Combined laparoscopic spleen-preserving distal pancreatectomy and islet autotransplantation for benign pancreatic neoplasm

Gianpaolo Balzano, Michele Carvello, Lorenzo Piemonti, Rita Nano, Riccardo Ariotti, Alessia Mercalli, Raffaella Melzi, Paola Maffi, Marco Braga, Carlo Staudacher

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

AIM: To evaluate the safety and feasibility of laparoscopic spleen-preserving distal pancreatectomy (LSPDP) with autologous islet transplantation (AIT) for benign tumors of the pancreatic body-neck. METHODS: Three non-diabetic, female patients (age 37, 44 and 35 years, respectively) were declared candidates for surgery, between May and September 2011, because of pancreatic body/neck cystic lesions. The planned operation was an LSPDP associated with AIT from the normal pancreas distal to the neoplasm. Islets isolation was performed on the residual pancreatic parenchyma after frozen section examination of the margin. Purified autologous islets were infused into the portal vein by a percutaneous transhepatic approach the day after surgery. RESULTS: The procedure was performed successfully in all the three cases, and the spleen was preserved along with its vessels. Mean operation time was 283 ± 52 min and average blood loss was 133 ± 57 mL. Residual pancreas weights were 33, 22 and 30 g, and 105.200, 40.390 and 94.790 islet equivalents were isolated, respectively. Surgical complications occurred in one patient (grade A pancreatic fistula). Postoperative stays were 6, 6 and 7 d, respectively. Histopathological evaluation revealed mucinous cystic neoplasm in cases 1 and 3, and serous cystic neoplasm in patient 2. No postoperative insulin administration was required. One patient developed a transient partial portal thrombosis 2 mo after islet infusion. Patients are insulin independent at a mean follow up of 8 ± 2 mo. CONCLUSION: Combination of LSPDP and AIT is feasible and could be effective to minimize the surgical impact for benign neoplasm of pancreatic body-neck.

Original languageEnglish
Pages (from-to)4030-4036
Number of pages7
JournalWorld Journal of Gastroenterology
Volume20
Issue number14
DOIs
Publication statusPublished - 2014

Fingerprint

Pancreatectomy
Autologous Transplantation
Pancreatic Neoplasms
Spleen
Islets of Langerhans Transplantation
Neck
Neoplasms
Pancreas
Insulin
Pancreatic Fistula
Frozen Sections
Portal Vein
Ambulatory Surgical Procedures
Thrombosis
Safety
Weights and Measures

Keywords

  • Autologous islet transplantation
  • Benign neoplasm
  • Laparoscopy
  • Minimally invasive treatment
  • Pancreas
  • Pancreatogenic diabetes
  • Spleen preservation

ASJC Scopus subject areas

  • Gastroenterology
  • Medicine(all)

Cite this

Combined laparoscopic spleen-preserving distal pancreatectomy and islet autotransplantation for benign pancreatic neoplasm. / Balzano, Gianpaolo; Carvello, Michele; Piemonti, Lorenzo; Nano, Rita; Ariotti, Riccardo; Mercalli, Alessia; Melzi, Raffaella; Maffi, Paola; Braga, Marco; Staudacher, Carlo.

In: World Journal of Gastroenterology, Vol. 20, No. 14, 2014, p. 4030-4036.

Research output: Contribution to journalArticle

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abstract = "AIM: To evaluate the safety and feasibility of laparoscopic spleen-preserving distal pancreatectomy (LSPDP) with autologous islet transplantation (AIT) for benign tumors of the pancreatic body-neck. METHODS: Three non-diabetic, female patients (age 37, 44 and 35 years, respectively) were declared candidates for surgery, between May and September 2011, because of pancreatic body/neck cystic lesions. The planned operation was an LSPDP associated with AIT from the normal pancreas distal to the neoplasm. Islets isolation was performed on the residual pancreatic parenchyma after frozen section examination of the margin. Purified autologous islets were infused into the portal vein by a percutaneous transhepatic approach the day after surgery. RESULTS: The procedure was performed successfully in all the three cases, and the spleen was preserved along with its vessels. Mean operation time was 283 ± 52 min and average blood loss was 133 ± 57 mL. Residual pancreas weights were 33, 22 and 30 g, and 105.200, 40.390 and 94.790 islet equivalents were isolated, respectively. Surgical complications occurred in one patient (grade A pancreatic fistula). Postoperative stays were 6, 6 and 7 d, respectively. Histopathological evaluation revealed mucinous cystic neoplasm in cases 1 and 3, and serous cystic neoplasm in patient 2. No postoperative insulin administration was required. One patient developed a transient partial portal thrombosis 2 mo after islet infusion. Patients are insulin independent at a mean follow up of 8 ± 2 mo. CONCLUSION: Combination of LSPDP and AIT is feasible and could be effective to minimize the surgical impact for benign neoplasm of pancreatic body-neck.",
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AU - Balzano, Gianpaolo

AU - Carvello, Michele

AU - Piemonti, Lorenzo

AU - Nano, Rita

AU - Ariotti, Riccardo

AU - Mercalli, Alessia

AU - Melzi, Raffaella

AU - Maffi, Paola

AU - Braga, Marco

AU - Staudacher, Carlo

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N2 - AIM: To evaluate the safety and feasibility of laparoscopic spleen-preserving distal pancreatectomy (LSPDP) with autologous islet transplantation (AIT) for benign tumors of the pancreatic body-neck. METHODS: Three non-diabetic, female patients (age 37, 44 and 35 years, respectively) were declared candidates for surgery, between May and September 2011, because of pancreatic body/neck cystic lesions. The planned operation was an LSPDP associated with AIT from the normal pancreas distal to the neoplasm. Islets isolation was performed on the residual pancreatic parenchyma after frozen section examination of the margin. Purified autologous islets were infused into the portal vein by a percutaneous transhepatic approach the day after surgery. RESULTS: The procedure was performed successfully in all the three cases, and the spleen was preserved along with its vessels. Mean operation time was 283 ± 52 min and average blood loss was 133 ± 57 mL. Residual pancreas weights were 33, 22 and 30 g, and 105.200, 40.390 and 94.790 islet equivalents were isolated, respectively. Surgical complications occurred in one patient (grade A pancreatic fistula). Postoperative stays were 6, 6 and 7 d, respectively. Histopathological evaluation revealed mucinous cystic neoplasm in cases 1 and 3, and serous cystic neoplasm in patient 2. No postoperative insulin administration was required. One patient developed a transient partial portal thrombosis 2 mo after islet infusion. Patients are insulin independent at a mean follow up of 8 ± 2 mo. CONCLUSION: Combination of LSPDP and AIT is feasible and could be effective to minimize the surgical impact for benign neoplasm of pancreatic body-neck.

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KW - Benign neoplasm

KW - Laparoscopy

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KW - Pancreas

KW - Pancreatogenic diabetes

KW - Spleen preservation

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