Patient Reported Outcomes After Total Pancreatectomy With Islet Autotransplantation: A Narrative Review

Chronic pancreatitis and recurrent acute pancreatitis are progressive disorders associated with severe pain, functional limitation and major impairment in health-related quality of life. For selected patients with disease refractory to medical, endoscopic or limited surgical therapy, total pancreatectomy with islet autotransplantation (TPIAT) offers definitive pain control whilst preserving endogenous insulin production. Whilst metabolic outcomes such as insulin independence have traditionally guided evaluation of this procedure, patient-reported outcomes provide a broader assessment of its clinical impact and are increasingly relevant to surgical decision-making. This narrative review synthesises the available evidence on health-related quality of life, psychological well-being and occupational outcomes following TPIAT in adult patients. Across published cohorts, TPIAT is consistently associated with clinically meaningful improvements in global quality of life, particularly in pain, physical functioning and emotional well-being, with benefits observed even amongst patients who remain insulin dependent. Psychological health generally improves following surgery, although detailed characterisation is limited by infrequent use of validated psychiatric instruments. In contrast, occupational recovery is more variable, often constrained by long-standing pre-operative disability, prolonged opioid exposure and socioeconomic factors rather than surgical outcomes alone. Interpretation of existing data is challenged by small sample sizes, heterogeneous outcome measures and limited long-term follow-up. Overall, current evidence supports TPIAT as a procedure that confers substantial patient-centred benefits for appropriately selected adults with refractory pancreatitis. These findings highlight the importance of timely referral, comprehensive pre-operative assessment, and structured multi-disciplinary post-operative support, and underscore the need for standardised, prospective evaluation of patient-reported outcomes to better inform surgical counselling and optimise long-term recovery.