Assessment of five-year experience with abdominal organ cluster transplantation.
BACKGROUND
Upper abdominal exenteration (resection of the liver, stomach, spleen, pancreaticoduodenal complex, and part of the colon) for the treatment of otherwise unresectable tumors is one of the more radical operations in oncology. This study was done to analyze retrospectively a five-year experience with exenteration in 57 patients treated with variations of resectional and transplant reconstructive techniques.


METHODS
Sixty-one transplantations were performed upon 57 patients. Three different organ replacement techniques were used: liver-pancreas-duodenum en bloc (original procedure), liver only (modified procedure), and liver plus pancreatic islets. The diagnoses were cholangiocarcinoma (20 patients), hepatocellular carcinoma (12 patients), endocrine neoplasms (14 patients), sarcoma (six patients), and adenocarcinoma of the pancreas (two patients), colon (two patients), or gallbladder (one patient). Analyses of survival and tumor recurrence were stratified by procedure variations, type and extent of tumor, and immunosuppressive regimen.


RESULTS
The three month and one, two, three, and five year actuarial patient survival rates were 82, 56, 38, 33, and 30 percent, respectively. Eighteen (31.5 percent) of the 57 patients are alive after 425 15 (standard deviation) months (range of 17 to 61 months) and 12 patients are tumor free. The actuarial survival rates stratified by transplantation procedure, immunosuppression, and tumor diagnosis and extent showed no statistically significant differences beyond the three different transplantation groups. Endocrine tumors had a better three-year survival rate (64 percent) than sarcoma (44 percent), hepatocellular carcinoma (25 percent), cholangiocarcinoma (20 percent), and the other adenocarcinomas (20 percent). Twenty-three patients (40 percent) died as a result of tumor recurrence. Patients with combined factors of no lymph node involvement, absence of vascular invasion, and metastases to the liver only (11 patients) had the lowest incidence of recurrence (27 compared to 73.5 percent, p = 0.006).


CONCLUSIONS
Patients with unresectable endocrine neoplasms, fibrolamellar hepatocellular carcinoma, and selected cholangiocarcinoma confined to the liver can benefit from this radical operative approach. Patients with sarcoma can achieve long survival periods but have a high recurrence rate.
Alessiani
M
M
Pittsburgh Transplant Institute, University of Pittsburgh Medical Center, PA.
Tzakis
A
A
Todo
S
S
Demetris
A J
AJ
Fung
J J
JJ
Starzl
T E
TE
D000008:Abdominal Neoplasms / Q000401:mortality / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D001650:Bile Duct Neoplasms / Q000601:surgery; D006528:Carcinoma, Hepatocellular / Q000601:surgery; D002648:Child; D018281:Cholangiocarcinoma / Q000601:surgery; D004386:Duodenum / Q000637:transplantation; D004701:Endocrine Gland Neoplasms / Q000601:surgery; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000379:methods / Q000401:mortality; D016035:Pancreas Transplantation; D010190:Pancreatic Neoplasms / Q000601:surgery; D012509:Sarcoma / Q000601:surgery; D015996:Survival Rate