Use of an Insulin Pump in the Elderly Surgical Patient: Tolerance of Total Pancreatectomy After Neoadjuvant Chemotherapy for Multifocal Pancreatic Cancer.

Pancreatic cancer is one of the most fatal cancers if not caught early and is associated with late disease presentation. Multifocal pancreatic cancer is particularly difficult to treat as cases that are amenable to surgical resection require total pancreatectomy. Such patients will develop brittle diabetes as they require exogenous insulin after surgery and in the apancreatic state lose counter-regulatory homeostatic mechanisms (i.e., glucagon). We present an elderly patient who underwent neoadjuvant chemotherapy and total pancreatectomy. The patient has adequate glycemic control postoperatively being managed with an insulin pump and remains disease free at 3 years and 3 months after resection. A 72-year-old male presented with two tumors, in the head and tail of the pancreas, respectively, which were consistent with pancreatic adenocarcinoma by endoscopic ultrasound biopsy. Neoadjuvant FOLFIRINOX had been administered and total pancreatectomy was performed. The patient did well postoperatively and was discharged on postoperative day 8. The patient was seen by endocrinology pre- and postoperatively who started an insulin pump for glycemic management 2 weeks postoperatively. The patient's HbA1c was 7.9% at 3 months. The patient remains disease free at 3 years and 3 months with an HbA1c of 7.0% and a normal CA19-9. This case highlights that glycemic control after total pancreatectomy with the use of an insulin pump in the elderly population is achievable. Elderly patients can struggle with certain technologies and selecting appropriate patients for insulin pump therapy after total pancreatectomy is imperative.