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

Guosheng Wu, Xin Wang, Qingchuan Zhao, Weizhong Wang, Hai Shi, Mian Wang, Jingson Zhang, Zengshan Li, Daiming Fan

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. 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. 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. 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.