The medical bulletin appeared late yesterday afternoon: “The patient is doing well, resting and should be out within a week.” Two days earlier, admitted to the digestive oncology surgery department of the Paoli-Calmettes Institute, this patient underwent a total pancreatectomy (removal of the pancreas) to treat cancer of the head of the pancreas. But if his case is important, it is because a small medical revolution was achieved with the automatic transplantation of pancreatic cells (islets) into his liver, 48 hours after the first intervention.
But why are we talking about revolution? “In a large majority of cases, these adenocarcinomas (tumors) are located in the head of the pancreas. The proximity of other organs and important blood vessels makes the operation technically complex and with a high risk of postoperative complications. says Dr. Jonathan Garnier, from the pancreatic surgery team at the Paoli-Calmettes Institute. It is a major operation, in two stages: one for resection of the head of the pancreas and one for reconstruction of the digestive circuit, which must be performed in an expert center. Nevertheless, this operation is often associated with complications that can disrupt, delay or make impossible any postoperative chemotherapy. This is a failure of the oncological strategy because the patient only benefits from part of the treatment. The alternative sometimes considered is total removal of the pancreas to avoid connection of the digestive tract to the remaining pancreas and reduce postoperative risk. However, this has another consequence: the occurrence of disabling diabetes with severe hypo- or hyperglycemia that is difficult to control, and sometimes fatal. Total pancreatectomy with autotransplantation of pancreatic islets will allow us to prevent pancreatic complications without the risk of diabetes. Specifically, this procedure consists of transplanting the pancreatic cells responsible for regulating sugar (islets of Langerhans) recovered during the operation.“
This operation mobilized the teams from Marseille and Lille. This required the arrival of a member of the team from the University Hospital of Lille, Dr. Mikaël Chetboun, who, after the organ was removed and conditioned, returned to the University Hospital of Lille to isolate and purify the islets of Langerhans.
Two days later, the islets returned to Marseille to be reinjected into the patient by perfusion on a special catheter, into the portal vein… without further general anesthesia. “These islets are grafted into the liver, which plays a chimeric role and thus regulates blood sugar levels, as before the pancreas. Another advantage, since it is an autograft, is not. It is necessary to place the patient on immunosuppressants to avoidable rejection, which has a threefold advantage.
In the short term we reduce the risk of serious postoperative complications, in the medium term we have diabetes that is easier to control and in the long term an oncological benefit because the therapeutic strategy will be completed,” continues Dr. Garnier.
This multicenter study led by Professor François Pattou, head of the department of general and endocrine surgery at the University Hospital of Lille and pioneer of islet autotransplantation in France, was launched in early 2022 to evaluate the benefit of this innovative approach. The Paoli-Calmettes Institute in Marseille and seven other French centers with expertise in pancreatic surgery are participating. Over the past year and a half, 6 patients have benefited from this technique, 2 of which benefited from the IPC.