title: Combined laparoscopic spleen-preserving distal pancreatectomy and islet autotransplantation for benign pancreatic neoplasm.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  Combination of LSPDP and AIT is feasible and could be effective to minimize the surgical impact for benign neoplasm of pancreatic body-neck.
authors.affiliation: Gianpaolo Balzano, Michele Carvello, Riccardo Ariotti, Marco Braga, Carlo Staudacher, Department of Surgery, San Raffaele Research Institute, 20132 Milan, Italy.
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Balzano
authors.affiliation: Gianpaolo Balzano, Michele Carvello, Riccardo Ariotti, Marco Braga, Carlo Staudacher, Department of Surgery, San Raffaele Research Institute, 20132 Milan, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Carvello
authors.affiliation: Gianpaolo Balzano, Michele Carvello, Riccardo Ariotti, Marco Braga, Carlo Staudacher, Department of Surgery, San Raffaele Research Institute, 20132 Milan, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Piemonti
authors.affiliation: Gianpaolo Balzano, Michele Carvello, Riccardo Ariotti, Marco Braga, Carlo Staudacher, Department of Surgery, San Raffaele Research Institute, 20132 Milan, Italy.
authors.forename: Rita
authors.initials: R
authors.lastname: Nano
authors.affiliation: Gianpaolo Balzano, Michele Carvello, Riccardo Ariotti, Marco Braga, Carlo Staudacher, Department of Surgery, San Raffaele Research Institute, 20132 Milan, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Ariotti
authors.affiliation: Gianpaolo Balzano, Michele Carvello, Riccardo Ariotti, Marco Braga, Carlo Staudacher, Department of Surgery, San Raffaele Research Institute, 20132 Milan, Italy.
authors.forename: Alessia
authors.initials: A
authors.lastname: Mercalli
authors.affiliation: Gianpaolo Balzano, Michele Carvello, Riccardo Ariotti, Marco Braga, Carlo Staudacher, Department of Surgery, San Raffaele Research Institute, 20132 Milan, Italy.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Melzi
authors.affiliation: Gianpaolo Balzano, Michele Carvello, Riccardo Ariotti, Marco Braga, Carlo Staudacher, Department of Surgery, San Raffaele Research Institute, 20132 Milan, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Maffi
authors.affiliation: Gianpaolo Balzano, Michele Carvello, Riccardo Ariotti, Marco Braga, Carlo Staudacher, Department of Surgery, San Raffaele Research Institute, 20132 Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Braga
authors.affiliation: Gianpaolo Balzano, Michele Carvello, Riccardo Ariotti, Marco Braga, Carlo Staudacher, Department of Surgery, San Raffaele Research Institute, 20132 Milan, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Staudacher
mesh_terms: D015746:Abdominal Pain / Q000000981:diagnostic imaging / Q000473:pathology; D000328:Adult; D005260:Female; D006801:Humans; D007515:Islets of Langerhans / Q000473:pathology; D016381:Islets of Langerhans Transplantation; D010535:Laparoscopy / Q000379:methods*; D010179:Pancreas / Q000473:pathology; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000601:surgery* / Q000628:therapy*; D056844:Renal Colic / Q000000981:diagnostic imaging / Q000473:pathology; D013154:Spleen / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D014180:Transplantation; D016896:Treatment Outcome
keywords: Autologous islet transplantation; Benign neoplasm; Laparoscopy; Minimally invasive treatment; Pancreas; Pancreatogenic diabetes; Spleen preservation
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