Total Pancreatectomy With Islet Autotransplantation (TPIAT) for High-Risk Patients With Pancreatic Tumors

Inclusion Criteria: * Adults aged 18 and older. * Patients with periampullary neoplasms requiring pancreaticoduodenectomy, including but not limited to: * Distal bile duct adenocarcinoma * Duodenal adenocarcinoma * Leiomyosarcoma of the duodenum * Pancreatic neuroendocrine neoplasms * Ampullary adenoma * Duodenal gastrointestinal stromal tumor (GIST) * High-risk Intraductal Papillary Mucinous Neoplasm (IPMN) as per Fukuoka criteria * Mucinous cystic neoplasm * Serous cystadenoma * Presence of soft pancreatic tissue and a main pancreatic duct ≤ 2 mm based on preoperative imaging. * Adequate islet function with measurable C-peptide preoperatively to justify islet isolation and transplant. Exclusion Criteria: * Pregnancy * Active alcohol or illicit drug use * Poorly controlled psychiatric illness that limits compliance with care * Pre-existing insulin-dependent diabetes with absent C-peptide * Portal vein thrombosis or significant portal hypertension * Contraindications to major surgery * Body Mass Index (BMI) \> 35 kg/m².