Islet Autotransplantation After Left Pancreatectomy for Non-Enucleable Insulinoma

Abstract

Insulinoma is a rare, almost always benign endocrine tumor of the pancreas, clinically characterized by hyperinsulinemic, hypoglycemic episodes. Surgical excision is the therapy of choice, which may lead to postpancreatectomy diabetes mellitus in the case of extensive pancreatic resection.We present the cases and the metabolic follow up of two patients, 81 and 73 years old, with insulinoma localized close to the main duct in the pancreatic neck. Both patients underwent an 80% left pancreatectomy, avoiding a pancreatico-enteric anastomosis. In order to prevent postpancreatectomy diabetes, the islets from the tumor-free part of the resected pancreas were isolated and injected via a right colic vein into the portal system. After a follow up of 6 and 3 years respectively, both patients remained insulin-independent without any dietary restrictions. Fasting and glucagon-stimulated C-peptide-levels and glycosylated hemoglobin remained within normal range. There were no signs of recurrent insulinoma. Liver biopsy performed in one patient at 1 year after autotransplantation, showed intact, insulin-producing islets within the portal spaces.In conclusion, autologous islet transplantation can preserve the insulin secretory reserve after extended left pancreatectomy for the treatment of benign tumors in the pancreatic neck.

Intramuscular Autotransplantation of Pancreatic Islets in a 7-Year-Old Child: A 2-Year Follow-Up

“…OGTT were performed at regular intervals. At 5,8,15 and 27 months after IAT, her basal fasting and stimulated plasma C-peptide levels were 0.7 ± 0.05 and 3.22 ± 0.83 ng/mL, respectively. There was a clear trend toward higher glucose-stimulated C-peptide values with increasing time posttransplantation (Figure 2).…”

“…Total or near total pancreatectomy combined with islet autotransplantation (IAT) is indicated for various pancreatic diseases, including complicated chronic pancreatitis, hereditary pancreatitis and benign tumors of the pancreas (2)(3)(4)(5). It is well known that the pancreatectomized patients suffer from brittle diabetes, which is characterized by pronounced blood glucose variability and frequent episodes of hypoglycemia, while ketoacidosis is infrequent (6).…”

Extending Indications for Islet Autotransplantation in Pancreatic Surgery

“…11 First performed in 1977 at the University of Minnesota, 12 total pancreatectomy with IAT is being used almost exclusively in patients undergoing pancreatectomy because of chronic pancreatitis. 11,[13][14][15] More recently, the indication of IAT has been extended to the loss of pancreatic parenchyma for the resection of benign tumors of the mid-segment of the pancreas [16][17][18] or after total pancreatectomy for severe abdominal trauma. 19,20 In this study, we report our experience with IAT for the treatment of patients undergoing pancreatic surgery for both nonmalignant and malignant diseases, including subjects undergoing completion pancreatectomy because of anastomosis leakage after pancreaticoduodenectomy (PD) and subjects with pancreatic anastomosis deemed at high risk of failure during PD.…”

Total Pancreatectomy and Islet Autotransplantation for Chronic Pancreatitis

“…IATs have been done after pancreatic resection for focal benign pancreatic processes, including pancreatic pseudocysts (Clayton et al, 2003) cystic neoplasms such as intrapapillary mucinous neoplasms IPMN (Berney et al 2004;Lee et al, 2005), insulinomas (Berney T et al, 2004;Oberholzer et al 2003) neuroendocrine and other tumors (Berney T et al, 2004;Ris;. In a series of 14 patients in Seoul, Korea with a mixture of benign tumors, including IPMN (Jung et al, 2009), pathologic evaluation was completed in each before the IAT to confirm that the lesions were benign.…”