Research Report
Copyright ©2014 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Apr 14, 2014; 20(14): 4030-4036
Published online Apr 14, 2014. doi: 10.3748/wjg.v20.i14.4030
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
Gianpaolo Balzano, Michele Carvello, Riccardo Ariotti, Marco Braga, Carlo Staudacher, Department of Surgery, San Raffaele Research Institute, 20132 Milan, Italy
Lorenzo Piemonti, Rita Nano, Alessia Mercalli, Raffaella Melzi, Paola Maffi, Division of Immunology, Transplantation, and Infectious Diseases-Diabetes Research Institute, Islet Processing Activity, San Raffaele Research Institute, 20132 Milan, Italy
Author contributions: All the authors contributed equally to this manuscript.
Correspondence to: Gianpaolo Balzano, MD, Department of Surgery, San Raffaele Research Institute, Via Olgettina 60, 20132 Milan, Italy, balzano.gianpaolo@hsr.it
Telephone: +39-2-26432664  Fax: +39-2-26437802
Received: November 24, 2012
Revised: February 5, 2013
Accepted: March 6, 2013
Published online: April 14, 2014
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.

Keywords: Pancreas, Benign neoplasm, Laparoscopy, Minimally invasive treatment, Spleen preservation, Pancreatogenic diabetes, Autologous islet transplantation

Core tip: The article describes, for the first time, a combination of techniques to reduce all possible consequences of pancreatic resection for benign/borderline neoplasms located at the pancreatic body-neck. The procedure combines laparoscopy, spleen preservation and islet autotransplantation. The laparoscopic approach reduces the access trauma of an extensive surgery. The spleen preservation avoids infectious and hematological complications related to splenectomy. Islet autotransplantation could reduce the incidence of pancreatogenic diabetes after resection.