Perioperative Complications and Outcomes after Intestinal Autotransplantation for Neoplasms Involving the Superior Mesenteric Artery.

BACKGROUND: Intestinal autotransplantation (IATx) is a novel surgical technique for neoplasms arising from the pancreas, duodenum, mesentery, or retroperitoneum with involvement of the superior mesenteric artery (SMA). The value of this aggressive procedure remains to be defined. We describe its surgical indications, postoperative complications, and clinical outcomes after IATx. METHODS: Fifteen patients aged 20 to 67 years (mean 44.9 years) underwent IATx in our program from January 2011 to January 2018. In all patients, selection and harvesting of a healthy bowel autograft were initially carried out, and an extended en bloc resection of neoplasms was performed afterward. RESULTS: Of the 15 patients, there was one early death from a pancreatic leak and two late deaths either from disease recurrence or sudden cardiac arrest. Ten patients developed 23 postoperative complications. Of these, one patient lost his bowel autograft due to arterial thrombosis 48 h later. Delayed gastric emptying, pleural effusions, pancreatic fistula, and relaparotomy were the most common complications. In our series, four of nine patients with invasive malignant neoplasms had evidence of disease recurrence at 13, 13, 16, and 18 months after IATx. At a median follow-up of 29.9 months, 11 patients undergoing successful IATx remained alive with a well-functioning bowel graft. CONCLUSION: Our results indicate that IATx is technically feasible with acceptable perioperative morbidity and mortality. This procedure should be considered in selected patients presenting with locally invasive neoplasms involving the SMA.

Intestinal autotransplantation for neoplasms originating in the pancreatic head with involvement of the superior mesenteric artery.

PURPOSE: We describe the operative techniques and perioperative morbidity of intestinal autotransplantation (IATx) for neoplasms originating in the pancreatic head with involvement of the superior mesenteric artery (SMA), particularly focusing on oncological outcomes of patients with ductal adenocarcinoma. METHODS: Six patients with pancreatic head neoplasms aged 20 to 67 years underwent IATx in our center from January 2012 to January 2016. The operative procedure involves (1) selection and procurement of a segment of small intestine as the autograft, (2) completion of an en bloc resection of the tumor along with involved organs, and (3) autotransplantation of the autograft. RESULTS: In all six patients, the median operative time was 12.1 h (range, 9.5-16.5) with a median blood transfusion of 7 units (range, 4-10). All patients had margin-negative resections. Complications occurred in three of six patients with no perioperative mortality. The median duration of hospital stay was 19 days (range, 15-26). These six patients have had a well-functioning autograft and have not required any intravenous fluid hydration since discharge. At 5.9-, 10.9-, and 12.4-month follow-ups, serum levels of CA19-9 remained normal in two and elevated in one of three patients with ductal adenocarcinoma. At a median follow-up of 12.1 months (range, 4.9-42.9), all patients have remained alive without evidence of local recurrence and gross metastatic disease. CONCLUSION: IATx combined with extensive pancreaticoduodenectomy and SMA resection can be performed in highly selected patients with an acceptable morbidity and mortality. Careful preoperative assessment and planning are the keys to the success of this aggressive operation.

Clinical and nutritional outcomes after intestinal autotransplantation.

OBJECTIVE: This study describes the operative techniques and early clinical and nutritional outcomes after intestinal autotransplantation (IATx). BACKGROUND: IATx is a novel surgical strategy for patients with abdominal neoplasms involving the root of the superior mesenteric and/or celiac arteries, but the effects of IATx on clinical and nutritional outcomes are not well-known. METHODS: Six patients aged 24-67 years (mean, 54) underwent consecutive IATx in our center from January 2011 to January 2015. In all patients, selection and harvesting of a segmental autograft of bowel was carried out first, and radical en bloc resection of the neoplasm was performed second. RESULTS: One patient lost the autograft owing to arterial thrombosis 48 hours postoperatively, and another succumbed to a pancreatic fistula at 21 days. The remaining 4 patients survived with no evidence of tumor recurrence currently at 9-, 23-, 23-, and 39-months of follow-up. These 4 patients have had well-functioning autografts and have not required any intravenous fluid hydration since discharge. Serum d-xylose levels recovered fully 2 weeks postoperatively, and plasma proteins and cholesterol levels normalized 12-18 months later. The surviving 4 patients gained body weight without major alterations in lifestyle, work habits, or psychosocial conditions. CONCLUSION: Although IATx is associated with considerable operative risk, this aggressive approach allows patients with selected abdominal neoplasms involving the major mesenteric vessels to be completely resected and attain early intestinal autonomy from parenteral nutrition.