Intestinal Autotransplantation for Locally Advanced or Locally Recurrent Colon Cancer Invading Superior Mesenteric Artery.

Abstract

To examine the outcomes of intestinal autotransplantation (IATx) in patients with locally advanced (LACC) or locally recurrent (LRCC) colon cancer invading the superior mesenteric artery (SMA). SMA 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. This retrospective cohort study included patients undergoing IATx between May 2018 and December 2022 in intestinal transplant programs at 2 university-affiliated hospitals in China. Patients with LACC or LRCC concomitantly with SMA contact of more than 180 degrees were included. Patients with a locoregional peritoneal, pelvic, or distal metastasis were excluded. Ten patients underwent either IATx combined with pancreaticoduodenectomy (n = 8) or IATx alone (n = 2). Eight patients (80%) were males, and the median age was 55 years (range, 32-71 years). 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 10 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, 8 patients (80%) were currently alive without evidence of disease. Extended resection for LACC or LRCC invading SMA can be performed safely and is associated with prolonged survival.