Search for tag: "pancreas"

Dr. Miller: Surgical treatments for uncommon pancreatic cancers. We're going to talk about that next on Scope Radio.

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Dr. Miller: I'm here with Dr. Thomas Chaly. He's a pancreatic transplant surgeon, and we're going to talk about other kinds of pancreatic cancers. I think most people, Thomas, are used to knowing about the standard pancreatic cancer, but what we treat here at the University of Utah are more rare types of cancer called neuroendocrine tumors of the pancreas. Can you talk about that a little bit?

Dr. Chaly: Pancreatic neuroendocrine tumors are a rare tumor, like you stated, representing approximately 5% of all tumors of the pancreas.

Dr. Miller: Not common.

Dr. Chaly: Not very common at all. They can be described as in two ways, nonfunctional versus functional, functional being quite more common than the other. The spectrum of these tumors range from insulinomas, glucagonomas, VIPomas. These may just sound like large terms, but basically my point to get across is these are hormone-producing tumors.

Dr. Miller: So tell me what an insulinoma does.

Dr. Chaly: An insulinoma is a tumor that's secreting insulin from the pancreas.

Dr. Miller: That's where insulin is made anyway, right?

Dr. Chaly: Correct.

Dr. Miller: Okay. So if you have diabetes, your insulin-producing cells of the pancreas aren't producing enough, but in this case, too much.

Dr. Chaly: Right. They're overproduced and then they're secreted based on the tumor so it's uncontrolled. It's an uncontrolled tumor secreting insulin in extreme amounts.

Dr. Miller: And then there are other types of neuroendocrine tumors.

Dr. Chaly: Correct. Like glucagonomas, which are increasing the amount of glucose you have in your body in extreme amounts.

Dr. Miller: Almost the opposite of what the insulinoma does.

Dr. Chaly: Exactly. In addition to that, there's also something that's more common on the spectrum, which would be a gastronoma.

Dr. Miller: Would you think that these neuroendocrine tumors are as dangerous as pancreatic cancer as we commonly know it?

Dr. Chaly: I would say they're dangerous in the fact that they act like ninja tumors, as I like to call them.

Dr. Miller: That's interesting. What is a ninja tumor?

Dr. Chaly: Well, tumors of the pancreas, I would say, can go relatively unnoticed for a longer period of time, kind of like a ninja. Now, maybe that's just kind of a term that's a little too broad, but I would say that these tumors are dangerous in that aspect, that they go unnoticed for long periods of time. Dr. Miller: So they're small. They may not produce much in the way of hormones. People don't notice them, and then later on as they get bigger and produce more hormones, all of a sudden they develop symptoms.

Dr. Chaly: Right. And then at that point, that's when the diagnosis may in some cases be too late. But in other instances, this is just the tip of the iceberg of all their symptoms.

Dr. Miller: One question I have is, are neuroendocrine tumors generally malignant in the sense that they can metastasize or not?

Dr. Chaly: So that's an excellent question, and the answer is 50/50. Most are benign, but some are malignant and in some cases they can metastasize to the liver, which can be very scary to the patient themselves.

Dr. Miller: So to point out to the audience, even though they're benign they still produce hormones like insulin or glucagon and that causes abnormal symptoms in the patient and then has to be treated. So generally, even though they're benign, if they're functional they are taken out or treated.

Dr. Chaly: Right. So there are multiple treatment options, obviously surgical resection being one of the first and foremost. But in addition, there are other palliative measures as well that can temporize the hormone production of all of these tumors.

Dr. Miller: Now, Dr. Chaly, when do you get involved? Are you getting involved when these are malignant and their metastatic?

Dr. Chaly: Well, at this point our division gets involved when these lesions are metastatic to the liver. This indicates what we would call an expanded disease at this point, where they've gone beyond the lymph nodes and beyond the primary tumor sites, and have gone to areas in the liver where maybe not all practitioners are familiar with.

Dr. Miller: Now, that's concerning because when we think about metastatic disease, we think about terminal disease. But you're also saying, maybe not. Maybe we have treatment for that.

Dr. Chaly: Right. There are excellent results here at The U in regards to neuroendocrine tumor resection, in regards to debulking of these tumors, and it has been well-described that these tumors, if debulked and surgically managed, can be beneficial to the patient long-term.

Dr. Miller: Debulking; could you describe that term for them?

Dr. Chaly: It's basically an 80% reduction in the amount of tumor that's in the liver. If you're able to attain an 80% reduction in metastatic volume of the liver, essentially a metastasectomy of the liver, then you are doing a quite significant benefit to the patient's long-term survival.

Dr. Miller: Now, if you leave some of that cancerous tissue in, do you have to go back in later and do another resection?

Dr. Chaly: That's a possibility as well if it continues to grow. Another modality that can be used is interventional radiology and radio frequency ablation, essentially just burning the areas of the liver that would have remnant tumor in certain areas.

Dr. Miller: Now, how do patients with these neuroendocrine tumors, especially ones that are metastatic to liver, find their way to your door?

Dr. Chaly: Well, it's usually a situation where a patient had a primary tumor of the pancreas and it was found to be a neuroendocrine tumor. Then, they were later diagnosed, maybe a year or two later, sometimes less, where they had tumors now in the liver. The original physician maybe thought that a more experienced liver surgeon may have some other modalities that weren't available to him at his initial encounter.

Dr. Miller: Now, I'm curious as to how many of these patients you see a year.

Dr. Chaly: We see quite a number of patients a year. I would say we see close to 100 patients who need liver resections in some capacity. Maybe approximately 20% of those are pancreatic neuroendocrine tumors or neuroendocrine tumors that have metastasized to the liver.

Dr. Miller: Now, I'm thinking that since these are pretty rare pancreatic tumors, patients are coming to see you from all over the place, probably from outside the state, elsewhere. Is that true?

Dr. Chaly: Correct. We're getting patients from all over the surrounding states. They come concerned because of these liver metastases and what we're able to offer them. I would tell that it's not a death sentence by any means. Neuroendocrine tumors that have metastasized to the liver can be treated in a variety of ways. In addition to those that I've mentioned, surgical resection and burning them, liver transplantation is also an option in selective cases.

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Dr. Miller: Pancreatic neuroendocrine tumors and hepatic transplants. We're going to talk about that next on Scope Radio.

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Dr. Miller: Hi, I'm Dr. Tom Miller and I'm here for Scope Radio with Dr. Thomas Chaly from the Department of Surgery. Thomas is a transplant surgeon and he also specializes in metastatic neuroendocrine pancreatic cancers.

These are rare cancers, Tom, as we've talked about in a previous session and my understanding is that in certain cases one might transplant the liver in order to cure a metastatic neuroendocrine tumor of the pancreas.

Dr. Chaly: That's correct. So in instances where resection or interventional radiologic methods are not applicable to certain patients, University of Utah has shown excellent results in transplanting, in whole liver transplantation of these patients, and with a great long-term survival.

Dr. Miller: Would you initially debulk the tumor in the liver, or would you decide to go straight to hepatic transplant?

Dr. Chaly: That's an excellent question. Debulking is one of the primary modalities, and if we could debulk the tumor safely, leaving enough liver remnant, we would do that. But in instances where debulking wouldn't provide a benefit to the patient, transplantation is the next best option.

Dr. Miller: Do you debulk first and then in some cases transplant later, or is that generally not done?

Dr. Chaly: No, that is done. Debulking can offer a temporary solution of patient symptoms, and if this is not successful and there's a recurrence in the immediate post-operative period, approximately six months, we may consider transplantation at that point.

Dr. Miller: Now perhaps for the audience we should distinguish this from regular or more common pancreatic cancer. You would not debulk or transplant a patient with what we know as common pancreatic cancer.

Dr. Chaly: That is correct. Pancreatic cancer, or pancreatic adenocarcinoma, is extremely aggressive and debulking or transplantation, given the immunosuppression that the patient's on, would be of no benefit.

Dr. Miller: So these neuroendocrine tumors, some are functional, that is, that they produce hormones and cause symptoms, and others are silent. I think you like to use the term ninja cancers. I think you might say that the ones that are less functional or not functional, that is, they don't produce hormones, are the ones that actually metastasize more frequently?

Dr. Chaly: Well, that's correct that they metastasize a little more frequently, and that happens primarily because they're so silent and they're not producing hormones, so we're unaware of their activity. And so at this point, after the primary tumor has been controlled, a liver transplant is an option in some of these patients.

Dr. Miller: What percent of patients with neuroendocrine disease in the liver, metastatic disease in the liver, would undergo a transplant versus the debulking that you talked about previously?

Dr. Chaly: I would say the vast majority of patients would actually undergo a surgical debulking, and in select patients where debulking wasn't an option, maybe less than 10% transplantation would be available for them.

Dr. Miller: But if that's the case, it sounds like the University of Utah would be a great place to have that treatment.

Dr. Chaly: Absolutely. We've had an excellent experience in transplanting these patients and have had a great success rate, and these patients have done well over the long-term period.

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Dr. Miller: You've been told that you might need a Whipple. What does that mean? We're going to talk about that next on Scope Radio.

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Dr. Miller: Hi, here with Dr. Courtney Scaife. She is a professor of surgery here in the Department of Surgery at the University of Utah. And she also specializes in cancer surgery. Courtney, what is a Whipple?

Dr. Scaife: A Whipple is an operation on the pancreas when you have a neoplasm, which can be a mass or a tumor or a cyst, those are all synonyms, in the proximal part or we call it the head of your pancreas. And the Whipple removes that part of the pancreas.

Dr. Miller: So the Whipple is the name of the type of surgery that you do. Is that pretty typical as pancreatic surgery goes?

Dr. Scaife: That's correct. Well, the Whipple is the only surgical procedure of the pancreas that's named after the doctor who first described the operation. Other pancreas surgeons are often more anatomically referenced, such as a distal pancreatectomy or an enucleation of a tumor out of the pancreas.

Dr. Miller: So Whipple has been a surgery that's been practiced for many years, I think. Is that right?

Dr. Scaife: Dr. Whipple first described the operation in the 1950s. And as first described, it was a two-day operation where the pancreas was taken apart, and the next day, everything was put back together.

Dr. Miller: My understanding is that Whipple surgery is a curative surgery for some patients with pancreatic cancer.

Dr. Scaife: That's correct. So again, Whipples are done for all types of neoplasms. And again, neoplasms can be masses, tumors, cysts in the pancreas. And so a Whipple for a non-cancerous neoplasm is obviously curative. And a Whipple for pancreas cancer can also be curative.

Dr. Miller: If one has a pancreas cancer and they're going to undergo Whipple, the purpose of that would be to cure the cancer, I think, obviously, right?

Dr. Scaife: Yes.

Dr. Miller: And once that takes place, what can the patient expect after a Whipple surgery?

Dr. Scaife: So a Whipple operation is complex. It's a six- to eight-hour operation.

Dr. Miller: That's a big operation.

Dr. Scaife: Yeah. And because of the location of the head of the pancreas intimately involved with the bile duct and the first part of the small intestine, we have to rebuild all of those. So we rebuild the pancreas. We rebuild the first part of the small intestine. And we rebuild the bile duct. But in the end, the patients can eat normally. They can eat any food they like. And they do quite well after recovering from the operation.

Dr. Miller: Is there anything that you tell your patients in that preoperative period when you first meet them before they undergo the surgery?

Dr. Scaife: We frequently tell patients that the surgery, again, takes six to eight hours. They'll be in the hospital for approximately seven days. For a month after a big surgery like this, their appetite, their energy, and their strength will all be much lower than they normally expect. And it usually recovers four to six weeks after surgery.

Anything someone has before surgery gets a little bit worse and harder to manage after surgery. So diabetes, high blood pressure are all a little bit harder to manage after a big operation like this. But it recovers about a week or two after surgery and goes back to their baseline.

Dr. Miller: So that's interesting. Do you use a team approach with another physician such as an internist to help manage the patient after the surgery if they have diabetes or other complications?

Dr. Scaife: Generally we manage it on our own. Because they're short-lived, we're able to manage it on our own.

Dr. Miller: Do they ever experience diarrhea following pancreatic surgery? Is that something that they need to worry about?

Dr. Scaife: Yeah, chronic diarrhea after a Whipple operation is extremely uncommon, but not zero. Some patients get dumping syndrome, which happens in less than 10% of our patients.

Dr. Miller: What is that? What's dumping syndrome?

Dr. Scaife: It's from operating on the stomach and re-plumbing it effectively to the small intestine or rebuilding that first part of the small intestine. Some patients can have a syndrome where they eat rich foods, and the foods go through the stomach. And the next part of the small intestine, it's not used to seeing such rich foods, reacts by pouring a lot of water into the intestine.

And that neurologic response can result in almost like a hot flash-type symptom. And then after all of that water gets emptied into the intestine, 30 to 60 minutes after a meal, patients can have diarrhea from the water flushing through their system.

Dr. Miller: Now, generally, that resolves in a couple of weeks? Or does that continue?

Dr. Scaife: In 10% of our patients, after the Whipple surgery, they experience that. Fewer than 1% of the patients have a long-term problem with that. It normally resolves on its own and the few patients that it doesn't, learn to eat around it so they don't stimulate those symptoms.

Dr. Miller: So over time, people who have a Whipple procedure, they potentially are cured of their cancer. Do they end up keeping the same weight that they had before? Do they lose weight after a Whipple where part of the pancreas is taken out? And as I understand it, the pancreas is very important in digestion.

Dr. Scaife: That's right. So the answer to the first part of your question is that most of our patients, 80% of our patients, do well and maintain their normal appetite, normal diet, and normal weight. We do have different ends of the spectrum, obviously. There are some people who gain weight and some people who don't eat as well after the operation, but that's very unusual.

The second part of your question, the pancreas does two things. It manages your blood sugars and it helps you with digestion. And so after we remove part of the pancreas, it's very uncommon to cause someone to be a diabetic from a pancreas surgery. You only need 10% of a normal pancreas to manage your blood sugars normally. So very few people become diabetic as a result of the operation.

Dr. Miller: So you're not taking out the entire pancreas during the Whipple.

Dr. Scaife: Correct, correct. And really about a third to only 20% of the pancreas comes out with the operation.

Dr. Miller: Now, this is a big operation, as you've outlined. Do patients experience much pain postoperatively or in the several months following surgery?

Dr. Scaife: No, we're really able to manage the pain very well. We use local anesthesia in the incision or an epidural in the postoperative care. And then patients actually recover quite well in usually one to two weeks out from surgery. They're off of any pain medications and starting to resume their normal activities and functions.

Dr. Miller: Can you give us a wrap-up about who comes to you for potential surgery?

Dr. Scaife: Most of our consults for pancreas neoplasms are simple cysts or benign cysts in the pancreas. And so 80% of our patients don't need an operation, even though they're referred to us for evaluation. Of the few that do need an operation, those patients do extremely well. They don't all need Whipples. There are other less invasive operations of the pancreas that can be done. And all of those patients, including the patients who do Whipples, ultimately return to a very normal lifestyle.

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Interviewer: Coming up next on The Scope, if you are a brittle diabetic, a possible treatment option.

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Interviewer: If you suffer from a kind of diabetes called brittle diabetes, you might want to consider a different type of treatment you might not have heard of before. We're with Dr. Jeffrey Campsen from the University of Utah Health Care. He's a transplant surgeon here. The process is called pancreas alone surgery. What exactly is that?

Dr. Campsen: What we're talking about today are patients with type I diabetes that have very unstable diabetes, meaning they've tried their best to control it but they're still very brittle. What that means is they have swings in their sugar levels, their glucose levels, whether they go too high but more importantly they go too low. If you have too low sugars, it's known as hypoglycemia and that can be deadly. If you have the inability to control this with standard therapies, which is insulin and insulin pumps, one therapy we may offer you is a pancreas transplant.

Interviewer: All right. So if some of these other things haven't been working for whatever reason, a pancreas transplant might be the key. How would somebody know if this is something that would be right for them?

Dr. Campsen: Well I think first of all, there's two types of diabetes. There's type I diabetes, which means that your pancreas doesn't actually make the hormones that you need, insulin and glucagon and other things. Then there's type II diabetes, which means that you're resistant to the insulin. So a pancreas transplant doesn't work very well if I'm giving you a pancreas and you're already resistant to insulin, so we're just talking about the type I diabetics.
Once you know that you're a type I diabetic, and most people do know that, it's are you able to comfortably treat this safely. Many people use insulin, they have insulin pumps and monitors, but the problem is not only do they not produce insulin, but they don't produce a hormone called glucagon, which then keeps them from going too low. If they continue to have these episodes where they get too low sugars, then it risks their life. So if this is happening they're referred to as a brittle diabetic.
The final thing is that if they're brittle and the insulin levels are swinging back and forth and the glucose levels are swinging back and forth, they may have other complications. Whether or not they're going blind because of the diabetes, they have nerve damage, they have other issues, chronic infections. These may be reasons that we'll then offer you a pancreas transplant that you would then benefit from.

Interviewer: The name pancreas alone sounds interesting to me. Why is it called that?

Dr. Campsen: Historically the diabetes will attack the patient's kidneys over time. As their kidneys go into failure, we can give them a kidney transplant. But a kidney transplant in a type I diabetic doesn't work as long as it does in non-diabetics because the diabetes comes back and attacks the graft, the kidney transplant, and shortens the life of the kidney transplant. So historically we would give both a pancreas and a kidney to those patients that would need it to protect the kidney. The other school of thought is, why wait until your kidneys have already failed? Why not give you a transplant sooner, a pancreas transplant alone, that then protects your kidneys so you never need a kidney transplant?

Interviewer: So kind of the old school way of thinking was, when it gets to the really dangerous situation, that's when you do the transplant. This is a little bit more proactive.

Dr. Campsen: That's right. And you have to understand that there's a balance, because transplant surgery is a big deal. The surgery itself is a large vascular surgery, and on top of that you have to take immunosuppressive medications for the life of the transplant. So you're kind of trading diabetes for the disease of transplant. However the disease of transplant is much smaller and safer than this brittle diabetes that people talk about or kidney failure.

Interviewer: So if catching the patient before things get terrible is the key, how soon could somebody get one of these transplants?

Dr. Campsen: Many type I diabetics are diagnosed when they're children. That's probably too young because you have to have someone who's very responsible who can take care of the transplant. So we like to see the patients get at least towards their late teens if not into their 20s. They have to really show that they've really tried to manage their diabetes aggressively and very good compliance with their insulin and they've still failed.

Interviewer: All right. What should a patient know at this point? This isn't something that necessarily a lot of physicians would refer.

Dr. Campsen: Right. I think the interesting thing about type I diabetics is the only way that they survive is by really managing their disease. Obviously physicians, endocrinologists, medical doctors have to help them and support them to do this. But they're living every second of their day and their lives with this, and if they're able to control it, then they know a lot about diabetes. They know whether or not they're brittle. They know whether or not their other organs are starting to fail because of the diabetes. Then I think a patient who has this needs to realize that we now offer this as a therapy to help cure the diabetes.

Interviewer: What would be your one takeaway for somebody listening to this?

Dr. Campsen: I think if you're a brittle diabetic, and you know who you are, then pancreas transplant may be an option for you and you should come talk to us. You'll meet our transplant team, the professionals that manage different types of transplants at the University of Utah, and we'll sit down and see if you qualify for this and more importantly will you benefit from an organ transplant?

Interviewer: What are some of the benefits of getting the transplant versus not?

Dr. Campsen: Well I think that basically there's nothing better than a human organ. Everything that we do outside of transplant is approaching the quality that a human organ can give you, but there's nothing better than that. So if you're having trouble with your diabetes and you're noticing it's still damaging you, whether it's giving you heart disease, eye disease, nerve disease, all the kind of things that really happen because of type I diabetes, the fact that you're married to your insulin pump, then a pancreas transplant is an option that then will cure your diabetes. The moment that you have the transplant you're off insulin.

Interviewer: It sounds like the sooner that you contact somebody and talk about this, the better because I would imagine there is a wait time for pancreas transplants.

Dr. Campsen: There is a wait time. First of all you have to go through the workup, and then once you're listed the available organ has to be offered to you. It can be a year or two.

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Interviewer: This is Pancreas 101. What does it do? What can go wrong, and what can you do about it? That's coming up next on the Scope.

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Interviewer: All right. Time to learn your pancreas basics with Dr. Jeffrey Campsen from the University of Utah, First of all, let's start out with what is the pancreas?

Dr. Jeffrey Campsen: The pancreas is an endocrine exocrine organ, and what that basically means is it sits in the middle of your abdomen, and it secretes hormones and different substances into the bloodstream but also into the intestines. People know it mostly as the organ that secretes insulin which then controls your glucose or your sugar. And if you don't have that, you become a diabetic. But it does a lot of other functions that helps with digestion of food and regulation of the body's means to produce energy through the breakdown of sugar.

Interviewer: So a pretty important organ.

Dr. Jeffrey Campsen: It's a very important organ in the sense that you could live without it, but it's very difficult to live without it, and you can't live without it without supplementation of the products that it produces.

Interviewer: And what problems can arise with the pancreas, and are they just naturally occurring or is it lifestyle oriented?

Dr. Jeffrey Campsen: It's both. First, some people are born with deficiencies in their pancreas. They're most known as Type 1 Diabetics where early on as a child it's found that the pancreas actually doesn't work particularly right. Many people believe that it's an autoimmune disorder where the body is actually attacking the pancreas. It works maybe at birth, but sometime in the next ten years the body actually attacks it and it fails. And then they become a diabetic from that. There's also you can damage your pancreas by treating your body poorly through alcohol, drug use, different substances that you put into your body can actually destroy your pancreas. Then ultimately you become a diabetic, or a pancreas cripple from that standpoint. And then other types of infection can actually ruin the pancreas. It's attached to your liver through a series of ducts, and if you have liver disease or gallbladder disease, that can actually damage your pancreas and cause pancreatitis which then pancreatitis then heals from that, scars, and slowly becomes fibrotic and also stops working.

Interviewer: Let's get back to the lifestyle. So how do you really have to abuse your pancreas before it's going to stop working?

Dr, Jeffrey Campsen: I don't think very much actually. I think to get to the point where it's completely burnt out, that's probably years worth of abuse to the pancreas. But everybody's built differently, and some people are much more susceptible to alcohol or different type substances and can damage their pancreas. Whereas other people are built in a way that they can tolerate it more. So you don't know until it's too late whether or not those substances have hurt you to the point where you can't recover from that.

Interviewer: And what are some of the symptoms then of a pancreas not functioning? What would I experience?

Dr. Jeffrey Campsen: I think acutely, meaning immediately, if there's a problem you would have intense abdominal pain, nausea probably, vomiting. Over the long-term, it sneaks up upon you insidiously with feeling very lethargic, tired, off. And that's basically showing an imbalance of your ability to regulate your sugar. So what you're actually having is very high sugar levels in your blood creating a feeling of basically feeling sick. Then, a lot of these patients go to the doctor. They find out that their sugar which should be maybe at a level of 100 is actually at a level of 600 which actually ultimately can be life threatening. Some people are actually found in a coma before they realize what has happened. And at that point you may not actually come out of that coma.

Interviewer: What type of life do you have if your pancreas fails you?

Dr. Jeffrey Campsen: It's a very difficult life. If your pancreas fails you, you become what they call a "brittle diabetic." Not only can you control your sugars going into high, but then if you add insulin they can actually go very low. And your pancreas keeps your sugars from going too low. If your sugars go too low, the cells in your body can't work, including the cells in your brain that allow you to breathe and your heart to beat. And so it can become fatal.

Interviewer: And what about other lifestyle considerations, like are you going to have to carry a piece of equipment around with you?

Dr. Jeffrey Campsen: Many patients are able to regulate their sugar with something called an insulin pump. And this pump basically then reads your sugar levels and then doses insulin in. Some patients are able to do it with just pills. I think it depends on the type of diabetes that you ultimately have, meaning there's Type 1 where you don't really produce any insulin and then Type 2 where you actually produce insulin but you're resistant to it. To get back to what you were saying as far as lifestyle, the Type 2 diabetics that actually produce insulin but are resistant to it are the patients that you want to counsel to lose weight. Obesity is one of the major health issues in the world today, and the people that are overweight ultimately are hurting their pancreases. Their pancreases can't handle the weight, and then they become a Type 2 diabetic.

Interviewer: And finally, what's your final thought for somebody listening to this when it comes to the pancreas?

Dr. Jeffrey Campsen: I think basically the healthier your body is the better the organs that you house are going to do. And so if you want to live a long time, you have to treat your body well, which is an old concept but it still holds true.

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Interviewer: A lot of people with Type 1 diabetes believe that the insulin shots and a pump is enough, but there might actually be a better option, a pancreas transplant. We're with Dr. Paul Campsen, Surgical Director of Pancreas Transplant Surgery with the University of Utah. That option is pancreatic surgery.

Dr. Paul Campsen: That's correct. Right now we do pancreas transplants for Type 1 diabetics. Type 1 diabetics can't survive without insulin, so they give themselves shots and they can administer this sometimes through am insulin pump which is a very good way to keep them alive. The control that they get from that is not a replacement for the human organ, the pancreas. That's where the pancreas transplant comes into play in the sense that you can help yourself stay alive just like dialysis helps with kidney transplant, or with failure. A pancreas transplant gives you back the human organ that you actually need.

Interviewer: Plus, also a better quality of life.

Dr. Paul Campsen: A much better quality of life. Over the long term the pancreas transplant itself is completely correcting the diabetes, so any of the sequelae of diabetes, whether it be peripheral vascular disease, damage to your eyes, damage to your nerves, damage to your coronary arteries, all of that stuff is stopped with a pancreas transplant.

Interviewer: Not with the insulin shots or the pump?

Dr. Paul Campsen: No, I think that the insulin helps a lot. It slows down the damage. Obviously it literally saves their lives by giving them insulin, but it doesn't stop the diabetes because you're still a diabetic. The pancreas produces a variety of different enzymes and secretes many things that actually help the body including insulin, also glucagon, which keeps the sugars from going too low which can be life threatening, and any of the pancreatic enzymes that help with digestion. None of that' s given with the insulin pump. When you replace the pump with a human pancreas you get all of those benefits.

Interviewer: It sounds like a great solution. Why aren't more people doing it? Is it a dangerous surgery or is it fairly safe?

Dr. Paul Campsen: The diabetics who come to us hate their diabetes so much and they're so scared by it, and their so scared by brittleness of their, meaning they go too high with their sugar or too low, that they would do almost anything not to have to use insulin anymore, but they're scared because surgery is a big deal. The vast majority do very well with this surgery. It's very safe. They stay in the hospital for about a week afterwards, but the moment that they leave surgery they're not a diabetic anymore.

Interviewer: That's pretty amazing, isn't it?

Dr. Paul Campsen: It is pretty amazing. Many of the patients that come to us, their diabetes has also ruined their kidneys, so they're on dialysis at the same time. We'll do a simultaneous pancreas and kidney transplant. The moment that they leave the surgery the next morning they're cured of their diabetes and they're cured of the their renal failure and they're not on dialysis. The other thing that's very interesting in these patients is if you just give them a kidney transplant their Type 1 diabetes will still attack the kidney transplant.

Interviewer: It just kills that organ.

Dr. Paul Campsen: That's exactly right. The pancreas transplant added on top, because it cures the diabetes, actually protects the kidney transplant. Then both organs survive much longer.

Interviewer: Who would be a good candidate for this type of surgery?

Dr. Paul Campsen: I think anybody who has Type 1 diabetes. We're talking about unfortunate people who were diagnosed with diabetes probably before they were 20. We'd like to see these patients well before they get into their 30's. The earlier we see them the better.

Interviewer: OK. What are your final thoughts for somebody that has Type 1 diabetes and is a little on the fence?

Dr. Paul Campsen: I think basically this is a safe surgery. Coming and seeing us doesn't mean we're going to trap you and give you the surgery, but it's something where we can talk about it and see if this is the right surgery for you. If it is, we can cure your diabetes. If you have kidney problems we'll take care of those too.

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