Segmental Pancreatic Autotransplantation with Enteric Drainage after Total or Subtotal Pancreatectomy for Pancreatic Cancer or Chronic Pancreatitis

Heterotopic autotransplantation of the distal pancreas with enteric drainage was performed to preserve the pancreatic function after total or subtotal pancreatectomy in 4 cases of cancer of the pancreas and 3 cases of chronic pancreatitis. In cases of cancer of the pancreatic head who necessitated regional total pancreatectomy for large vascular involvements by the cancer, only the distal pancreas segment which was revealed to be free of cancer invasion by intraoperative pathologic examination was autotransplanted to the iliac vessels. Their pancreas grafts have been functioning and normoglycemia could be maintained without exogenous insulin administration. The present cases of the pancreatic cancer are alive and free from recurrence at present (the longest follow-up duration is 25 months). In cases of chronic pancreatitis with diffuse calcification or no dilatation of the pancreatic duct, distal subtotal pancreatectomy was done and the removed pancreas segment was autotransplanted to the iliac vessels with enteric drainage. Their grafts have survived, and normoglycemia without insulin administration could be maintained in all cases but one who had required insulin administration preoperatively. Painless effect was satisfactory (the longest follow-up duration is 56 months). In conclusion, segmental autotransplantation of the distal pancreas is effective to improve the quality of life after total or subtotal pancreatectomy.