2023-11-16 14:42:46
The medical bulletin came out yesterday late afternoon: “The patient is doing well, he is resting and should be out within a week.” Two days earlier, received in the digestive oncological surgery department of the Paoli-Calmettes Institute, this patient had a total pancreatectomy (removal of the pancreas) to treat cancer of the head of the pancreas. But if his case is of interest it is because a small medical revolution was achieved with the auto-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 surgery technically complex and at high risk of post-operative complications, comments Dr Jonathan Garnier, from the pancreatic surgery team at the Paoli-Calmettes Institute. It is a major surgery, in two stages, one for resection of the head of the pancreas and the other for reconstruction of the digestive circuit, which must be carried out in an expert center. Despite this, this surgery is often associated with complications which can disrupt, delay or prohibit any post-operative 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 with the remaining pancreas and reduce the post-operative risk. However, this has another consequence of the appearance of disabling diabetes with severe hypo or hyperglycemia that is difficult to control, sometimes fatal. Total pancreatectomy with pancreatic islet autotransplantation will allow us to avoid pancreatic complications without the risk of diabetes. Concretely, this procedure consists of transplanting the pancreatic cells responsible for regulating sugar (islets of Langerhans) recovered during surgery.“
This surgery mobilized the Marseille and Lille teams. It required the arrival of a member of the Lille University Hospital team, Dr. Mikaël Chetboun, who, once the organ was removed and conditioned, returned to the Lille University Hospital 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, in the portal vein… without further general anesthesia. “These islets are grafted into the liver, which plays a chimeric role and thus regulates the blood sugar level, like the pancreas before. Another advantage, as it is an autograft, it is not It is necessary to place the patient on immunosuppressants to avoid rejection. This has a triple benefit.
In the short term, we reduce the risk of serious post-operative complications, in the medium term, we have diabetes that is easier to control and in the long term, an oncological benefit since the therapeutic strategy will have been complete,” continues Dr. Garnier.
This multicenter study led by Professor François Pattou, head of the general and endocrine surgery department at Lille University Hospital 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, including 2 at the IPC.
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