• Annals of surgery · Dec 2023

    Intestinal Autotransplantation for Locally Advanced or Locally Recurrent Colon Cancer Invading SMA.

    • Guosheng Wu, Long Zhao, Weiqin Jiang, Chaoxu Liu, Xile Zhou, Wentong Zhang, Jinhai Wang, and Tingbo Liang.
    • Department of Colorectal Surgery and Intestinal Transplant Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China, 310002.
    • Ann. Surg. 2023 Dec 13.

    ObjectiveTo examine the outcomes of intestinal autotransplantation (IATx) in patients with locally advanced or recurrent colon cancer (LACC or LRCC) invading the superior mesenteric artery (SMA).BackgroundSMA Involvement in LACC or LRCC is deemed unresectable and is associated with a poor prognosis. Combined extended resections of multiple organs together with SMA, followed by IATx may offer favorable clinical outcomes. However, data on its safety and efficacy are scarce.DesignThis retrospective cohort study included patients undergoing IATx between May 2018 and December 2022 in intestinal transplant programs at two university-affiliated hospitals in China. Patients with LACC or LRCC concomitantly with SMA contact of more than 180° were included. Patients with a locoregional peritoneal, pelvic, or distal metastasis were excluded.ResultsTen patients underwent either IATx combined with pancreaticoduodenectomy (n=8) or IATx alone (n=2). Eight patients (80%) were male, and the median age was 55 years (range, 32 - 71 y). The Kaplan-Meier estimates for recurrence-free survival and overall survival at 3 years after IATx were 68% and 80%, respectively. No perioperative deaths occurred. All ten patients experienced postoperative complications including Clavien-Dindo grade I (n=1), grade II (n=4), grade IIIa (n=1), grade IIIb (n=3) and grade IVa (n=1), which comprised acute venous thromboses, upper gastrointestinal hemorrhage, anastomotic leak, gastropareses and significant pleural effusions. With an average follow-up of 23.9 months, eight patients (80%) were currently alive without evidence of disease.ConclusionExtended resection for LACC or LRCC invading SMA can be performed safely and is associated with prolonged survival.Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.

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