Total pancreatectomy (TP) is a treatment option for patients experiencing chronic pancreatitis (CP) refractory to medical management. Patients who are candidates for TP benefit from islet autotransplantation (IAT), which preserves available β-cell mass and thereby reduces the risk of brittle diabetes. Malignancy is an absolute contraindication for IAT to prevent the transplantation of occult malignant cells. We present the case of a patient with CP who was approved to undergo TP with IAT (TPIAT) but was intraoperatively discovered to have a pancreatic neuroendocrine tumor. The case illustrates a number of important surgical decision-making considerations for patients undergoing TPIAT and should help guide surgeons should they be presented with this clinical scenario. We stress the importance of vigilance for possible malignancy and to consider an intraoperative biopsy to further investigate unexpected findings that might represent an occult pancreatic malignancy in patients with CP undergoing TPIAT.
Bibliographical noteFunding Information:
From the *Division of Transplantation, Department of Surgery; †Division of Anatomic Pathology, Department of Laboratory Medicine & Pathology; ‡Schulze Diabetes Institute; §Department of Pediatrics; ||Department of Surgery; and ¶Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota Medical School, Minneapolis, MN. Received for publication November 2, 2017; accepted April 11, 2018. Address correspondence to: Oscar K. Serrano, MD, MBA, Division of Transplantation, Department of Surgery, Mayo Mail Code 195, 420 Delaware St SE, Minneapolis, MN 55455 (e‐mail: firstname.lastname@example.org). The authors declare no conflict of interest. O.K.S., K.J.P., and T.B.D. provided conception and design. O.K.S., K.J.P., T.M., T.B.D. did data acquisition. OKS, K.J.P., J.J.W., M.D.B., G.J.B., T.L.P., and T.B.D. analyzed and interpreted the data. By submission of this article, all authors listed agree that the contents of this article have not been copyrighted or published previously. The contents of this article are not now under consideration for publication elsewhere. Permission to reproduce copyrighted materials is given to Pancreas. Each author agrees that no financial support or incentive was provided for this article. The authors of this article have no conflicts of interest to disclose as described by Pancreas. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/MPA.0000000000001069
© 2018 Wolters Kluwer Health, Inc.
Copyright 2018 Elsevier B.V., All rights reserved.
- Key Words/Abbreviations
- chronic pancreatitis
- pancreatic neuroendocrine tumor
- total pancreatectomy with islet autotransplantation