Laparoscopic spleen-preserving distal pancreatectomy combined with autologous islet transplantation for intraductal papillary mucinous neoplasms: a case report and literature review

Abstract:

Background and Aims Laparoscopic spleen-preserving distal pancreatectomy (LSPDP) is a standard procedure for intraductal papillary mucinous neoplasms (IPMN) of the pancreatic body and tail, but it may increase the risk of postoperative type 3c diabetes mellitus (T3cDM) due to loss of normal pancreatic tissue. Autologous islet transplantation (AIT) may preserve endocrine function; however, its application in IPMN remains controversial. This study aimed to evaluate the safety and feasibility of LSPDP combined with AIT.Methods A 56-year-old woman with IPMN underwent LSPDP combined with AIT. A total of 41.6 g of pancreatic tissue was resected, and islets were isolated in a GMP facility, yielding 1 139 IEQ/kg with 20% purity and 97% viability. Islets were infused into the portal vein under laparoscopic and intraoperative ultrasound guidance. Postoperative management included anticoagulation, nutritional support, and strict glycemic control.Results The postoperative course was uneventful, with no complications such as bleeding, infection, portal vein thrombosis, pancreatic fistula, or tumor recurrence. During 1-year follow-up, fasting and postprandial glucose levels and C-peptide remained within normal ranges, and no T3cDM occurred. Imaging showed no evidence of recurrence, and endocrine function was well preserved.Conclusion Under strict patient selection and oncological safety, LSPDP combined with AIT may achieve tumor resection while preserving endocrine function in IPMN patients, demonstrating favorable short-term safety and feasibility. Long-term metabolic and oncological outcomes require further validation.