The “autotransplantation of pancreatic islets” is a procedure developed by experts from San Raffaele and Humanitas in Milan: safe and effective, it improves postoperative glycemic control and the quality of life of patients
Only two out of ten pancreatic cancer patients are eligible for surgery: in most cases, in fact, the neoplasm is diagnosed at an advanced stage and the scalpel is an option applicable to a small and selected number of people. Making things even more difficult is the fact that the cpancreatic surgery it is very complex, which is why it is advisable to go to a hospital with great experience, where specialists are able to perform (when possible) cutting-edge interventions, limiting possible complications to a minimum. This is the case, for example, of“Autotransplantation of pancreatic islets” developed by researchers from the San Raffaele Diabetes Research Institute and by surgeons from both the Pancreas Center of the IRCCS San Raffaele Hospital and the IRCCS Istituto Clinico Humanitas, the subject of a study just published in the scientific journal Annals of Surgery.
The autotransplantation of pancreatic islets
The transplantation of one’s pancreatic islets (or autotransplantation) is a procedure performed per prevent or reduce the severity of diabetes, after partial or total removal of the pancreas. It consists of extracting endocrine tissue from the removed pancreas and infusing it into the portal vein, thus engineering the liver to produce insulin without the need for immunosuppressive therapy. “Over the years, autotransplantation has been used almost exclusively in patients undergoing pancreatic removal due to chronic pancreatitis, when it is not possible to treat it with standard medical and surgical procedures – he explains. Alessandro Zerbi, head of Pancreatic Surgery of the IRCCS Humanitas Clinical Institute and professor at Humanitas University -. The study just published demonstrates how it is possible to expand the use of islet transplantation, safely, even in the presence of other pathologies such as pancreatic cancer “. There are about 14,500 compatriots, most of them among the 60 and the 80-year-olds, who each year receive a diagnosis of pancreatic cancer. Statistics clearly indicate that the risk of death or complications is greater if one turns to centers that treat few cases. In more experienced hospitals, on the other hand, you are more likely to have access to the most appropriate care in the individual case, which is followed by a multidisciplinary expert group.
I study
Recently published research shows that it is possible to reduce the complications of some particularly complex pancreatic interventions by completely removing the pancreas and using, at the same time, the patient’s pancreatic islet transplantation technique to preserve the production of pancreatic hormones. insulin and glucagonneeded to regulate blood glucose control. The Italian study evaluated for the first time the possibility of associating (in patients at high risk of pancreatic fistula) with the total removal of the pancreas the autotransplantation of pancreatic islets, as an alternative to the standard duodenocephalopancreatectomy. The results confirmed that islet autograft total pancreatectomy reduced the number and severity of complications compared to standard surgery. The islet autotransplantation allowed to preserve, at least in part, the production of pancreatic hormones, improving postoperative glycemic control and facilitating the management of diabetes following total pancreatectomy. “When the pancreas is very fragile, the surgeon is aware that a pancreatic fistula will develop after surgery, however he does not completely remove the pancreas as he fears the metabolic consequences that will ensue – clarifies Gianpaolo Balzano, surgeon of the Pancreas Center of the IRCCS San Raffaele Hospital -. This study demonstrates, for the first time, that thanks to the new cell transplant therapies, there is an alternative, and that the autotransplantation of pancreatic islets allows to resort to total pancreatectomy with less fear of worsening the patient’s quality of life. “.
New solutions, safe and effective
Duodenocephalopancreatectomy (removal of the head of the pancreas, duodenum and terminal biliary tract) is one of the most complex and most at risk of complications of all abdominal surgery. The most frequent complication is the pancreatic fistula, i.e. the escape of pancreatic juices through the seam that reconnects the residual pancreas to the intestine. Pancreatic fluids have a digestive action and their release can damage surrounding tissues, causing infections and bleeding. When the pancreas is particularly fragile, the surgeon may decide to completely remove the organ to eliminate the risk of pancreatic fistula, but total pancreatectomy inevitably involves diabetes that is particularly difficult to treat, linked to the total loss of hormones that regulate blood sugar control. (insulin, glucagon, somatostatin, pancreatic polypeptide). “The study has allowed us to demonstrate that we can offer new, safe and effective solutions to patients presenting with different characteristics and surgical risks – he adds. Lorenzo Piemonti, director of the San Raffaele Diabetes Research Institute of the IRCCS San Raffaele Hospital -. In fact it is an example of precision medicine with the use of a personalized cell therapy aimed at obtaining the best result for the individual patient ».
Collaboration between the centers
For the execution of the autotransplantation it is necessary to coordinate the surgical activity with that of the tissue production in the laboratory, and this study has also shown how it is possible that several Institutes make use of a single facility for the collection and processing of pancreas for the production of pancreatic islets. «It is an example of synergy and optimization for the development and large-scale application of advances in regenerative medicine – concludes Piemonti -. The structures and knowledge for the manipulation of cells and tissues have a high specialized content and are very expensive to manage and set up. The possibility of concentrating this competence in a few highly specialized structures, which then carry out a service function for the clinical community, is the model to be pursued to ensure sustainability and the widest possible accessibility to these particularly advanced approaches to therapy “.
October 11, 2022 (change October 11, 2022 | 10:11)
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