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Pancreatic Neoplasms: HELP
Articles by Paola Maffi
Based on 3 articles published since 2009
(Why 3 articles?)
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Between 2009 and 2019, Paola Maffi wrote the following 3 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
1 Article Single-centre experience of extending indications for percutaneous intraportal islet autotransplantation (PIPIAT) after pancreatic surgery to prevent diabetes: feasibility, radiological aspects, complications and clinical outcome. 2016

Venturini, Massimo / Sallemi, Claudio / Colantoni, Caterina / Agostini, Giulia / Balzano, Gianpaolo / Esposito, Antonio / Secchi, Antonio / De Cobelli, Francesco / Falconi, Massimo / Piemonti, Lorenzo / Maffi, Paola / Del Maschio, Alessandro. ·1 Department of Radiology, San Raffaele Scientific Institute, Milan, Italy. · 2 Department of Pancreatic Surgery, San Raffaele Scientific Institute, Milan, Italy. · 3 Vita-Salute University, San Raffaele Hospital, Milan, Italy. · 4 Department of Internal Medicine, Transplant Unit, San Raffaele Scientific Institute, Milan, Italy. · 5 Diabetes Research Institute, San Raffaele Scientific Institute, Milan, Italy. ·Br J Radiol · Pubmed #27327404.

ABSTRACT: OBJECTIVE: Islet allotransplantation is a less invasive alternative to surgical pancreas transplantation for Type 1 diabetes, while percutaneous intraportal islet autotransplantation (PIPIAT) is usually performed after pancreatic surgery to prevent diabetes. Our aim was to assess the feasibility, radiological aspects, complications and clinical outcome of PIPIAT following pancreatic surgery for not only chronic pancreatitis but also benign and malignant nodules. METHODS: From 2008 to 2012, 41 patients were enrolled for PIPIAT 12-48 h after pancreatic surgery (extended pancreatic surgery for chronic pancreatitis and benign/malignant neoplasms). PIPIAT was performed using a combined ultrasonography and fluoroscopy-guided technique (4-F catheter). PIPIAT feasibility, median follow-up and metabolic (insulin independence rate, graft function based on C-peptide levels) and oncologic outcomes were recorded. RESULTS: PIPIAT was not performed in 7/41 patients (4 cases for an inadequate islet mass, 2 cases for haemodynamic instability and 1 case for islet culture contamination), while it was successfully performed in 34/34 patients. Procedure-related major complications occurred in four patients: two bleedings requiring transfusions, one patient with left portal vein thrombosis and one patient with sepsis. Median follow-up duration was 546 days. Insulin independence was achieved in 15/34 (44%) patients, partial graft function in 16/34 (47%) patients and no function in 3/34 (9%) patients. None of the 17 patients with malignant nodules developed liver metastases during follow-up. CONCLUSION: PIPIAT, performed under ultrasound and fluoroscopy combined guidance and not requiring immunosuppression, is feasible, with a relatively low complication rate and a better metabolic outcome than allotransplantation. ADVANCES IN KNOWLEDGE: PIPIAT can prevent pancreatogenic diabetes. Ultrasound is a useful tool for the guidance and monitoring of PIPIAT.

2 Article Combined laparoscopic spleen-preserving distal pancreatectomy and islet autotransplantation for benign pancreatic neoplasm. 2014

Balzano, Gianpaolo / Carvello, Michele / Piemonti, Lorenzo / Nano, Rita / Ariotti, Riccardo / Mercalli, Alessia / Melzi, Raffaella / Maffi, Paola / Braga, Marco / Staudacher, Carlo. ·Gianpaolo Balzano, Michele Carvello, Riccardo Ariotti, Marco Braga, Carlo Staudacher, Department of Surgery, San Raffaele Research Institute, 20132 Milan, Italy. ·World J Gastroenterol · Pubmed #24744593.

ABSTRACT: AIM: To evaluate the safety and feasibility of laparoscopic spleen-preserving distal pancreatectomy (LSPDP) with autologous islet transplantation (AIT) for benign tumors of the pancreatic body-neck. METHODS: Three non-diabetic, female patients (age 37, 44 and 35 years, respectively) were declared candidates for surgery, between May and September 2011, because of pancreatic body/neck cystic lesions. The planned operation was an LSPDP associated with AIT from the normal pancreas distal to the neoplasm. Islets isolation was performed on the residual pancreatic parenchyma after frozen section examination of the margin. Purified autologous islets were infused into the portal vein by a percutaneous transhepatic approach the day after surgery. RESULTS: The procedure was performed successfully in all the three cases, and the spleen was preserved along with its vessels. Mean operation time was 283 ± 52 min and average blood loss was 133 ± 57 mL. Residual pancreas weights were 33, 22 and 30 g, and 105.200, 40.390 and 94.790 islet equivalents were isolated, respectively. Surgical complications occurred in one patient (grade A pancreatic fistula). Postoperative stays were 6, 6 and 7 d, respectively. Histopathological evaluation revealed mucinous cystic neoplasm in cases 1 and 3, and serous cystic neoplasm in patient 2. No postoperative insulin administration was required. One patient developed a transient partial portal thrombosis 2 mo after islet infusion. Patients are insulin independent at a mean follow up of 8 ± 2 mo. CONCLUSION: Combination of LSPDP and AIT is feasible and could be effective to minimize the surgical impact for benign neoplasm of pancreatic body-neck.

3 Article Extending indications for islet autotransplantation in pancreatic surgery. 2013

Balzano, Gianpaolo / Maffi, Paola / Nano, Rita / Zerbi, Alessandro / Venturini, Massimo / Melzi, Raffaella / Mercalli, Alessia / Magistretti, Paola / Scavini, Marina / Castoldi, Renato / Carvello, Michele / Braga, Marco / Del Maschio, Alessandro / Secchi, Antonio / Staudacher, Carlo / Piemonti, Lorenzo. ·Department of Surgery, San Raffaele Scientific Institute, Milan, Italy. ·Ann Surg · Pubmed #23751451.

ABSTRACT: OBJECTIVE: To assess metabolic and oncologic outcomes of islet autotransplantation (IAT) in patients undergoing pancreatic surgery for either benign or malignant disease. BACKGROUND: IAT is performed to improve glycemic control after extended pancreatectomy, almost exclusively in patients with chronic pancreatitis. Limited experience is available for other indications or in patients with pancreatic malignancy. METHODS: In addition to chronic pancreatitis, indications for IAT were grade C pancreatic fistula (treated with completion or left pancreatectomy, as indicated); total pancreatectomy as an alternative to high-risk anastomosis during pancreaticoduodenectomy; and distal pancreatectomy for benign/borderline neoplasm of pancreatic body-neck. Malignancy was not an exclusion criterion. Metabolic and oncologic follow-up is presented. RESULTS: From November 2008 to June 2012, 41 patients were candidates to IAT (accounting for 7.5% of all pancreatic resections). Seven of 41 did not receive transplantation for inadequate islet mass (4 pts), patient instability (2 pts), or contamination of islet culture (1 pt). IAT-related complications occurred in 8 pts (23.5%): 4 bleeding, 3 portal thromboses (1 complete, 2 partial), and 1 sepsis. Median follow-up was 546 days. Fifteen of 34 patients (44%) reached insulin independence, 16 patients (47%) had partial graft function, 2 patients (6%) had primary graft nonfunction, and 1 patient (3%) had early graft loss. Seventeen IAT recipients had malignancy (pancreatic or periampullary adenocarcinoma in 14). Two of them had already liver metastases at surgery, 13 were disease-free at last follow-up, and none of 2 patients with tumor recurrence developed metastases in the transplantation site. CONCLUSIONS: Although larger data are needed to definitely exclude the risk of disease dissemination, the present study suggests that IAT indications can be extended to selected patients with neoplasm.