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

Inclusion Criteria: * Adults aged 18 years and older. * Patients with periampullary neoplasms requiring pancreaticoduodenectomy, including but not limited to: * Pancreatic adenocarcinoma * Distal bile duct adenocarcinoma * Duodenal adenocarcinoma * Leiomyosarcoma of the duodenum * Pancreatic neuroendocrine neoplasms * Ampullary adenoma * Duodenal gastrointestinal stromal tumor * High-risk intraductal papillary mucinous neoplasm according to Fukuoka criteria, specifically focal Intraductal Papillary Mucinous Neoplasm (IPMN) in the head of pancreas with high-risk stigmata or worrisome features on endoscopic ultrasound with fine-needle aspiration * Mucinous cystic neoplasm * Serous cystadenoma * Soft pancreatic gland and main pancreatic duct ≤2 mm at the neck of the pancreas 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 ability to comply with care. * Pre-existing insulin-dependent diabetes with absent C-peptide. * Portal vein thrombosis or significant portal hypertension precluding islet infusion. * Contraindications to major surgery. * Body mass index greater than 35 kg/m².