The following is a summary of the “Spleen-preserving total pancreatectomy and islet autotransplantation with complete preservation of the splenic arterial and venous supply does not impact islet yield and function” published in the November 2022 issue of Surgery by Coluzzi et al.
Standard total pancreatectomy and islet autotransplantation (TPIAT) procedure for chronic pancreatitis, however, TPIAT could be carried out without one if the spleen’s blood supply is fully preserved.
Between 2015 and 2021, patients who received TPIAT at the facility with or without splenectomy had their metabolic and clinical results compared. Seventeen individuals had a spleen-preserving complete pancreatectomy (SPTP) out of a total of 89 patients who were included in the research.
Demographic and metabolic indicators were comparable across the two research groups. Long-term results were comparable to short-term morbidity. With a median operating time of 9.91 hours (interquartile range [IQR] 8.89-10.83) as opposed to 10.78 hours (IQR 10.2-11.6) for SPTP, the splenectomy procedure required considerably less time (P = 0.021). Postoperative morbidity was comparable across all groups. When compared to the splenectomy group, the SPTP group had improved metabolic results at one year, with a median daily insulin demand of 7 units (IQR 4-12) vs. 15 units (IQR 7-26; P = 0.049) and a median C-peptide at one year of 0.65 (IQR 0.40-1.26) vs. 1.00 (IQR 0.80-1.90; P = 0.63). Both the decline in pain score and the decrease in daily morphine milligram equivalents were considerably superior in the SPTP group (P< 0.001) over time.
TPIAT did not negatively impact islet yield and function in combination with complete arterial and venous preservation of the spleen. The whole splenic artery and vein, as well as the spleen, can be preserved when doing TPIAT safely and successfully. In every TPIAT procedure, the spleen should be maintained if at all possible.