nesidioblastosis. However, the most frequent cause of TP is severe chronic
pancreatitis unresponsive to a variety of possible treatments, including
dietary regimens, drugs (analgesic like opiates, anti-inflammatory, and
neurotropic agents), as well as more or less invasive procedures like chemical
neurolysis, Endoscopic Retrograde Cholangiopancreatography (ERCP), spinal cord
stimulation or intrathecal drug delivery devices Both endocrine and exocrine
functions of the pancreas are fatally lost after total pancreatectomy. As for
the former, the intervention induces loss of both, the insulin secreting α-cells
but also glucagon secreting α-cells. Loss of α-cells means abrogation of the
counter-regulatory system that usually protects from deleterious effects of
hypoglycemia, and greatly helps maintenance of normal Blood Glucose (BG) levels
under any circumstances.
On the non-endocrinepancreatic front, TP patients experience all the symptoms associated with
exocrine pancreatic insufficiency: abdominal bloating, cramps after meals,
flatulence, fatty or oily and frequent stools, indigestion and weight loss. In
fact, the total absence of pancreatic exocrine enzymes leads to malabsorption
of almost all nutrients, micronutrients and fat-soluble vitamins. Pancreatic
Exocrine Enzyme Replacement Therapy (PERT) is therefore indispensable for
control of the malabsorption syndrome. Moreover, impairment of digestive
function in these patients makes it hard to manage insulin replacement therapy.
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