Total pancreatectomy with intraportal islet autotransplantation for pancreatic malignancies: a literature overview

ABSTRACT

Introduction

‘Brittle Diabetes’ (BD) is a life-threatening metabolic complication after total pancreatectomy (TP). More than 500 Intraportal islet autotransplantation (IAT) have been performed to prevent this complication, with almost 70% insulin independence after 3 years. Even when insulin independence was not achieved, IAT successfully prevented severe hypoglycemia. Currently, preliminary results for oncologic situations are promising, but their oncological outcomes are still a matter of debate.

Areas covered

We performed a bibliographic research of the last 25 years of data. Articles published in English in peer-reviewed journals were retained. In France, auto- and allo-islet transplantation was recently recognized as a valuable treatment for BD by the national health authority. While accepted for benign diseases, the risk of tumor spreading after IAT in oncologic situations is a source of concern.

Expert opinion

Preliminary results of IAT in oncological situations are very encouraging. So far, there is no evidence of tumor dissemination. In our opinion, to overcome BD TP with IAT for resectable pancreatic malignancies in patients with a higher risk of postoperative pancreatic fistula and extended pancreatic cancers can be safely performed. Diagnosis of malignancy should not be considered as an exclusion criterion for IAT.

KEYWORDS:

• KEY-words: pancreas
• pancreatic cancer
• brittle diabetes
• islet transplantation
• islet autotransplantation
• total pancreatectomy

Article highlights

• BD is a life-threatening metabolic complication that could arise after total pancreatectomy. We proposed intraportal islet autotransplantation to prevent this complication after pancreatic malignancies.

• Tumor dissemination after TP with IAT with careful indication, safety margin, and purification could overcome the feared metabolic post-operative complications

• TP with IAT is indicated for resectable pancreatic malignancies for patients with a single focal pancreatic lesion, high risk of post-operative pancreatic fistula, extended pancreatic cancers, and it should be avoided in a multifocal lesion.

• This box summarizes key points contained in the article.

Declaration of Interests

The authors declare no relevant affiliations with any organization or entity linked to the matter or materials discussed in the manuscript and declare no financial conflict: this includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants for patients or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper is not funded.