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


CONCLUSIONS
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.
Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, #127 Changle West Rd, Xi'an, Shaanxi, People's Republic of China, 710032. Guosheng_w@yahoo.com.
Guosheng
G
Wu
Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, #127 Changle West Rd, Xi'an, Shaanxi, People's Republic of China, 710032.
Xin
X
Wang
Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, #127 Changle West Rd, Xi'an, Shaanxi, People's Republic of China, 710032.
Qingchuan
Q
Zhao
Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, #127 Changle West Rd, Xi'an, Shaanxi, People's Republic of China, 710032.
Weizhong
W
Wang
Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, #127 Changle West Rd, Xi'an, Shaanxi, People's Republic of China, 710032.
Hai
H
Shi
Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, #127 Changle West Rd, Xi'an, Shaanxi, People's Republic of China, 710032.
Mian
M
Wang
Department of Radiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.
Jingson
J
Zhang
Department of Pathology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.
Zengshan
Z
Li
Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, #127 Changle West Rd, Xi'an, Shaanxi, People's Republic of China, 710032.
Daiming
D
Fan
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007421:Intestine, Small / Q000637:transplantation*; D008297:Male; D017538:Mesenteric Artery, Superior / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D016378:Tissue Transplantation / Q000379:methods*; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult
Extensive resection; Intestinal autotransplantation; Pancreatic head neoplasms; SMA resection